The Power Within Communities Is the Prescription We Keep Overlooking
We often look for prescriptions in clinics, but the most powerful tools for improving health begin in neighborhoods, schools, and communities.
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I held my breath as the final data came in.
From February 2020 through the height of the pandemic and into 2025, our team ran the H2GO! study, a randomized community-based trial to reduce sugary drink consumption and obesity risk among youth.
It was the kind of study that demanded both scientific rigor and real-world resilience, the kind of research that unfolds not in controlled lab settings, but in the unpredictable, beautifully chaotic everyday environments where children actually live and learn. It required patience, heart, and more than a decade of relationship-building with Boys & Girls Clubs (BGC) across Massachusetts.
H2GO! wasn’t a light-touch survey or a one-off workshop. It was an intensive community-based nutrition intervention, carefully co-developed with BGC staff in a successful pilot study, delivered in the middle of busy after-school programs.
Over multiple waves of delivery at each intervention site, our study staff and community partners showed up in-person week after week, leading hands-on group sessions twice a week for six weeks across five Boys & Girls Clubs. We ran taste tests, scavenger hunts, parent engagement activities, media-literacy games, and supported youth-created health messages focused on two simple nutrition goals: drink fewer sugary drinks and drink more water.
The curriculum was standardized, but the implementation was intentionally tailored: each child designed their own health messages and shared them with their families and peers. In this way, youth weren’t just participants — they shaped the intervention itself and helped deliver it, embedding their voices and stories directly into the behavior-change process.
In the middle of a pandemic, in under-resourced communities, a program grounded in youth empowerment and community partnership made a measurable difference.
We also collected rigorous longitudinal data across all 11 study sites (5 intervention, 6 comparison), recruiting more than 400 parent-child pairs and tracking children’s height, weight, and dietary and beverage intake at baseline, 2, 6, and 12 months to assess change in age- and sex-adjusted body mass index (BMI) over time. More than two-thirds of child participants in our study were eligible for free-and-reduced-price lunch, underscoring the economic hardships shaping their daily food environments.
We launched our study right when COVID-19 hit, when children’s health behaviors were sliding in the wrong direction. We pivoted to smaller cohorts, distancing, masks, and constant contingency planning. Meanwhile, childhood BMI and obesity rates were rising, and diet quality, sleep, and physical activity were declining. With so much stacked against us, part of me braced for null results.
Then the numbers came in, and they revealed something far more hopeful than I expected.
Children who received the H2GO! intervention reported drinking more water, fewer sugary drinks, and moved toward healthier weight ranges over 12 months. In the middle of a pandemic, in under-resourced communities, a program grounded in youth empowerment and community partnership made a measurable difference.
What Empowerment Really Means
At its core, empowerment begins with a simple belief: people and communities are capable of extraordinary things when supported with the right tools and resources. In public health, empowerment is the process by which individuals and communities gain the knowledge, skills, and confidence to make informed decisions and shape the systems that affect their lives. Research, including ours, shows that youth in empowerment programs gain self-efficacy, a stronger identity, and a deeper sense of responsibility.
That means moving participants from recipients of health information to agents of change. In H2GO!, kids didn’t just hear lectures about sugary drinks. They did taste tests, analyzed beverage ads, rewrote jingles, and built campaigns for their peers and parents. They learned to try new beverages, question marketing tactics, make their own choices, and share what they knew. When a 10-year-old can walk into their kitchen and convince their family to try lemon-flavored water, or persuade a friend to swap out a soda for water, that’s empowerment in action.
How Empowerment Shows Up in Communities
Community empowerment, whether through youth, parents, or neighborhood coalitions, means supporting residents to define priorities, access resources, and shape strategies that reflect their realities. Across the country, programs that hand the mic to participants are seeing results. Youth leadership in nutrition and physical activity programs strengthens healthy habits and improves well-being. Photovoice projects help residents document and advocate for neighborhood changes, from safer sidewalks to healthier corner stores. Community-engaged research partnerships, like the decades-long Strong Heart Study with Tribal Nations, build interventions that last because communities design and own them.
When interventions are designed with the people who live there, rather than for them, public health can shift from delivering messages to building capacity, from short-term change to long-term resilience.
Food literacy programs illustrate this well. In Maine, the Food Literacy Boot Camp helped teens navigate their food environments and make healthier beverage choices. Teens CAN, a comprehensive food literacy program in California, improved students’ willingness to try new foods and emphasized peer-modeling as a catalyst for behavior change. These programs build practical skills and personal confidence needed for long-term health behavior change.
The common ingredient? People closest to the problem help shape the solution.
Designing for Staying Power
Empowerment doesn’t mean we abandon the push for policy or environmental change. It’s what we do in the meantime – the practical, community-driven actions that make a difference today, while we push for the broader, slower-moving reforms that demand consensus and investment. The strongest community-centered programs balance clear goals with participant-driven content. In practice, this often looks like:
- Co-designing with community members from day one.
- Embedding real-world skills, like media literacy, public speaking, advocacy, or navigating local systems.
- Creating feedback loops so participants guide the program’s evolution.
- Training staff in trauma-informed practices to build trust.
Policy as the Backdrop
A family can’t prioritize healthy food and beverage choices when wages don’t cover groceries or when food assistance benefits lapse. A child can’t walk to a Boys & Girls Club safely without investment in sidewalks and streetlights. Structural barriers can blunt even the most enthusiastic and committed community efforts.
Youth participation in policymaking is one way to strengthen this connection. The United Nations has proposed 11 core principles for meaningful youth engagement in policy, including adequate funding, transparency, training, and recognizing youth as partners in decision-making, reminding us that policies are stronger when young people shape them. Their insights sharpen relevance, fairness, and effectiveness.
The Real Prescription
We tend to look for prescriptions in clinics. But across our work and that of many others in community-engaged research, some of the most powerful prescriptions to improving health begin in neighborhoods, schools, and community settings, crafted by the people who live there. This includes youth and young people. When interventions are designed with the people who live there, rather than for them, public health can shift from delivering messages to building capacity, from short-term change to long-term resilience.
When we trust and invest in communities with the tools, space, and power to shape their health, the results can surprise us. They can even make us hold our breath, in the best way possible.
