The paper aims to, together with youth, create knowledge regarding their relation to health, food choices, and how these can be expressions of their ability to achieve desired health-related goals.  A specific focus is how youths experience that their health goals and food choices are affected by social, political and commercial determinants of health and how resulting health literacy capabilities relate to the sustainability challenge of antimicrobial resistance.  To this end, a structured observational study was conducted in a region of Zimbabwe to explore youth's health literacy capabilities.

The paper responds to the special call of network eight (8) by engaging the task of knowledge co-production in health education and well-being by taking a praxeological approach (Mol 2002).  ´Good' health thus emerges in context, emphasizing the co-development together with students of their valued beings and doings regarding health and how these goals relate to food and AMR.  Health literacy highlights the need for people to achieve competence beyond the immediate educational situation by developing understandings, the ability to evaluate information relating to health critically as well as to take action based on reflective health-related decision making (Nutbeam, 2000; Sørensen et al., 2012; Veenker & Paans, 2016; Ward, Kristiansen, & Sørensen, 2019).  As Van der Heide et al. (2013) illustrated, health literacy presents a conceptual avenue to explore the relationship between education and health and offer a way to bridge the 'implementation gap' between knowledge of health and health-promoting practices.  Meanwhile, there are calls for more significant consideration for individual agency and a less prescriptive element to health literacy through the operationalization of the capabilities approach, encompassing critical conceptual understandings of health (Pithara 2019: Ruger, 2010).  Drawing on the capabilities approach (Sen 2003; Crocker & Robeyns, 2009; Kronlid, 2014), we can shift from health as individual skills and competencies to consider commercial, social and political determinants, which enable or enable or inhibit youth's capability for health literacy.  Health literacy principles are thus operationalized together with participating youth.  Youth in the global south are disproportionately affected by health-related issues, such as food security, poor food choices and exacerbating health challenges such as Cholera, TB and HIV/AIDS (Pithara 2019: Ruger, 2010).

The paper presents a space in which youth could explore a plurality of understandings of health and well-being and how such diversity can co-exist as part of situationally rational health and well-being practices.  The paper attempts to counter the marginalization of local health knowledge and the health goals and experiences of youth.

In the study, learning is understood as enabling the conversion of resources and facilitating youth's agency, and health capabilities are understood as significant freedoms.  Nussbaum (2011) and McGarry (2014) noted that the kind of learning is the crucial question.  Consequently, learning as a transformational process becomes a pathway for comprehending, critically assessing, and even transcending new information with the help of our own and others' experiences (Dewey 1997).  These, what we call transformative learning processes, are relational to persons, nonhumans, artefacts, or collectives making such relationships potential conversion factors as in opportunities for change (Grasso 2007).  

Three research questions are formulated:

• How do the youth describe their health-related goals?
• What links are made between these health goals and food as well as AMR?
• How has the youth experienced encounters between commercial, political and social determinants for health and their effect on their health goals?

Group interviews combined with semi-structured participant observation was used as the data generation method, operationalized in face-to-face interactions with participating youth to explore the questions as part of a knowledge co-creation process. The chosen method enables capturing participants' attitudes, experiences, and meaning-making as part of interactions, enriching the validity of data (Patton 2002). A checklist was prepared to capture participants verbal and non-verbal communication as part of the observation. Using direct observation addresses the methodological memory problem of surveys since actions are observed in situ rather than remembered by the participants from memory (Bryman 2019). Before research visits to the selected schools, clearance was sought and granted by the Ministry of Primary and Secondary Education in Zimbabwe and consent from parents and guardians of the participating youth. From six (6) secondary schools/high schools in Zimbabwe (two urban schools, two peri-urban schools and two high-density schools), a population of one hundred and twenty (120) students were purposively sampled. These included. For ethical consideration, consent forms were distributed during initial visits to the schools. Forms were collected with signatures from the parents/guardians of participating youth on subsequent data generation visits. A pre-designed interview questionnaire was used through group interviews and participant observation with interview questions focused on health, food nutrition, food choices, sources of health information and antibiotic and antimicrobial resistance. An observation schedule was used to support the semi-structured participatory observation, which created a systematic approach to the observations while still allowing for recording unexpected observations during the group interviews. Each observation in the six schools followed a shared method while creating the space for the participating youth as knowledge co-creators of contextual health goals and how these could be achieved. Each group interview lasted around - 60 minutes. The interviews were moderated by two of the researchers. Focus in the data generated from the group interviews and accompanying observations are their health goals, preferences and experiences of food consumption and how they experienced commercial and social influences regarding their food choices.

