Institutional Determinants of Health: Adolescent Health Crises as Sites of Social Intervention and Practical Reform

Institution-level interventions can lead to positive health outcomes for individuals and communities. Focusing attention on how the organization of specific institutions leads to negative health outcomes can provide the basis for systemic reform that addresses structural, social, and environmental determinants of health in immediate and practical ways. Enacting policy and practical reforms in institutions requires identifying and overcoming mythical thinking through robust, interdisciplinary qualitative health research that addresses the narratives that stakeholders employ to keep institutions as they are. This article focuses on two contemporary health crises among American adolescents to describe how institutions promote negative health outcomes through commonsense policies and practices that are rooted in American mythic thinking. These institutional practices stand in opposition to scientific, medical, and qualitative evidence that demonstrate the immediate and long-term effects of specific institutional practices, including early school start times and exposure to injury through contact sports. Overcoming the institutional resilience to change depends on identifying norms and their basis in mythic thinking, and, secondarily, supplanting those norms with narratives based in the reality of institutional effects on individual lives and communities. Qualitative health research that draws strengths from across the social sciences, humanities, and arts is poised to aid in these institutional reforms but must shift its focus to institutions as a primary driver in promoting well-being.