Spring 2016 Bulletin

The Journey Home

Felton James Earls

Witnessing the death and destruction caused by Hurricane Katrina in my hometown of New Orleans a decade ago triggered an obligation to test the utility of all that I have learned in a long career as a public health scientist.

Looking back to my training in pediatrics and psychiatry, health became a more compelling concern than disease. It did not take long to decide that working in clinics and hospitals would not fulfill this aspiration. As I turned to the community and its institutions for answers, I recognized the need to extend my training to include population science and public health. Health promotion, as the process of enabling people to exercise control over the threats to well-being, became the discipline within public health that organized my thinking. This sense of purpose sustained me during the turbulent political climate of the 1960s and 1970s. Since then, I have spent decades searching for theories and methods to guide my understanding of how the social environment contributes to healthy growth and development of children in large cities.

In the early 1990s, I seized the opportunity to develop and direct the Project on Human Development in Chicago Neighborhoods (PHDCN). With substantial support from the John D. and Catherine T. MacArthur Foundation and the National Institute of Justice, the project was launched with the expectation that new knowledge on the causes of urban violence would be substantially advanced. As Principal Investigator, I became absorbed in forging a disciplinary alliance between public health and criminology, on the one hand, and sociology and psychology, on the other. This was a necessary starting point for progress to be made.

The study succeeded in launching a complex design in which a representative sample of Chicago’s families and children were followed from infancy to adulthood. The personal development of these participants was evaluated within the distinctive neighborhoods in which they were growing up. Together with Academy Fellows Robert Sampson and Stephen Raudenbush, our report of the discovery of neighborhood collective efficacy was enthusiastically received.1 This feature of neighborhoods is reflected in the willingness of residents to respond to social and physical threats of disorder and to take constructive, shared actions to achieve the common good. The attitudes and perception of adults toward the protection and supervision of local children is a key feature of collective efficacy.

This finding gives scientific credibility to neighborhood dynamics that operate beyond demographic characteristics, such as race/ethnicity and wealth, to impact levels of community disorder and violence. The same propensity that results in low rates of violence proves to be beneficial for other health conditions, including birth weight, asthma, mental health, and age of sexual debut. Collective efficacy introduces a mechanism that could be the target of interventions to enhance health and well-being.

While entrenched in carrying out the PHDCN, I virtually ignored the historical United Nations endorsement of the Convention on the Rights of the Child (CRC) and its near universal ratification. It took nudging from Mary Carlson, my enduring companion and scientific colleague, to bring to light the potential significance of this manifesto to advance collective efficacy for children. The text of the CRC underscores a fundamental tension between the protection and participation rights of children.

By highlighting the protection and supervision of children, the PHDCN’s finding on collective efficacy takes the perspective of adults. The potential contribution children can make to the common good was not taken into consideration in planning the study. Yet, the CRC’s participatory rights require that the perspectives of children be given due weight in accordance with their age and maturity in efforts to enhance health and well-being. This unbalanced approach was recognized only after the PHDCN was in the field. While it was too late to include measures of collective efficacy from the child’s point of view, we were able to make up some ground by engaging small groups of children in becoming active and informed participants in the research program.

Over the past decade, Carlson and I have been immersed in a study in which representative samples of young adolescents, ages 10 to 14, were provided with opportunities to be community agents in harnessing the progression of the HIV epidemic. A more balanced approach to the theory and measurement of collective efficacy was incorporated into this new study. This project was implemented and evaluated in Moshi, Tanzania, a municipality of 200,000 residents and 60 geopolitically defined neighborhoods.

The research design was a cluster randomized controlled trial in which 30 of the municipality’s neighborhoods were assigned to treatment or control conditions. In the treatment neighborhoods, young adolescents were engaged in a participatory curriculum. The modules of the curriculum were based on children learning to deliberate in groups, to know the political and civic structure of their communities, and to understand how to identify and address health conditions in their communities, such as HIV infection and malaria. They applied these skills in community-wide campaigns that engaged residents of all ages. Community drama was used to convey scientific facts of HIV infection and local health fairs were organized to promote HIV testing. The results of the trial went beyond our expectations by showing both enhanced self-efficacy of adolescents and higher levels of collective efficacy among adult residents.2 Children had become recognized not just as effective health agents, but also as deliberative citizens.

In terms of amassing empirical evidence and articulating an ethical framework, the research has been gratifying. While the path charted by the findings from Chicago and Moshi may stimulate initial interest, they have not galvanized a firm belief in the capacity of children to effect social change among many of our colleagues. Sometimes I think our work would connect better to policy-makers and practitioners if we used expressions like social capital and building character rather than collective efficacy and deliberative citizenship. To do this, however, would undermine the importance of the ethical framework that guides our work.

What we have learned is that a developmental deficit, referred to as late social deprivation, is created by the failure to fully recognize the emerging social and cognitive capacities of children. This exclusion, or marginalization, as a function of age robs the larger society of the opportunity to promote the health and well-being of children and youth as well as the longer-term benefits of sustaining strong democratic ideals and practice.3

Much work remains to be done. Since 2006, Carlson and I have been making a determined effort to bring the 25-year experience of the research in Chicago and Moshi (and elsewhere) to bear on enhancing human development in the neighborhoods of New Orleans. As the city approaches its 300th anniversary, there is much to show in its commercial recovery from the devastation of the costliest hurricane ever to strike the United States. Yet, the majority African-American population remains heavily impacted by blighted neighborhoods, mass incarceration, pervasive unemployment, and the dismantling of neighborhood public schools. Our effort to apply the concepts of collective efficacy and child citizenship in New Orleans is severely challenged by the historical legacies of racism and its intersection with contemporary manifestations of inequity. The fact that this tragedy is on display in an advanced democracy, and in a place I still call home, makes it all the more compelling to settle.

Felton Earls is Professor of Human Behavior and Development, Emeritus, in the Department of Social and Behavioral Sciences at Harvard T.H. Chan School of Public Health, and Professor of Social Medicine, Emeritus, at Harvard Medical School. He has been a member of the American Academy of Arts and Sciences since 1993.

© 2016 by Felton Earls



1. Robert J. Sampson, Stephen W. Raudenbush, and Felton Earls, “Neighborhoods and Violent Crime: A Multilevel Study of Collective Efficacy,” Science 277 (1997): 918–924.

2. Mary Carlson, Robert T. Brennan, and Felton Earls, “Enhancing adolescent self-efficacy and collective efficacy through public engagement around HIV/AIDS competence: A multilevel, cluster randomized-controlled trial,” Social Science and Medicine 75 (2012): 1078–1087.

3. Felton Earls, “Children: from rights to citizenship,” Annals of the American Academy of Political and Social Science 633 (2011): 6–16.