Successes and Challenges of Teaching the Social Determinants of Health in Secondary Schools: Case Examples in Seattle, Washington

Abstract

This article describes a new curriculum developed by Just Health Action (JHA), which teaches the social determinants of health (SDOH) as a strategy to promote health equity. Motivated by the mounting evidence that improvements in health ultimately require taking action on the social, political, and economic determinants of health, JHA has worked since 2004 to teach adolescents critical health literacy, which combines the understanding of the SDOH with skills to take action. This article explains JHA's curricular methodology, provides two case examples of school-based partnerships, and discusses the successes and challenges the authors have experienced in their efforts. JHA's teaching has been enthusiastically received, but its biggest barrier in teaching the SDOH in secondary schools is general lack of awareness of the SDOH and their impact on health outcomes. The authors echo international and national calls to raise awareness of the SDOH through training and education. Incorporating the SDOH into secondary school curriculum first requires a citizenry convinced by its importance who will in turn influence curriculum change. The authors recommend that the SDOH be taught to health professionals in continuing education, as a required course in schools of public health, and in the new initiative to teach public health in undergraduate education.

Does public health advocacy seek to redress health inequities? A scoping review

“…Gould et al . () highlight the predominance of a societal belief that health inequities are the result of poor individual choices and behaviours, which confounds efforts to mobilise action towards redressing the underlying causes of health inequities.…”

“…Barriers originating outside of public health organisations may include: proponents of political philosophies that undermine health at the expense of economic considerations or that promote the idea of 'equal agency' and equal opportunities for all citizens (Farrer et al 2015); concern by the public and influential minorities about 'nanny' state interference with civil liberties (Chapman 2001, Breen 2004, Moore et al 2015; a public mood that values individual responsibility and minimum collective action (Farrer et al 2015); influential vested commercial interests (Krieger & Higgins 2002, Breen 2004, Kreuter 2005, Stanley & Daube 2009); limited opportunities based on the current political radar (Chapman 2004); 'political short-termism', where health targets are generally short-term and not amenable to the long-term action required to improve health equity (Farrer et al 2015); insufficient co-operation between health and other sectors that hamper efforts to advocate for policies that tackle health inequities (McAndrews & Marcus 2014, Farrer et al 2015; stigmatisation or inequities based on race, social class and gender (Satcher & Higginbotham 2008); academia's focus on publication and grants rather than social change (Chapman 2001, Klugman 2011, Livingston 2011; lack of minority and low-income representation on community advisory boards (Grogan, & Gusmano 2007); remote geography (Snider & Bellamy 2002); constraints imposed by government policy and procedures (Galer-Unti et al 2004); the growing complexity of policy arenas (Yeatman 2002); and the ever-changing social structure that produces the conditions for inequities (Adshead & Thorpe 2009). Gould et al (2010) highlight the predominance of a societal belief that health inequities are the result of poor individual choices and behaviours, which confounds efforts to mobilise action towards redressing the underlying causes of health inequities.…”

Canadian adolescent perceptions and knowledge about the social determinants of health: an observational study of Kingston, Ontario youth

“…Just Health Action (JHA) has been working since 2004 to develop a health curriculum that educates students throughout the United States about the SDH [32]. Educators have reported success in teaching SDH within the secondary school system, and have supported and advocated for the inclusion of explicit SDH content in health courses [33]. …”

Screening for the Social and Behavioral Determinants of Health at a School-Based Clinic

“…The World Health Organization, AAP, Healthy People 2020, Centers for Disease Control and Prevention, and the Centers for Medicare and Medicaid all recommend SBDOH screening for all children and adolescents (AAP, 2016;Baer et al, 2013;Giuse et al, 2016). The National Academy of Sciences advocates for inclusion of SBDOH training in all medical schools (Colvin et al, 2016;Gould, Mogford, & DeVoght, 2010;Kenyon, Sandel, Silverstein, Shakir, & Zuckerman, 2007). The AAP Agenda for Children, the Academic Pediatric Association Task Force on Child Poverty, and the Robert Wood Johnson Foundation all recommend including some form of SBDOH screening in every clinic visit as the new standard of care (Cheng et al, 2015;Chung et al, 2016;Fierman et al, 2016).…”