Engaging in Anti-Oppressive Public Health Teaching: Challenges and Recommendations

Data Collection

Purposive sampling was used to identify public health faculty (N = 26) across SPH espousing an explicit commitment to social justice within mission and vision statements that are publicly shared on school websites; snowball sampling and word-of-mouth approaches were also employed. The primary author conducted semistructured in-depth interviews between January and April 2020 on Zoom, an online videoconferencing platform (“Zoom,” 2020). All interviews were audio-recorded and transcribed verbatim by a professional transcription company. Field and self-reflexive notes were handwritten and typed after each interview. Incentives were not provided.

Institution Selection and Participant Recruitment

There are 59 ¹ accredited SPH in the United States, of which six explicitly name social justice in their mission or vision statements. Social justice was selected because anti-oppression was not used in any statements, and because social justice has a more pronounced history within public health compared with anti-oppression—as many leaders, educators, and researchers consider public health a social justice venture (Beauchamp, 1976; Late, 2011). Anti-oppression has recently grown in use and is more well known in particular areas of public health that have a legacy—albeit complex and at times, flawed—of aligning their work with anti-oppressive practice, for example, research about the impacts of racism on health (Devakumar et al., 2020) and community-based participatory research (Nyden, 2003).

Following selection of eligible SPH, published class syllabi and faculty biographies were reviewed in order to develop a list of potential contacts for study participation. Inclusion criteria for faculty were as follows: (1) full-time faculty (e.g., instructor, assistant, associate, or full professor) and (2) mentioned the following or related concepts on their publicly available syllabi or biographies: justice (e.g., social, environmental, reproductive, criminal), social determinants of health, health equity, human rights, racism, cultural competency or humility, sociocultural factors, social power, or power dynamics. The terms were selected because these concepts are related to social justice and anti-oppressive principles. Faculty who met the inclusion criteria (N = 73) received an email introducing the study and an invitation to participate. Those who expressed interest in participating were scheduled for an interview. Thirty-five additional faculty referred through snowball recruitment were contacted. All faculty received an initial invitation and two follow-up emails.

Measures and Analyses

A semistructured interview guide allowed interviewees to respond freely to five overarching questions which included (1) participant’s conceptualization of anti-oppression, (2) participant’s implementation of anti-oppression within pedagogy, (3) barriers and facilitators to participants implementing anti-oppression within their institution, (4) culture of curriculum development within participant’s departments, and (5) practice of social justice within participant’s institution.

The primary author coded the transcripts in the software program MAXQDA Plus. All analyses were informed by tenets of constructivist grounded theory (Charmaz, 2000). The primary author conducted open coding on five transcripts using the main interview guide questions to guide the process and received feedback from coauthors in finalizing the codebook which were applied to the remaining transcripts. Participants who chose to provide input on quotes used in dissemination were emailed their quotes to review, edit, and approve for use. Edits sent by participants were incorporated into this research study.

Ethics and Funding

The institutional review board at JHSPH reviewed the protocol for this research study and it was deemed nonhuman subjects research. However, all procedures were conducted with standard institutional review board protocols and human subjects protections in mind. Written consent forms were not used; however, participants were asked to provide verbal informed consent prior to their interview. The consent form was reviewed aloud with each participant prior to the interview, and they were provided ample opportunity to ask questions. This study was funded by the JHSPH Department of Health, Behavior and Society Doctoral Support Awards. The funder was not involved in collection, interpretation, or presentation of data.

Reflexivity

Reflexivity is “the explicit acknowledgment of the personal, political, disciplinary, and epistemic stances that inform and shape all aspects of the research process and is a core principle of qualitative research” (Bowleg et al., 2017, p. 581). Because critical self-reflection is also a core tenet of anti-oppressive practice, it is important for us to situate ourselves within this work and recognize our power and privilege as individuals working within an academic system. Among us, we bring a variety of experiences on pedagogical and anti-oppressive practice—both within teaching specifically and public health broadly. We used memos, group discussion, and mindfulness techniques to facilitate self-reflection throughout the data collection and analysis process to recognize the roles of power, privilege, and oppression as they showed up during interviews.

Participant Characteristics

A total of 108 invitations were sent to faculty who taught public health content across the United States. Of those, 58 faculty responded of which 32 faculty declined to participate due to time constraints and the remaining 26 completed an interview—representing eight accredited SPH and one school of medicine (Table 1). Select demographics of participants who shared quotes are presented in Table 2.

