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BRIEF COMMUNICATION
Year : 2021 | Volume
: 34
| Issue : 3 | Page : 101-104
From millstones to milestones: Scaffolding a house of public health on political science foundations
Farah M Shroff1, Swetha Prakash2, Trish L Varao-Sousa3
1 Harvard T.H. Chan School of Public Health, Boston, MA, USA
2 University of Alberta Faculty of Medicine and Dentistry; University of British, Columbia
3 University of British, Columbia
Correspondence Address:
Farah M Shroff
Harvard T.H. Chan School of Public Health, Boston, MA
USA
Source of Support: None, Conflict of Interest: None
CheckDOI: 10.4103/efh.EfH_256_18
Background: We analyze the University of British Columbia's Department of Political Science's first course on health, “Global Politics and Health,” to determine whether one course could inform political science students to tackle health issues. The major concept was global public health is politics writ large, as determinants of health are rooted in economic and social power. Course objectives encouraged student agency in ameliorating population health status. Methods: We use three surveys, with qualitative and quantitative components, to assess interest and knowledge of public health issues, and determine whether student agency increased as the course progressed. Results: We confirmed that political science develops an excellent foundation for the analysis of issues related to global public health status. One course can stimulate curiosity in health issues. Unexpectedly, we discovered that students' greatest learning outcome integrated personal, interpersonal, and scholarly analyses of health issues. This provided an avenue for students outside of the health sciences to frame mental health, sexuality, and other stigmatized subjects within scholarly discourse. After the course, virtually all students had developed a sense of agency, hope, and tools to understand the roots of mental and physical health. Following case studies on various countries, students quickly grasped the significant impact of politics and economics on people's health. Discussion: We recommend that political science departments offer courses that focus on health for all alongside existing courses on healthcare systems' politics. Furthermore, departments of public health may benefit from including political science courses as core elements of their curriculum to assist graduates in navigating the highly politicized infrastructure of public health. Both disciplines stand to gain from this interdisciplinary opportunity-- in the service of better health for all.
Keywords: Health equity, political science, public health, scholarship of teaching and learning
It is counterintuitive to see health issues rooted in social, political, environmental, and economic issues. A majority of Canadians believe that better health is based on more medical care,[1] yet this is inconsistent with evidence. Worldwide, those who hold less financial and social power experience worse health outcomes as a result of limited access to education, clean water, housing, and social services.[2]
We examine the Department of Political Science at the University of British Columbia's (UBC) first course on “Global Politics and Health,” which emphasized socio-political determinants of health including income, social equity, housing, education, mental health, women's health, sexuality, and HIV. Case studies illustrated how government policies (which political science graduates could influence) improve social and economic conditions, and by extension health. We aimed to encourage students to develop confidence in defining health as well-being to establish a better understanding of health equity. Our goal was to determine whether political science students gained a sense of agency in health issues through this course. Specifically, could one course stimulate sustained curiosity in health issues?
MethodsWe conducted online course evaluations to assess student interest and knowledge of global public health issues, and to determine whether student agency increased as the course progressed at three timepoints: (1) Precourse, (2) at midterm, and (3) at end of term. We adapted the surveys to include content-specific questions, but consistent questions were examined using within-subjects analyses. The surveys included a mix of quantitative and qualitative questions. We analyzed the open-ended qualitative questions using Framework Theory.[3]
Twenty students were enrolled in this upper-year seminar course, and most students completed each survey. All students were in the Faculty of Arts, and none had a background in public health. Students in the course (all but one of whom completed all three surveys) included 9 male presenting and 12 female presenting with ages typical of an undergraduate course at UBC (between 20 and 30 years old). Additional student demographic information was not collected as they were irrelevant to our assessment of the course and student experience questions outlined above. Student data were made anonymous prior to analyses. Statistical analyses were conducted using RStudio statistical software.[4]
ResultsDefinition of health and conceptualizing social determinants of health
When surveyed about past public health education, the majority of students did not have formal knowledge in this field. Although they thought that health and politics were linked, most students were unable to explicate this connection. Most precourse survey responses linked health to access to care, or directly to medicine. One student's definition of health included, “…the healthcare system that the government is supposed to provide, protect and finance. This includes… hospitals, clinics, helicopters, ambulances… pharmacists, doctors, and nurses.”
Students continued to conflate health with medicine through early-term assessments. A concerted effort was then made to separate wellbeing from the absence of disease and access to medical care. By the midterm survey, student perceptions began to change, and were now informed by newfound understanding of the social determinants of health (SDOH):
“I have learned more and more that the difference between us is not necessarily genetic, luck or individual choice but determined by social factors such as early childhood development, environment, income, and education. As I take the journey of this class, health has become more and more intertwined with politics in my mind.”
Creating a public health “scaffolding”
Over the semester, students developed significant public health fluency. [Figure 1] illustrates the notable gains in knowledge that students displayed throughout the 12-week term.
Figure 1: Students' learning related to public health concepts over the class termIn the final survey, students indicated changes in knowledge, attitudes, and/or practices towards course issues and topics, with the largest change in the areas of SDOH, childbearing practices, and public health solutions [Figure 2].
A repeated-measures analysis of variance indicated that interest in global public health changed significantly over the term (F (2, 37) = 3.82, P = 0.03), with students reporting significantly more interest at the end of the term as compared to the start of the term (t(19) = 2.46, P = 0.02).
