Pedagogy in Health Promotion

This reflective article describes how we, a trio of doctoral students, applied critical pedagogical approaches to identify gaps in our public health training, reflect on the value of our lived experiences and ancestral histories, and take action toward advancing change within our School of Public Health. Additionally, we argue that our future effectiveness in leading systemic change toward health justice requires our public health training institutions to deliver course content that addresses racism and other systemic forms of oppression, largely responsible for reproducing health inequities. We also reflect upon how our efforts to find spaces in which to critically engage with content related to social and structural determinants of health transformed into a collaborative learning opportunity that has served to strengthen our skills as public health researchers, advocates, and future educators. We conclude by calling upon our schools of public health to take the lead in preparing the public health workforce of tomorrow for the challenges of addressing systemic causes of health inequities. Our goal is to share our experiences so that graduate students across public health training institutions may look to this piece as a concrete example of how we can shape our schools of public health to meet our needs.

This pilot mixed methods evaluation describes the impact of an anti-oppression workshop on allyship development among a group of public health graduate students. After completing a mandatory anti-oppression workshop, a survey including closed- and open-ended questions was administered to 41 public health students specializing in health promotion. Closed-ended questions gathered basic demographic data and Likert-type scale responses to assess changes in participant knowledge, awareness, and attitudes surrounding anti-oppression concepts discussed during the workshop, while open-ended questions asked respondents to reflect on how such changes might influence their development as allies. A response rate of 65.85% (27 respondents) was achieved. The majority of the study group were between the ages of 20 and 24 years (74.07%), self-identified as straight (77.8%), and self-identified as non-White (77.8%), while almost the entire group identified as female (92.59%). Five key themes emerged from a directed content analysis of qualitative data, identifying the importance of anti-oppression workshops for allyship development: conducive environments, positionality, knowledge, active listening and learning, and advocacy. These themes were used to construct a mixed methods joint display for comparative interpretation of quantitative and qualitative data. Mixed methods analysis revealed that anti-oppression workshops can promote allyship development by increasing knowledge of key terms and concepts associated with anti-oppression and facilitating critical reflections on power, privilege, and social location. Our findings demonstrate a profound need for ongoing anti-oppression training among future public health students and professionals.

Implicit bias is a topic many faculty/instructors may feel uncomfortable teaching and discussing with their students. As public health professionals, it is important that we teach the next generation of public health professionals about bias so that they are able to address the elements in society that allow these biases to affect the health care that is received and the health outcomes that occur because of these biases. This article provides detailed information on an activity around bias conducted with undergraduate students in an Introduction to Public Health course. The article discusses how this activity can be adapted and guidance on how to make this activity work for any course.

Racism is a critical determinant of health that affects outcomes; shapes practice, policy, research, and interventions; and disproportionately burdens nondominant racial populations. The racial justice challenges of today, combined with persistent health inequities exacerbated by the COVID-19 pandemic, have intensified the need for racial equity–minded public health professionals. Because training programs play a key role in developing professionals, they must center teaching about racism and promoting antiracism within their curricula. The critical race theory–grounded strategy Public Health Critical Race Praxis (PHCRP) provides a useful framework, calling for examination of how racism operates within individuals and the systems, such as public health, in which they work. Foundational public health courses provide a vital opportunity to launch such an examination and lay the groundwork for antiracism praxis. This article offers a curricular model that integrates PCHRP with a creative approach to facilitate exploration of racial identity among public health students. Students in our course use photography and written reflections to create dual portraits, one depicting how they see themselves and the other imagining how they might be seen by others in our racialized society. Our pedagogical process prompts critical self-reflection about racial identity, a crucial foundation for addressing the health consequences of structural racism. Spurred by creative inquiry, students of all racial and ethnic backgrounds tell us that our course boosts their racial consciousness, enhances their understanding and ability to engage diverse communities, equips them to see and name racism in the public health context, and galvanizes them to work toward dismantling it.

Emphasizing the value of utilizing both facts and stories to teach and learn about health, race, and social justice, this reflection makes a case for using The Immortal Life of Henrietta Lacks and Well: What We Need to Talk About When We Talk About Health to create a dialogue with undergraduate health education students. The unique combination of facts and stories that the two books provide sparked conversations from which both my students and I were grateful to learn.

Scientific racism, or the belief that racial hierarchies are explained by biological differences, among health care professionals may contribute to the oversight of social causes of health problems and result in poor quality of care. This study examines the extent to which scientific racism may permeate undergraduate pre–health professions student worldviews before entering advanced training. Undergraduate students (n = 251) pursuing training in health professions from The University of Texas at San Antonio completed a survey in 2018 measuring respondent level of agreement with statements about biological differences between U.S. racial and ethnic groups, as well as agreement with statements about cognitive differences, health behaviors, and systemic racism. Analyses showed that the students agreed with false statements regarding biological, behavioral, and cognitive differences among races and agreement was significantly stronger among students at earlier stages of education but did not differ by student race/ethnicity. Adjusted analyses showed that third- and fourth-year undergraduate students exhibited less agreement with false statements about race than first- and second-year students ( β ^ = - 10 . 86 , 95% CI [−18.33, −3.39], p < .00). The joint effect of higher class level and public health major ( β ^ = - 6 . 57 , 95% CI [−11.98, −1.16], p = .02) was also significantly associated with less agreement with false statements regarding systemic racism. This exploratory study suggests that even among diverse student populations, scientific racism persists but may improve over educational careers. Future research may determine how structural reforms and training can further improve student understandings of race as a social construct and not a biological reality.