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Table 1.

Participant Characteristics.

Participants’ school of primary appointment selected demographics
Category	N = 9
Explicit mention of social justice in its
Mission statement	3
Vision statement	2
Value statement	2
Location in the United States
Northeastern region	4
Southeastern region	3
Midwestern region	1
Northwestern region	1
Type of institution
Private	4
Public	5
Participant demographics
Category	N = 26
Highest degree achieved
PhD	19
DrPH	2
Other (e.g., MPH, JD)	5
Academic rank
Instructor/Lecturer	2
Assistant	10
Associate	9
Professor	5
Race/ethnicity
Asian	3
Black	5
Latinx/Latine	2
White	14
Multiracial/multiethnic	2
Gender identity
Cis woman	17
Cis man	9
Age (years), range	30–70
Total years teaching (years), range (mean)	2–40 (13)

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Table 2.

Selected Demographic Identifiers for Participants Providing Quotes (n = 12).

Participant identifier (No.)	Faculty ranking	Racial/ethnic identity	Gender identity a	Total years teaching
1	Associate professor	White	Man	17
2	Assistant professor	White	Woman	5
3	Instructor/Lecturer	Latinx/Latine	Woman	8
4	Associate professor	Asian/White	Woman	9
5	Assistant professor	Black	Woman	23
6	Professor	White	Man	20
7	Associate professor	Asian	Woman	6
8	Professor	Black	Man	30
9	Assistant professor	Black	Woman	4
10	Assistant professor	White	Woman	4
11	Assistant professor	White	Woman	20
12	Assistant professor	Black	Woman	2

a

All participants identified as cis-gender.

Facilitating Critical Consciousness

All participants noted that being able to engage in anti-oppressive teaching requires fostering facilitating critical reflection. One noted, “Public health practitioners need to be skilled. Absolutely. But we also need to be self-reflective as individuals, and we need to be self-critical and critically reflective of our field” (Participant 1). In order to support that, participants offered a variety of mechanisms through which they modeled critical self-reflection for their students. Some facilitated critical self-reflection through acknowledging their own positionalities which included situating themselves in the course material by recognizing their race, gender, sexual orientation, and relationship to the topics taught,

I try to start it from the beginning. And I’m very open with the class—starting off sort of with positionality. So, I identify as White, cisgender, queer. I’m married to a woman. And the first day of class I show a picture of my wife. And we’ve been using identifying pronouns in the classroom very early . . . So, I’m always trying to be very reflective and work with my students to sort of understand their own position in relation to the communities that we’re going to be talking about and talking about the challenges in the context of that there are people in this room that are part of these communities. (Participant 2)

In addition to critical self-reflection, participants also emphasized the necessity to address how power dynamics impact public health classrooms beginning with how power dynamics show up in the classroom and subsequently translate into public health practice as one participant shared,

It comes down to constantly talking about the power dynamics that are at play. . . . Where they tend to have power as student researchers within the broader context of the research complex and enterprise itself. Where they tend to have relatively less power and are often subject to some PI [principal investigator] or the structures of the academic program that they’re in. But then also simultaneously thinking about their power as student researchers in relation to the communities that are affected by the work that they’re doing. . . . So long-winded way of saying I try and bring into the classroom explicit considerations of power in ways that we don’t often do it. (Participant 3)

In discussing how to recognize intersections of power, privilege, and oppression within public health course content, most participants expressed that this knowledge offered students the first step toward the skill set necessary to evaluate and challenge oppression within public health practice. While most participants did not offer many ways of how to do this, one participant did note that they assigned critical self-reflection assignments to their students as they shared,

There is often an early assignment that relates to reflexivity . . . that’s a way of getting to know students and sort of understanding people a little bit more in context, that sort of they situate, and a set of identities that they get to articulate. (Participant 4)

As such, participants offered different mechanisms through which their students could foster critical consciousness skill sets to carry into their public health practice.