Cultivating students' agency in public health
The capstone projects gave students an opportunity to apply their learning to public health problems. When asked whether the course helped students to re-imagine their role in public health and inequality, 84% (n = 16) responded yes. One student noted that, “before I think (thought?) my role would be a witness, but now I think my role can be someone who (is) involved in and investigating some issues of health.” Another student informed us that their capstone project in this course was the topic of their Master's thesis the following year.
This shift from bystander to agent was further reflected by 70% of students indicating that their response to a health-related situation would be different now compared to before the course. One student was prompted by the current opioid crisis in Vancouver to take action: “the topic inspired me to physically attend a Naloxone training session and actually be able to do something should I ever encounter someone who has overdosed. In that way, this course inspired me to learn a new skill and enriched my learning.” Notwithstanding this student's action, most students were inspired to sharpen their skills in political analysis related to health issues.
As the course progressed, we heard from students that analyzing their own lives and the lives of others with respect to physical and mental health issues was part of the course's main benefit to them. For example, one student highlighted that the course provided tools to unpack health situations for the first time using theoretical frameworks that reduced fear, blame, and shame.
Public health solutions: Case studies and capstone projects
Aiming to infuse students with optimism and hope for a better world through an anti-racism, anti-imperialism feminist lens, case studies about Brazil, Rwanda, India, and Canada were analyzed. These case studies influenced student understanding of public health solutions based on a foundation of political will. One student reflected that “…the Rwandan success and improvements of community health-care workers and decentralization of policies and Brazil's food security programs and cash transfer programs have all exemplified unique models that deconstruct and address social inequities that lead to better health.”
Capstone projects and presentations gave students an opportunity to propose ways to integrate political processes and “out of the box” solutions to global health problems, using creative media and techniques. Students chose to carry out group projects on the opioid crisis, indigenous youth mental health, indigenous women's health, international students' mental health, breastfeeding, and refugee health.
At the end of the course, we invited students to reflect on their sense of optimism about the possibilities of resolving global health problems (5-point Likert scale 1 = Not hopeful at all, 5 = Very hopeful); the median response was 4 (Hopeful). Half of the students reported that this perception had changed since the start of the term and one student noted that “…perhaps I feel more solidified in my answer after taking this class and interacting with all these passionate people. I also think that many of the successful case studies we learned about in this class made me all the more hopeful!” Others held a more skeptical view, such that: “…ultimately I think that humanity is innately selfish and those in power will want to keep it that way” and that “…people are becoming more polarized than ever, and the issues we talk about fall back to one thing: money.”
DiscussionThrough various assessments, students indicated that they felt enabled to enact change in the sphere of public health and saw themselves as changemakers within this field. The classroom became a place where students could engage beyond a purely scholarly and intellectual level.
Scaffolding on strong preexisting foundations of political theory, this course gave an introduction to the world of public health politics. While one course was not able to alter students' preexisting skepticism about politics in general, many students developed a sense of agency and optimism for a healthier society.
It appears that one course can have a significant impact on student learning, both in the personal and professional spheres. Atop a foundation of political science theory and the SDOH, each student customized their “House of Health” [Figure 3] according to their academic backgrounds and personal interests, using their own millstones from political science to individualize their public health milestones.
Figure 3: Scaffolding a house of health on political science FoundationsFor some students, a more personal understanding of mental illness in their own lives was one of the most beneficial learnings of the course. For others, taking their passion for environmentalism and constructing a “House of Health” on top of that, helped them to see the links between health and the environment. Students' backgrounds thus predisposed them to conceptually grasping the theme of the course: global public health is politics writ large.
Andragogical approach
An unanticipated, recurrent theme in student feedback was the andragogical approach. This included the use of participatory teaching methods and the respectful nature of their relationship with their professor, illustrating the importance of how the subject matter is taught has a strong bearing on students' ability to retain, engage, and analyze material.[5]
Limitations and areas for future investigation
As we examined one health course, this study is limited in its size. Future studies could explore a comparison of experiences between political science and public health students to further understand how courses like this one increase interdisciplinary education. To assess long-term impacts, a longitudinal study with this cohort at 1-year and 5-years postcourse would amplify the lessons in this paper.
Curriculum recommendations
We recommend that political science departments offer public health courses that focus on health status to show the versatility of political science in the field of health. Political scientists can, and should, work with governments and policy agencies to enact health-related changes.
Accordingly, public health course offerings ought to include a greater focus on political science, which is currently lacking in Canada.[6] With the infusion of more political theory and practice into public health, it will be possible to improve health for all with politically savvy, upstream solutions that emphasize health promotion and disease prevention.[7]
Acknowledgments
The authors would like to thank the contributions of the volunteer Student Advisory Committee, students who took this course: Raguram Baskar, Tanaz Dhanani, and Morgan Slessor. Each of them read two drafts of the paper, making astute and helpful comments. Their participation in this process is most valuable.
We would also like to appreciate the hard work of our research assistant, Vera Mistry, who was prompt, courteous and very helpful in the paper's completion.
We appreciate the Behavioural Research Ethics Board at UBC who we consulted on the project. They were kind enough to review the project and deem it exempt from the ethics review process.
Last but not least, we are grateful to the Centre for Teaching and Learning Technologies for a Scholarship of Teaching and Learning Seed Grant that was awarded to the first author.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
References
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