Public health faces complex, interconnected challenges requiring far-reaching change to our collective social, economic, political and ecological values. Relational practices, that is, how we connect, collaborate and construct a shared purpose, are key within such change. This is particularly charged for young people who are often excluded or marginalised in processes that shape their everyday lives. Systems theories hold an as yet overlooked potential for understanding the role of relational practices in public health, applied here in the context of local approaches to youth health and wider wellbeing. The aim of this thesis is to use a systems-informed critical inquiry to examine the role of relational practices in local approaches to supporting youth health and wider wellbeing.

The research was conducted in a borough in the North West of England in early 2017. 42 young people participated in focus groups in youth centres and youth groups including formal participatory channels. In the focus groups, young people guided discussion of their concerns, hopes and everyday experiences of seeking support and change. Additional systems perspectives were gathered from 16 local stakeholders, with their recruitment led by the issues and experiences identified by young people. The analysis draws on systems techniques including connection mapping, causal loop diagramming and examination of emergent whole-system characteristics, such as its rules, goals, beliefs and resilience.

Young people’s accounts emphasise their pressured existence and the consequences on their health and wider wellbeing. This also impacts on their approach to interactions with others, where connections are cautious and tested before trusted and utilised. Among stakeholders, understanding of the richness of young people’s lives diminishes from frontline to strategic levels, with approaches to connecting increasingly at odds with young people’s preferences, as brittle, shifting and one-sided exchanges undermine relationship building and compound core concerns. Furthermore, stakeholder actions lead to a drift in the emergent macroscale characteristics of the system under examination, such as its collective purpose and resilience, while also neglecting system leverage points for change.

Through systems telling, a novel application of systems theory, young people’s lived realities are centred in the system narrative, highlighting fractured relations and crossed purposes that obscure and obstruct opportunities to foster collective local approaches to supporting youth health and wellbeing. Furthermore, analysis of emergent behaviours demonstrates a missed opportunity to proactively develop whole-system characteristics such as resilience and shared purpose. This reframes relational practices as multi-layered actions for supporting youth health and wellbeing and public health practice. Systems learning highlights the potential for action across disciplines and at different scales of policy and practice, enriching the nature of connection while also building a system to better support and sustain connection in public health practice.