Participants also emphasized that part of critical self-reflection was the need to locate an individual’s positionality within the larger systems of oppression (e.g., sexism, racism). One participant specified that they pushed their students to reflect on how systemic oppressions and interpersonal power dynamics intersect:

Public health can be oppressive . . . And so teaching against that oppressive impulse and equipping in giving tools to students to be able to think about those things . . . we talk about positionality, right? Who are you as a researcher? . . . they’re required to talk about, reflecting on their own positionality, which means what are they doing there in the first place? Why are they even doing this work and are they able to hear and understand what people are telling them if they’re not from that community? If you are from that community, what is your connection and how do you understand yourself as being both and insider and outsider. (Participant 6)

In thinking further about systems, another participant noted that irrespective of our intentions, everyone is implicated within these systems of oppression:

I encourage us to think about how public health practice is itself a very powerful indicator of a certain kind of culture that it’s only intelligible within, and that the culture that makes public health intelligible also needs to be interrogated. In other words, we’re not free of those kind of movements and that power. We’ve got to figure out how we’re implicated in them and what we do about that as public health practitioners. (Participant 1)

This intersection between systems of oppression and power emerged consistently as participants discussed the importance for students to recognize their own role, power, and privilege and the power dynamics they experienced within the classrooms. These dynamics, participants explained, would often reflect the realities of the field. By addressing them in the classroom, participants hoped they could mitigate these potential negative impacts by preparing students to be critically conscious and show up as public health practitioners in ways that would not perpetuate intentional harms in the communities they worked with.

Creating Equitable and Mindful Classrooms

Participants highlighted the importance of establishing equitable and mindful learning environments that offer diverse forms and sources of knowledge. Specifically, when discussing equitable environments, participants described strategies related to classroom atmosphere, course content, and availability of resources.

For some participants, co-creating community guidelines to engage in brave spaces where issues of power, privilege, and oppression could be addressed with care and compassion was key to creating equitable and mindful classrooms. One participant shared details about their method:

I have my students read three articles before they set norms—all written by kind of antiracist thinkers and writers. And so, one of those articles is about how traditional group norms are set to appease the dominant White culture. I don’t allow a student’s positive intention as a norm in my class because I think that’s mostly bullshit. I also send them an article about call-in and call-out culture that’s written by a queer Black man and kind of the dangers of calling out. (Participant 7)

Participants also noted the importance of ensuring that they are prepared to meet different students’ needs, for example, by providing closed captioning for all videos, avoiding requiring students to purchase textbooks, and incorporating intentional time during class for students to reflect and seek clarification on concepts.

In addition to creating equitable and mindful classroom environments, many participants felt that it was useful to equip students with a foundation in important theories related to critical public health (e.g., critical race theory, intersectionality) and to ensure that a diversity of voices were represented in course materials (e.g., race, gender, nationality, discipline of study). Some participants brought diversity into their course content by incorporating readings from people of color and providing pictures of assigned authors on the syllabus, while others invited guest lecturers who were people of color.

Explicitly Acknowledging Historical Contexts and Systems of Oppression

Situating public health content within a historical and present context was seen as key to anti-oppressive public health teaching. In fact, many participants shared that they ground their course content within historical perspectives to ensure that students are aware of how systems of oppression have influenced public health practice. One participant said that through course lectures and readings they “build my courses to reflect the history and culture of oppression against marginalized populations” (Participant 8) because, as another participant shared, “you also have to know the history in order to debunk the history” (Participant 9). Oftentimes history paints a more favorable picture of public health gains without acknowledging the harms done to achieve those gains; as another participant pointed out, many of their colleagues lauded the contraceptive pill in their courses but never acknowledged that the questionable large-scale human trials were conducted in low-resourced settings with poor women in Puerto Rico with minimal consent protocols (Participant 10).

Participants were also asked how they incorporated history in their courses. Some situated each course module within a historical perspective while others focused on history early in the content. By bringing history to the forefront, participants felt that they could both acknowledge the systemic oppression and exploitation of marginalized communities and use it as a marker for what public health practice should address and avoid in the future:

There are ways we can still have these conversations that always keep us sort of in our mind of thinking what examples we’re using. . . . We can’t ignore what we know about syphilis because [what] we know, we know due to a horribly, unethical should have never happened study. But I think it’s been great that people continue to talk about that work. More so now in the context—in the legacy of it and continue to assess the legacy of mistrust in the community that it affected that has sort of permeated sort of all of health care. And not just sort of be, “Oh that was bad. We can’t talk about that.” Oh, we should talk about it. But we should use the right framework to talk about it so that we can learn from it. (Participant 2)

When probed about what constituted the “right” framework, the participant shared that it should be one that is cognizant of the historical context, the current legacy, and how that, overall, impacts public health practice among marginalized communities.

