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Health Equity: Beyond the Textbook

When students enter the classroom of HumBio 122H, Social and Environmental Determinants of Health, they are taken on a journey that blends theory with community-based service and empowers them to engage with community partners to tackle pressing health disparities.

HumBio 122H was developed over seventeen years ago by Dr. Lisa Chamberlain (as Peds 150/250) in collaboration with others at the Stanford Medical School. Initially designed for medical and graduate students, the course introduced students to social determinants and health equity. Because of growing student interest in health equity, the course expanded its reach in 2022 to include more undergraduates, opening doors for a diverse range of learners to dive into this important topic. 

Dr. Janine Bruce, a senior research scholar in the pediatrics department and the Associate Director of the Office of Child Health Equity took over the course in 2016, excited to both carry Dr. Chamberlain’s course and bring greater opportunities for student engagement in service-learning to the course. Today the class is taught by Dr. Bruce along with Dr. Baraka Floyd, a clinical associate professor in the pediatrics department, and Dr. Jorge De Luna, the Director of Community Engaged Learning in Health at the Stanford Haas Center and the Vice Provost’s Office of Graduate Education. With over 50 students enrolled, the class has become a dynamic platform for weaving together the theoretical knowledge of health inequities with practical experiences in community engagement.

The classroom experience is designed to be interactive, fostering a collaborative discussion of health disparities. Bruce kickstarts the journey with a comprehensive exploration of how to measure health and health disparities and identify the roots of health inequities. Floyd then homes in on race as one dimension of social determinants, dissecting some of the systemic injustices embedded in healthcare and other social systems. Throughout these initial conversations, the instructors encourage students to share their thoughts, experiences, and knowledge to build a rich, multidimensional understanding of health equity. “We invite our students to co-create and make the class rather than the framework that I’m the teacher and I’m the expert,” Floyd said. Students use these early conceptual conversations about racial equity as a foundation for the rest of the course as they discuss with, learn from, and listen to community members and health professionals about the kind of needs they see as well as potential solutions. 

In public health, data analysis is a crucial skill for identifying disparities and crafting effective interventions. The class teaches students to assess quantitative and qualitative data at the local, regional, and national level. Floyd explained that they highlight the importance of data received from the community through deep listening, as marginalized communities are often excluded from peer-reviewed literature as a result of structural racism and other barriers. The team also emphasizes the value of disaggregating data, particularly in populations often considered monolithic, such as Hispanic or Asian communities, to delve deeper into disparities within subsets of these communities and to identify tailored solutions.

With students coming from across the Stanford community, Bruce, De Luna, and Floyd recognize that their classroom will have a variety of perspectives, prior knowledge, and understanding of the social and environmental determinants of health. The team embraces these differences, encouraging students to listen to and learn from one another in a spirit of curiosity and humility. “In our foundational lectures, we set community agreements around how we engage, such as replacing judgment with wonder and listening to understand,” Floyd shared. 

At the heart of the course lies a transformative component of student learning: community engagement. The hands-on experience goes beyond learning from textbooks and lectures and immerses students in real-world scenarios across the Bay Area. “We want it to be an exercise where [the students] can learn what it’s like to partner with the community, be able to listen to the community, and derive a solution with a community partner,” Floyd explained. What makes these partnerships so successful is that students use their knowledge, skills, and energy potential not only to support the needs of the community partners and the people they serve but also to learn from them.

Each student is carefully matched with one of the teaching team’s many community partners such as Izzy Head Start (early education), Ecumenical Hunger Program, and Legal Aid Society of San Mateo County, to ensure the support and experience are beneficial for all involved. From creating informational brochures to conducting community surveys to providing translation services, students spend eight to ten hours each week working with local organizations to address disparities tangibly. 

Bruce, De Luna, and Floyd also invite partners such as Project WeHOPE to the classroom to share their health equity efforts, the needs that they see, and the solutions they are working to create. Students also take a trip to Sacred Heart Community Service, a core assistance agency offering assistance in many forms, including clothing and food programs, help in finding employment and signing up for medical care, early childhood education, and parenting classes. During this visit, students have the opportunity to connect with center staff and learn about the programs they offer and the needs they address. “We want our students,” Bruce said, “to walk out of our class feeling empowered and understanding how they’re able to be part of solutions to address social determinants of health in ways that actually find solutions within communities.”

Student response to the community engagement component of the course has been enthusiastic. Bruce shared that when students come into the class, they’re often excited and eager to start working with their partners. In their final reflections, most students convey a sense of fulfillment and inspiration that suggests that their hopes are borne out in their actual experiences. They appreciate the opportunity to witness firsthand the social determinants of health and the many inequities but also to be a part of the solution and work together to enact change. In some cases, students have extended their engagement beyond the duration of the class, continuing their commitment to health equity and their community partners. 

In a world where the social and environmental determinants that dictate health outcomes can seem overwhelming and intractable, the course, through its racial equity and social justice lens and its community engagement component, underscores the transformative power of education and community collaboration. As Bruce aptly stated, “Our students have a role to play and they have a lot of potential in being the change agents to make the big changes that we need to see to advance health equity overall.”