The Inland Empire of California is among one of the fastest-growing and most medically deprived areas in the country. The combined region includes both Riverside County and San Bernardino County, which is the largest contiguous county in the United States. In 1994, the region was established as a Medically Under-served Area by the California Healthcare Workforce Policy Commission.
The population of the region grew significantly over the last two decades: from 1.6 million in 1980 to 4.4 million in 2015. In 2011, there were only 43 doctors per 100,000 residents in the region. With the expansion of the Affordable Care Act, thousands of patients from among this new population are in desperate need of primary care. The Inland Empire Health Plan (IEHP) is a regional managed care organization that documented membership growth by over 60% from December 2013 to February 2015.
The city of Moreno Valley sits in the heart of Riverside County and represents the region as a whole. Of the approximately 500,000 people who fall into the medical service map of the city, roughly 40% are between 18-44 years old; however, more than 25% of those over age of 25 do not have a high school diploma. And 48% of the adolescents are classified as overweight or obese.
At the onset of the 2016-2017 health advocacy projects, demographic information about the junior students at three Moreno Valley High Schools was collected from two primary sources:
- A pre-test survey from the Stanford Public Health Advocacy Curriculum (nine questions covering topics of: upstream causes, community exploration, and public health advocacy)
- A baseline health assessment survey from Teaching Tolerance, a project of the Southern Poverty Law Center.
Moreno Valley Unified School District - Junior Students Demographic Data
Race / Ethnicity Identification
Students claim a voice in their community
This baseline data served as inspiration for the students' work in community advocacy. It also doubled as a needs assessment and indicator of the critical nature of health promotion and public health awareness in this particular school district.
In the first year of the Emerging Health Advocates program, the initial class periods (Sept to Nov 2016) focused on defining advocacy in health terms and identifying the specific health issues for each student group. The general health topics were based on the Leading Health Indicators as outlined by the Healthy People 2020 program. The students investigated assets and barriers to health within their schools or communities and highlighted the planned areas of change. Several of the teachers provided significant support, both in terms of class time and course credit, for participation and research on these projects.
After completion of their research and project designs (Dec 2016), students created plans for how to advocate for change, or even began to implement change on their own. The majority of groups utilized the skills they learned in class to meet with stakeholders, campaign via social media, or conduct surveys or petitions among their classmates. With the help of the supervising resident physicians, students reached out to local community organizations to advance awareness of their respective causes. For example, the advocacy group “Community NOW” partnered with the students in mental health awareness advocacy group to coordinate sponsorship with the nationally-recognized Trevor Project for LGBT youth.
The students finalized their project campaigns and put them into action in their schools and local communities (Jan to Feb 2017). Based on peer evaluation, two student groups were offered the opportunity to present at a meeting of the Moreno Valley City Council’s Emerging Leaders Council. All of the student groups had the opportunity to present at a "Advocacy in Action Day" at their respective schools; this was set up over two lunch periods, with posters and video displays highlighting their advocacy work. The event included local community leaders, teachers, and resident physicians supporting the student groups in demonstrating and explaining the entirety of their health campaigns.