As the United States continues to grapple with its relationship with race and racism in the weeks following George Floyd’s murder, more public health programs are speaking up about racism as a public health issue. While they are indeed correct, why haven’t they been explicitly teaching and educating on these important topics? Are public health professionals equipped with knowledge on how racist policies create health disparities?
The following is an observation of current gaps in public health education, based on my experience receiving a Master of Public Health degree from the University of South Florida (USF), beginning in the fall semester of 2017.
Before I started the program, the college did a major revamp of their curriculum, to make it more blended and to “reflect the true, interdisciplinary nature of public health.” All public health students are required to take the same foundational classes, then go on to their specific concentrations. USF was one of the first public health institutions to make this switch. USF is also ranked 16th in the country for its public health program, and first in the state of Florida—truly leading the academic field. The limited coverage of systemic racism and structural barriers is a telling sign that these critical topics may be limited in other public health institutions.
Our first semester of “Population Assessment 1” contained one module titled, “Cultural Competency.” We discussed the culture iceberg, and did an activity where you move if you’ve experienced a particular oppression or privilege. The rest was our Italian professor sharing an experience of accidentally hugging a Japanese student at the airport. This means there was one module in a full year of foundational classwork that was solely dedicated to culture topics, with a small discussion on implicit bias, but no direct discussion on racism, antiracism, institutional violence, white privilege, intersectionality, or other social justice principles.
Side note: Can we start using the term “humility” instead of competence? Learning about culture is a process and is ongoing; the term “competence” does not encapsulate that.
Our second semester had lessons about “built environments.” Racist policies, such as redlining, were never mentioned. Students were tasked with getting into groups to complete an assessment on either physical activity (parks) or nutrition (food stores), in either an affluent or lower socioeconomic community, and write a report on our findings. After reflecting on the assignment and my classmates’ reactions and comments about the neighborhood we visited, I wrote an email to our professor (see screenshots). My classmates could not look deeper to see how the racist policies enacted on this community are what created and perpetuated the food deserts we had just visited. After the assignment was submitted, that was the end of the conversation. No critical analysis or challenging dialogue on the systemic barriers put in place, severely impacting the health of our various communities, no reflection paper, nothing. The professor’s response to my concern about this significant gap in education was to brush it off, and there were no further attempts to engage in a meaningful conversation about systemic racism.
As mentioned previously, once students finish their foundational coursework, they move on to their various concentrations. I moved forward to the public health education track. Each concentration has required coursework. Luckily, mine included a class specifically on health disparities and social determinants of health, but for other concentrations a specific class is not necessarily included. These classes, however, did not come from an anti-racism lens.
On May 31, USF College of Public Health (COPH) posted a statement about the murder of George Floyd, stating, “Without racial justice, there can be no public health.” Cool, you’re right. But what about translating this statement into practice? After all, USF COPH fondly states, “Our practice is our passion.” After I shared my thoughts over Instagram on how the COPH faculty is primarily white-passing and barely covered systemic racism in their curriculum, USF COPH responded in a series of messages saying they acknowledge that there is more work to do to increase diversity among staff—“No school can claim victory; there are not enough in any of our programs”—while also detailing ways that they have “woven health equity and social justice throughout the fabric” of their curriculum. USF COPH also shared that their “newly elected president of the undergraduate public health student association, a young Black woman, is already planning a series of town halls and smaller group efforts for our students,” and that they are committing to “doing even more, not just in the core but across the curriculum, not just in the classroom but outside of it, and not just in public health but across USF Health in all of our inter-professional training.”
Dean Donna J. Petersen noted in an email sent out on June 8 that “[COPH] are also working on a series of events, conversations, programs, and pilot projects to commence this fall around this most central of issues. A group of our faculty are penning a statement clearly describing racism as a public health issue. Groups of student leaders are planning coffee hours. USF Health is exploring a series of events, using existing platforms to amplify these issues and to encourage debate and dialogue toward deliberate reforms.”
While USF is certainly taking steps in the right direction in incorporating more topics on systemic racism and increasing dialogue on racism’s impact on public health, it is critical to make multi-sectoral efforts to actively reshape the curricula, culture, research, and service to combat systemic and structural racism.
Here are seven ways public health institutions can do better as a whole:
Incorporate more antiracism content in first-year, core classes. The first year of one’s public health education is the foundation for the rest of their studies. Increase time spent throughout the year to introduce systemic racism, hold brave spaces, and engage in courageous conversations. Hold students accountable for their learning; this is not the time to tokenize Black students in creating these spaces. While students confront their biases and continue to unlearn the behaviors systems of white supremacy have taught us, add some reflection paper assignments. Make this year a time of critical thinking, connect how these systems create health disparities that we work to address through public health systems.
Require all concentrations to include a course on Health Disparities and Social Determinants of Health.
Encourage faculty and instructors to engage in conversations around systemic racism within our communities during class discussions. Create a safe space where students know they can explore these topics and think critically about some of the issues Black, Indigenous, and people of color communities face and stimulate solution-driven thinking to begin closing the gap in some of these disparities.
Test students’ knowledge of ways systemic racism, and overall systems built around white supremacy, create health disparities and impact our public’s health. If organizations such as the National Board of Public Health Examiners (NBPHE) and National Commission for Health Education Credentialing add questions to their certification exams (CPH and CHES, respectfully), universities will be obligated to educate on these topics more thoroughly.
Hire more Black, Indigenous, and people of color professors and faculty (period).
Support Black-led student groups that create safe spaces to address the effects of systemic racism in Black communities and forums on how Black public health professionals can actively mobilize and advocate for resources to improve health outcomes in Black communities.
Create a culture of learning that centers antiracist and social justice principles. Building more well-rounded public health professionals will greatly assist in our fight to achieve health equity.
We must continue to apply pressure. Students and alumni must persist, to keep these institutions accountable. As these current events continue to transpire, more students and alumni are speaking out, and their concerns are being heard.
In the spirit of accountability and transparency, we must continue to put pressure on the institutional leaders over the next six months, 12 months—however long it takes, until we see meaningful and system-wide change. Change does not take place overnight.
I hope this call to action is just the first step.