Participants also shared that in order to cultivate an anti-oppressive classroom, it was necessary to name and continuously examine topics of racism, sexism, classism, and other oppressions. Some encouraged this through readings and reflections and others intentionally created assignments that reflected real-world public health challenges to equip students with the practical tools needed to practice public health from an anti-oppressive lens. One participant shared an example of how they utilized an anti-oppressive lens to shift how they taught their data analysis course:

I teach a class on a statistical software program . . . we might talk about a question having to do with sex or gender identity. So, if you’re an epidemiologist and you love two-by-two tables, then you want to ask a question that says, “What’s your gender identity, male or female?” Because if you have a third or a fourth or a fifth part of that, you’re not going to be able to do a two-by-two table of that. I would use that as an example to talk about, what challenges does this pose from a data analysis perspective? That was a very simple way to be able to introduce something that for me is related to an anti-discrimination or an inclusive social-justice perspective into a class which on the face of it has very little to do with that topic. (Participant 11)

This example of broadening the scope of gender beyond a binary also reflected a culture shift. The participant used anti-oppression to deepen not only the learners’ technical skill set but also their contextual knowledge that gender exists on a spectrum and guided learners toward critical engagement. Another participant shared that they pushed their students to engage with a public health topic that the students were passionate about so that they could gain experience as citizens outside of the academic bubble. Through these varying techniques, participants found ways to support their students in situating their learning of public health within historical context through contemporary applications.

Challenges to Engaging in Anti-Oppressive Teaching

Participants acknowledged the challenges to anti-oppressive teaching. Some had colleagues who were afraid to say the wrong thing and that there was not adequate training on how to teach using an anti-oppressive lens. Faculty in one participant’s department often avoided various topics because they did not want to illicit negative reactions from their students:

There are times people are like, “I don’t even want to bring up demographics and race in the classroom because I don’t think I can—I’m worried I’m going to offend someone.” And then, students are like, “Why didn’t you talk about racial disparities related to this thing that is hugely disparate?” (Participant 2)

As the quote implies, the participant felt that faculty who avoided discussing race still garnered negative feedback from students because students identified missed opportunities to discuss why health disparities persist. Many participants noted that they themselves as well as their colleagues felt ill-equipped to address topics of oppression: “So I would say that that’s one of the biggest challenges, just that many of us have not necessarily been trained in this [anti-oppressive teaching] area.” (Participant 12). In response, one participant noted that widespread faculty training on teaching in general, and especially on anti-oppressive principles is needed across the board to support faculty in engaging with challenging conversations and addressing systems of oppression within their course content:

I think it needs to be a faculty training. So many of our faculty are so entrenched in the way positions are structured because, unlike other careers where you might switch roles over the course of a lifetime as well as companies, folks who are full professors have been in the academic world for 20, 30 years. And they have achieved a certain amount in terms of our publications etc., and so it is asking a CEO to make a major change. And they are so entrenched in it, and it can be really difficult, if not impossible, to get through. (Participant 10)

Yet at the same time, a participant of color cautioned that though SPH offered faculty trainings, these trainings were often introductory and geared toward White faculty members:

I’ve really struggled with all of those trainings, because they’re really—they’re just really dedicated to—for White people. And they’re really centered on the experience of White people, and I have struggled with as an educator of color is that, for the problems that I experience, there are literally no resources. There’s no book, there’s no article, there’s no training. (Participant 7)

This participant shared that though the administration may believe that they were supporting all faculty, the faculty with marginalized identities were being left out because trainings were not tailored to their specific needs.

Limitations

This study is not without its limitations. First, the primary author conducted all the coding and it is possible that there are themes that may have been missed which could be remedied by replicating this analysis with multiple coders. Second, faculty with commitment and knowledge of anti-oppressive pedagogical practice who did not work at SPH that explicitly espouse social justice values were not included in this sample, excluding potentially rich insight into mechanisms of anti-oppressive public health teaching. Last, faculty or departments of public health at nonaccredited SPHs who have institutional or personal commitments toward anti-oppressive practice were not represented in this sample.

Public Health Implications

Anti-oppressive public health education provides an opportunity to train a public health workforce that meets the needs and challenges of the 21st century by producing a thoughtful and critically conscious workforce that is prepared to address root causes of health inequities. Participants offered a variety of strategies for faculty aiming to employ anti-oppressive principles and practices within their classrooms and pointed to specific institutional needs that could better enhance faculty capabilities in this area (Box 1). Future research should include how faculty of different identities (e.g., gender identity, faculty status, race/ethnicity) engage in anti-oppressive pedagogy and types of courses faculty who practice anti-oppression teach.