The results illustrate how a majority of participating youth (56%) articulated freedom from diseases as their primary goal for good health, followed by living long (20%). When coupled with reflections on conditions for achieving these goals as eating a balanced diet (35%) and not eating junk food (25%), the importance of food and diet in creating the conditions of being free from disease emerges. Further expanding on youth's understanding of healthy and unhealthy food and food preferences, tension emerges in the results. Set against what the youth described as their sources for information on food, a dynamic of social and commercial determinants of health emerges with the family with its cultural/traditional values representing the primary source of information on health matters. In contrast, social media platforms came in as a second. Furthermore, while the social determinants informed the youth's food choices of family and community, their experienced ability to accomplish their food choices and health goals were significantly influenced by commercial and political determinants of food affordability, availability and accessibility. When discussing the balance between having enough to eat and eating what students perceived as healthy food, they depended on food availability and affordability (commercial determinants) and food accessibility (political determinants). Returning to the youth's health goals, finding ways to co-exist with microbes and bacteria as part of healthy practices was highlighted as ways of achieving the goals of remaining free from disease, thus impacting the emerging challenge of antimicrobial resistance, such as not having to visit the clinic or receiving antimicrobials due to bacterial, viral or parasitic infections. Furthermore, youth highlighted how antibiotics to treat domestic animals affect the availability of essential food such as milk due to needing to avoid consuming the milk for the antibiotic course duration.

Bryman, A.; Bell, E. (2019) Social Research Method - 5th Canadian Edition. Oxford University Press: Canada. Crocker, D. A., & Robeyns, I. (2009). Capability and agency. In Amartya Sen. https://doi.org/10.1017/CBO9780511800511.005 Dewey, J. (1997). Experience and education (Kappa Delta Pi (ed.); New). Simon & Schuster. Grasso, M. (2007). A normative ethical framework in climate change. Climatic Change, 81(3–4), 223–246. https://doi.org/10.1007/s10584-006-9158-7 Kronlid, D. O. (2014). Climate change adaptation and human capabilities : justice and ethics in research and policy. Palgrave Macmillan. McGarry, D. (2014). Empathy in the time of ecological apartheid : a social sculpture practice-led inquiry into developing pedagogies for ecological citizenship [Rhodes University]. http://www.dylanmcgarry.org/publications.html Mol, A. (2013). The Body Multiple. In The Body Multiple. Duke University Press. https://doi.org/10.1215/9780822384151 Nussbaum, M. C. (2011). Creating Capabilities: The Human Development Approach. De Gruyter. Nutbeam, D. (2000). Health literacy as a public health goal: A challenge for contemporary health education and communication strategies into the 21st century. Health Promotion International, 15(3), 259–267. https://doi.org/10.1093/heapro/15.3.259 Patton, M. Q. (2002). Qualitative research & evaluation methods. London: SAGE. Pithara, C. (2020). Re-thinking health literacy: using a capabilities approach perspective towards realizing social justice goals. Global Health Promotion, 27(3), 150–158. https://doi.org/10.1177/1757975919878151 Ruger, J. P. (2010). Health capability: Conceptualization and operationalization. American Journal of Public Health, 100(1), 41–49. https://doi.org/10.2105/AJPH.2008.143651 Sen, A. (2003). Development as Capability Expansion. In S. Fukuda-Parr & et al (Eds.), Readings in Human Development. Oxford University Press. Sørensen, K., Van Den Broucke, S., Fullam, J., Doyle, G., Pelikan, J., Slonska, Z., & Brand, H. (2012). Health literacy and public health: A systematic review and integration of definitions and models. BMC Public Health, 12(1), 80. https://doi.org/10.1186/1471-2458-12-80 Van Der Heide, I., Wang, J., Droomers, M., Spreeuwenberg, P., Rademakers, J., & Uiters, E. (2013). The relationship between health, education, and health literacy: Results from the dutch adult literacy and life skills survey. Journal of Health Communication, 18(SUPPL. 1), 172–184. https://doi.org/10.1080/10810730.2013.825668 Veenker, H., & Paans, W. (2016). A dynamic approach to communication in health literacy education. BMC Medical Education, 16(1). https://doi.org/10.1186/s12909-016-0785-z Ward, M., Kristiansen, M., & Sørensen, K. (2019). Migrant health literacy in the European Union: A systematic literature review. Health Education Journal, 78(1), 81–95. https://doi.org/10.1177/0017896918792700