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"How Racism Is Embodied: A New Health Advocacy Curriculum"

September/October 2010 issue of Poverty & Race

I really already knew that racism was bad but I didn’t know it could affect health or that is has affected how babies are when they are born.
Quote from a 7th grader from Seattle Girls School, Seattle, Washington

While the unfortunate realities of racial health inequities in the U.S. are indisputable, the mechanisms by which such inequities occur are hotly debated. However, there is now substantial evidence that racism and discrimination produce health inequities through socially-induced biological changes in utero and throughout the life course. Unfortunately, actions towards eliminating racial health inequities are hindered by popularly held explanations for racial health differences, such as intrinsic genetic differences and poor health behaviors, despite the lack of sufficient scientific evidence to support them. Furthermore, the current focus of health education on individualized medical treatment and an absence of teaching models for a societal/systematic understanding of health are barriers to teaching health advocacy at the broader community or societal level.

Just Health Action (JHA) is a non-profit organization (www.justhealth based in Seattle, Washington, that has developed unique curricula to teach the social determinants of health (SDOH) as a means to address the overarching factors that produce health equity. Social determinants include, but are not limited to, income, early life experiences, education, food security, employment, health care, social cohesion and political empowerment. Even more broadly, racism, classism and sexism —identified as the social determinants of equity—drive inequities in the SDOH. These determinants are sometimes referred to as the “causes of the causes” because they are an “upstream” source of “downstream” individual behaviors and biological traits. Understanding these determinants is essential for taking decisive action to improve health.

JHA has been working since 2004 to develop and teach students to understand the SDOH as well as the skills to take action on root causes of poor health both for individuals and populations. JHA’s pedagogy is interactive and encourages critical analysis and reflection, similar to empowerment education or education for “critical consciousness” advocated by Paulo Freire.

JHA believes that eliminating racial health inequities also requires a new empowerment approach that focuses on teaching evidence-based scientific concepts alongside strategies to inspire students towards collective action to reduce racism. Thanks to funding from PRRAC, JHA developed a new racism and health curriculum that was piloted at Seattle Girls School (SGS) in Spring, 2010. SGS is a private middle school located in a historically redlined district of Seattle that has made a firm commitment to ensuring a socio-economically and culturally diverse academic community. It shows through its student body: Over 40% of the girls self-report as students of color and at least 30% of the students receive need-based financial aid.

JHA worked with three post-baccalaureate interns to develop curriculum and then taught six lessons (totaling seven hours) at SGS over a two-week period. The six lesson titles were: 1.Three levels of racism; 2. What is a health inequity?; 3. Effects of racism-related chronic stress on disease; 4. Effects of racism on maternal and child health outcomes; 5. Intergenerational effects of racism expressed through the life course; and 6. Racism-advocacy brainstorming. The lessons consisted of interactive activities, including learning the evidence through the interpretation of graphs, exercises that explore the mechanisms of racism, and exercises designed to elicit empathy about racism and health inequities.

We employed JHA’s pedagogical framework in the design of our pre- and post-test instrument for this pilot project. In our evaluation, we measure students’ change along JHA’s 4 part framework: 1) Knowledge of the SDOH (in this case focusing on racism) and health disparities; 2) Compass—attitudes regarding the SDOH (again, focusing on racism) and activism; 3) Skills—empowerment to use new skills to take action on the SDOH/racism; and 4) Action—future intentions to take action on the SDOH/racism. We believe and have had previous teaching successes indicating that these four steps are absolutely essential to produce health activism.

Generally, we were very pleased with the evaluation results for this pilot curriculum. In post-tests, students were able to explain the dynamics of racism by discussing the inequitable distribution of “resources or opportunities” as well as the societal effects of racism. Post-test responses to students’ feelings about racism added rationale to moral claims about racism, as exemplified in the lead quote to this article. We noted a statistically significant difference in a question which asked students how capable (or empowered) do they think they are to change the effects of racism in their lives and/or community compared to the beginning of these classes on racism. One student wrote, “…now I know that racism can effect [sic] people’s health and I don’t want that to happen anymore.” Not surprisingly, some students’ capability score went down as they came to the realization that changing the effects of racism is “harder than I thought.”

We have received positive reviews from teachers, including advice on curriculum refinement and a recommendation that JHA present its pedagogy at teacher training workshops and teacher conferences. Since the pilot, we have re-developed our How Racism Is Embodied curriculum into eleven lesson plans.

JHA believes that our curriculum is unique not only in its pedagogical method of focusing education on health advocacy, but also in the content focus: the biological foundations of racial health inequities alongside the science that negates genetic and behavioral explanations for racial inequities. We believe that our curriculum can be a critical step in developing a societal understanding for the need to redress social inequities to improve health. We hope that our activities will complement work by other institutions, such as King County’s and Seattle’s Equity and Social Justice Initiative. JHA envisions being an important educational and advocacy bridge between policymakers and community efforts to reduce racial health inequities in our society.

For further information, contact Linn Gould,206/324-0297, gouldjha@

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