Preparing Public Health Professionals to Address Social Injustices Through Critical Service-Learning

The 2020 summer of protests for racial justice amid continued police violence coupled with the widening health disparities due to COVID-19 have made the need for social change and community-informed public health practice abundantly clear. These dual crises require a public health approach grounded in clear communication, community-centered decision making, justice-based planning for health equity, and the most cutting-edge public health practice available. This means that public health professionals must integrate reflection, history, social context, community outreach, team building, collaborative project planning, communication strategies, education, public health research and theory into any effective public health strategy that might impact these crises.

One might wonder, how can we fit all this into our curriculum? And yet, The Council on Education for Public Health (2016) has already asked much of this from public health programs, citing the expectations for accreditation that students learn history, environmental factors, social, political, and economic determinants of health; build coalitions, advocate for social policies, perform on interprofessional teams, and demonstrate competency through applied practice—to name a few. These expectations require more critical pedagogical methods than traditional teaching has to offer. There is only so much collaboration or community-informed work to be practiced through case studies or lectures (Boghossian, 2006). Understanding deeply the context and history of any given public health issue is often taught alongside fundamental health practice with little expectation for exploring the implications of how history may exacerbate injustice (Fleming, 2020). And while internships and practicum are vital to launching into professional practice, they are not always scaffolded to guide students in effective communication or critical reflection that draws together experience with public health theories in praxis (Madsen et al., 2019). The kind of high-level critical thinking, planning, and collaboration it takes to address the social determinants of health with justice-based implementation requires a critical pedagogy that embodies the praxis necessary to address health equity in public health interventions (Ford & Airhihenbuwa, 2010; Freire, 1972). We need a pedagogy that can draw together theories with professional practice without sacrificing one to the other—holding these in conversation can develop the kind of complex processing we need to address present public health crises.

In fact, there already exists an evidence-based teaching method, which relies on critical praxis pedagogy, that should be further institutionalized in public health schools and programs—critical service-learning (CSL; Mitchell, 2008; Mitchell & Latta, 2020). CSL draws together theory and research with a community-led project that aims for social change, authentic relationships, and the redistribution of power (Mitchell, 2008). To manage these moving parts, the pedagogical structure relies heavily on collaborative leadership between instructors, students, and community partners (Stoecker, 2016). Furthermore, participants in CSL use critical reflection to communicate honestly with each other about project progress, learning, and personal transformation (Derreth, 2018). Over the past two decades, CSL has been practiced by countless instructors (e.g., Adelabu, 2014; Morrell et al., 2015; Naudé, 2015), adopted as a core pedagogical approach at institutions globally (Cuban & Anderson, 2007; Furco, 2001), and highlighted as a “high impact practice” (Kuh, 2008) that reflects advanced cognitive, social, and civic outcomes for students while still reflecting community impact (Amerson, 2010; James & Logan, 2016). Some recent work has described approaches for successfully adjusting CSL to socially distant instruction by relying on community decision making, establishing trust through open planning, and practicing critical reflection as a core method of processing CSL experiences, course material and content, and the relation of course content to justice and equity (Grenier et al., 2020).

Even with the extensive practice and evidence, CSL in public health is still a relatively niche offering. Reflecting this, recent scholarship primarily cites the same two articles as evidence of service-learning in public health (Cashman & Seifer, 2008; Sabo et al., 2015). A pedagogical practice so well-suited for the complex, current issues of health inequity should not be relegated as a marginal teaching method. To ensure this is not the case, institutional support structures, faculty champions, and long-term community partners to provide leadership and stability are needed (Young et al., 2007).

Faculty advocates and instructors have recently shown the power of CSL in supporting meaningful and impactful experiences for students and communities. One such example, in a public health nursing course, graduate students join with a community network to respond to the needs of older adults by calling and connecting them with essential services across the city (Gresh et al., 2020). The authors identify eight advanced practitioner skills from assessment and analysis, to cultural competency and humility, to management skills and systems thinking. Meanwhile, students were able to make more than 100 referrals to the essential services older adults required during this pandemic.

Another CSL course on community-based public health evaluation shows the power of reflection, historical and contextual analysis, and community decision making to develop equitable evaluation tools for local nonprofit organizations (Derreth & Wear, 2020). This course had students critically analyze and deconstruct racist and classist implications of some traditional scientific and educational evaluation methods before working with community partners. This course worked to create more effective, culturally aware, equitable evaluation tools that asked questions centered on human experience and community-defined goals. These tools proved particularly important over the past few months as organizations worked to understand community needs and experiences during the pandemic and national movements for racial justice.

In a time of budget cuts that reach even the most deep-pocketed institutions and when faculty are being asked to do more with less (Anderson et al., 2020), institutional supports may be spread thin if they exist at all. At institutions with few committed resources to CSL, Young et al. (2007) point to the power of faculty champions like the examples shared above. These champions are key insiders who are “vehicles for disseminating commitment to service across the institution” (Holland, 1997 as cited in Young et al., 2007, p. 361). These champions work as powerful advocates for instigating institutional changes by sharing student and community outcomes of CSL courses, speaking to colleagues and administrators about the benefits of community-engaged work both for science and the public’s health, and training students in CSL practice. Bennet et al. (2016) extend this definition by describing authority champions and active champions, as those who hold leadership positions (e.g., deans, directors, department chairs) to give validity and those who lay groundwork and commit themselves to multiyear projects, respectively.

Furthering these findings, we conducted a qualitative analysis of responses about CSL advocacy from faculty participating in a service-learning development program. Based on their responses, we established four main themes using thematic coding to determine how faculty can advocate for CSL. Evaluation of CSL training was approved by the institutional review board. Table 1 provides practical recommendations from these faculty who have undergone training from our service-learning center. In this time of entrenched public health crisis, we as practitioners, experts, and educators should come together to advocate for institutional and field-wide structures that support a teaching practice that can prepare our students for the complicated problem solving that awaits them as professionals.

These advocacy measures are valuable because we know that faculty champions and collective faculty action are successful avenues for institutionalized change (Bennett et al., 2016; Vogel et al., 2010). Institutionalized change is necessary to ensure the success of CSL, which is a pedagogy seemingly tailor-made for these ongoing, confluent crises of health and racial justice (Haupt et al., 2017; Hernandez, 2017). Aside from the evidence of success with institutional support, a reframed educational structure based on administrative and instructional collaboration is also one that promotes equity and shared leadership—essential components to concretizing justice in our work.

Public health professionals are in the spotlight now more than ever, as they lead national and global responses to multiple pandemics. The most powerful proposals strive for change by drawing clear lines from entrenched racism and income inequality to ongoing and worsening health disparities. Today, public health professionals are asked to do complex tasks that combine their expertise, collaboration skills, social justice efforts, and public communication to inform public polices in a tumultuous political landscape. As the educators for the next generation of public health leaders, we must design curricula that can foster skills in community engagement and critical reflection—core elements in CSL—alongside public health expertise to prepare our students for their complex work ahead. CSL gives us a framework to support our students’ skills, commit to justice, and improve our communities’ health. As a response to the requirements put forth by Council on Education for Public Health (2016) and to the need for skilled public health leaders, we must act now to advocate, institutionally support, and implement CSL to equip our students and our communities in times of crisis.