Health organizations and public health programs are responding to the current pandemic of racial violence through releasing statements condemning these actions. They recognize that to be a health professional means addressing the structuralized inequities leading to reduced health outcomes and increased violence for portions of our population. However, the written and unwritten codification and curriculum about professionalism and what it looks like leads to the very biases that perpetuate inequities. This commentary examines the disconnect between the hidden curriculum of professionalism and the way we enforce how a professional is supposed to look through dress codes and stipulations on hair as well as other elements of appearance. We will then look at ways to “make the invisible visible” and open up conversation in the classroom. In order to address equity and serve all their students, organizations and public health programs need to open space to discuss the parts of our culture that reinforce biases and how these issues affect their communities.

Introduction. Public health students are not systematically trained how positionality and power impact public health practice. A grounding in anti-oppression equips practitioners with tools to recognize the impact of present and historical contexts, foster critical self-reflection, and address systems of oppression. The goal of this study was to gather evidence of how anti-oppression is incorporated in public health teaching. Method. Purposive sampling was used to identify public health faculty who engage in anti-oppressive practice across accredited schools of public health espousing an explicit commitment to social justice. Semistructured in-depth interviews were conducted between January and April 2020 via Zoom; analyses were informed by constructivist grounded theory. Results. Twenty-six faculty from eight schools of public health and one school of medicine participated. Participants highlighted challenges in and techniques on how to engage in anti-oppressive teaching. Three overarching methods for incorporating anti-oppressive principles in pedagogy were identified: facilitating critical consciousness, creating equitable and mindful classrooms, and discussing historical context and systems of oppression, alongside discussing challenges associated with using an anti-oppressive lens in teaching. Conclusions. Anti-oppression is an explicit framework that can be incorporated in training future public health practitioners to work toward dismantling systems of oppression through addressing issues of power and privilege. Findings from this study indicate that faculty are interested in and engage in anti-oppressive teaching but lack consistent training and institutional support. This study offers tools that faculty can employ in the classroom toward practicing anti-oppressive public health pedagogy.

The 2020 summer of protests for racial justice amid continued police violence coupled with the widening health disparities due to COVID-19 have made the need for social change and community-informed public health practice abundantly clear. Public health professionals need to combine public health knowledge with collaboration, communication, and reflection to address these health disparities and social injustices. Likewise, as public health educators, we need to develop curricula that train students in these complex skills in order to be effective practitioners. To do this, public health schools and programs should adopt critical service-learning as a central pedagogy in curricula because it is specifically designed to address our current crises with its combination of practice, research, and reflection that together aims for social change. As a means of institutionalizing the pedagogy, faculty can practice and advocate for resources as faculty champions of service-learning.

Community-engaged classrooms offer advantages to both students and community-based organizations by creating an environment where students become agents of change and contribute to meeting communities’ health needs. However, most community-engaged classroom research is done in high-income contexts in advanced curriculums with graduate students. This article explores a community-engaged classroom project at a minority- and indigenous-serving undergraduate institution, focusing on indigenous student empowerment. Commercial tobacco use prevention is of particular importance to indigenous contexts and resulted in a college policy change to reflect indigenous values. Students designed, implemented, and evaluated a tobacco product education campaign to effect change using a community-engaged approach. The educational activities included (1) understanding the tobacco context, (2) health communication course design, (3) forming key partnerships, (4) facilitating student activities through behind-the-scenes work, (5) designing and implementing a campaign, and (6) student growth and empowerment. We illustrate how academic and state partnerships can align interests in implementing public health policies and providing students with real-world public health communication and health equity experience.

Education and training support public health practitioners in identifying and addressing challenges related to equitable health concerns. This article details a four-step Curricular Responsive Review Model (CRRM) generated by educators in a Council on Education for Public Health–accredited public health program to systematically understand and gather feedback on how to develop a responsive curriculum for their students. A review of all course syllabi was conducted by two faculty members and a doctoral student to identify curricular gaps and overlap. These findings, critical team dialogues, and a review of the literature informed the development of a survey to identify the health equity concepts and skills needed by MPH students. Community partners (n = 4) responded to health equity education questions to detail the essential concepts and skills needed to teach students. Health equity educators (HEEs; n = 4) were then consulted on how to address knowledge gaps through pedagogy and educational resources. Community partners provided a list of areas that students should be educated in to enrich their health equity understandings. Recommendations were generated for integrating those concepts/skills into course teaching plans. The four-step CRRM in health equity education provides an opportunity for public health programs to engage in systematic mapping and critically reflective review processes to address curricular gaps and overlap. Mechanisms to receive real-world knowledge on health equity from a variety of stakeholders are essential to ensure real-word practical learning. The CRRM identifies systematic, responsive curricular mapping and review in public health as essential for meaningful, real-world equity education in disciplines beyond public health and health promotion.