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Placing the Needs of Youth at the Center of Health Care
If we got our hands on a magic wand, we would create more women like Dr. Angela Diaz. An internationally recognized leader in adolescent health care, Dr. Diaz has devoted much of her life to helping the most vulnerable teens. Having emigrated to the United States as a teenager herself, Angela relied on her intellect, tenacity, and strong community ties to lift her out of extreme poverty. She was empowered to fulfill her childhood dream of becoming a doctor, and is now the Director of the Mt. Sinai Hospital Adolescent Health Center (MSAHC) in New York City, the largest adolescent health program in the country.
Since Dr. Diaz took charge of MSAHC in 1988, the program has tripled in size. Today, more than 13,000 young people walk through its doors every year to receive comprehensive physical and mental health services—including sexual and reproductive health—free of charge.
Angela has been active in international health projects in Latin America, Asia, Europe, and Africa. She is also involved in health advocacy and policy in the United States. We were thrilled when Dr. Diaz accepted our invitation to speak with our staff about her life and work, and share her expertise in the field of sexual and reproductive health.
Tell us a little about the story of your life. How did you come to where you are today?
When I was eight, my mother came to New York to join my stepfather. It was an economic migration. We were very poor in the Dominican Republic. She left my two siblings and me with my biological father and my maternal grandmother.
By the time I reunited with my mother, I was almost fifteen. I lived in the South Bronx, West Harlem, and Washington Heights. We were living in extreme poverty and never had access to health care. I hadn’t been vaccinated when I was little, and when we got sick, we had to go to the emergency room basically dying because we didn’t have money.
Ever since I was in high school, when a person asked me what I wanted to be, I always said I wanted to be a doctor. My high school guidance counselor told me Mount Sinai had a program for inner-city youth who want to go into health careers. She encouraged me to apply, and they accepted me. MSAHC provided services to young people in this program, and that’s how I first came to the center: I was a patient.
How did you end up working at MSAHC?
MSAHC really helped me. They gave me counseling and a lot of encouragement. I dropped out of high school, and if it weren’t for MSAHC, I probably would never have gone back. We were so poor, and I had to work, but I was able to finish high school. Then I was a factory worker during the day and went to college mostly at night. After I got into medical school at Columbia University, everything fell into place.
I finished medical school and did my residency in pediatrics at Mount Sinai. The person running the MSAHC program said to me, “You seem to have a gift with teenagers. Why don’t you do a fellowship here after you complete your residency?” That’s why I went into adolescent medicine, and I just fell in love with the kids. It was the first time I ever loved my work.
MSAHC has been operating for an impressive 45 years. How has it evolved over time?
When MSAHC began in 1968, it was run by two people out of a small basement. There was an epidemic of heroin use in Harlem, so it was more of a drug treatment program when it opened. Now we provide integrated physical health services, which includes checkups, sexual and reproductive health, dental care, and mental health. Then we have specialized services for young people who deal with interpersonal violence, are HIV-positive, and are gay, lesbian, or transgender.
We cater to poor kids without insurance because those kids usually don’t have access to high-quality care. Ninety-eight percent of our clients are poor, but someone could have millions of dollars and we would treat them the same as everyone else. We don’t charge anyone. In fact, we don’t exchange money at all.
What brings young people to MSAHC?
I think the reason we’re so popular with young people is because we actually love them. Some of our youth are very disconnected and disadvantaged. We are there for them. We anchor and encourage them. We see their value and appreciate their strength. It’s not just about providing healthcare; we actually love these kids.
Our lens is wellness and prevention. We have professional health educators who sit down with these kids and find out what’s going on in their lives. They talk to them about how to live a healthier lifestyle and risk reduction. We nurture them, respect them, and don’t judge them. We try to guide them, but it’s not about them following our instructions. It’s about them feeling comfortable coming to us when they need us.
You have worked in many parts of the world. What challenges do young people have in common?
One of the major lessons I learned in the international arena is that the issues young people have are very similar. For example, there is a universal need for teenagers to have privacy when accessing health services. In the US, we are lucky to have laws that assure the right to confidentiality for young people. But they don’t have confidentiality laws like that in Mongolia, where teenagers told me they wouldn't share personal information unless they were assured of privacy. For a teenager, confidentiality is huge and that need has to be respected.
So much shaming happens around adolescent sexual behavior. How do you approach this with the young people you see?
Our approach is about empowering youth, helping them see the possibilities, and helping them amplify their voices. We work with teen parents, and we think they’re great. We don’t see being a teen parent in the way they’re portrayed by the media. We try to balance that portrayal with more positive messages. To me, the important thing is to give young people opportunities. That’s what they don’t have, and that’s what they need.
What challenges do young people face when accessing health care?
The traditional healthcare system was designed by adults and for adults; it does not work for kids. When we try to fit them into that system, it doesn’t work. Then we blame them by saying they’re not compliant or hard to reach.
Young people don’t know how to maneuver the health system, so we try to make it easy for them. We all love for people to make appointments, but that’s not how teenagers think or act. When we make appointments at MSAHC, we know that about half of the volume that day will come from walk-ins. So, we prepare for how we’re going to fit those clients in. We have to design a system with adolescent development in mind, and it has to be appropriate for young people to use.
What really makes a service youth-friendly?
The main thing is to be respectful, nonjudgmental, and friendly. What a young person needs is not about us. It’s about them, and they have to be at the center.