Health Equity & Social Justice in the U.S.

Purpose: to help other instructors teaching the same or similar courses

Common Course ID: HSC 407
CSU Instructor Open Textbook Adoption Portrait

Abstract: Open textbooks and other no-cost readings and media are being utilized in a public health course for undergraduate students by Brian Cole in the Health Science Department at California State University, Long Beach. Along with the two open textbooks that cover public health ethics and LGBTQ+ health issues, a curated collection of peer-reviewed journal articles, reports, and videos cover cross-cutting topics, such as upstream determinants of health, marginalization, and intersectionality, along with in-depth explorations of health equity issues experienced by specific racial/ethnic, sex/gender, geographic, and socio-economic groups. The main motivation to adopt an open textbook was to provide students with up-to-date, no-cost learning materials in a variety of media that are all available online.

Health Equity & Social Justice in the U.S. - HSC 407
Brief Description of course highlights:  Explores social determinants of health associated with health inequities in the U.S. Students will learn about historical and current social justice and ethical issues affecting positive health outcomes and access for diverse and vulnerable populations. Letter grade only (A-F). GE Designation: Upper Division C.

Student population: Designed for Health Science majors and minors who have completed lower division course work and at least one introductory public health course. This course may also be suitable for students majoring in child development, education, environmental science, nursing, public policy, social work, sociology, and other related majors. 

Course Prerequisites: GE Foundation, one or more Exploration courses and upper-division standing.

Learning or student outcomes:  Upon successful completion of the course the student will be able to:

1. Describe how health equity and social justice are interdisciplinary concepts incorporating ethics, history, sociology, and health sciences.
2. Explain the recent trend in health ethics moving beyond clinical issues to the broader issues of social justice and health equity.
3. Identify and describe the distribution of health inequities and their social justice contributing factors across vulnerable population groups (age, gender, gender and sexual orientations, location, & ability), disease outcomes and access to quality health care.
4. Research and analyze the historical conceptualization of race and ethnicity as they relate to health disparities in the United States. 
5. Trace and analyze the development ethical principles relevant to culture of individuals and their communities, including the principle of autonomy, beneficence, and justice as it applies to health promotion and research. 
6. Analyze how traditional ethical theories apply to various cultures (African American, Native American, Latinx, & Asian/Pacific Islanders) and extrapolate universal values that transcend culture. 
7. Evaluate concepts and arguments across disciplines (ethics, history, sociology and health science) related to health inequalities and social injustice.
8. Create an organized written analytical response to describe the development of health disparities within a vulnerable population group (race, ethnicity, ability status, gender, age, or sexual identity) due to historical treatment, cultural practices, and/or acculturation and critique strategies used to address health inequalities within that population. 
9. Use ethical theory to analyze case studies of health disparities and social justice issues and relate to personal narrative. 
10. Use self-narrative to examine personal relationship to ethics, health disparities, and social justice.

Syllabus and/or Sample assignment from the course or the adoption [optional]:
1. HSC 407 Course Topics Readings and Media Matrix.pdf (syllabus excerpt)

2. HSC 407 Worksheet 4 Ethical Analysis of Strategy Paper Recommendations.pdf

Textbook or OER/Low cost Title: 

Brief Description: The course relies on a mix of different readings and other media available to students at no-cost, including chapters from two OER textbooks. Both OER textbooks address equity issues in public health practice and research. While the course is focused on health equity and social justice in the U.S., both textbooks are replete with case studies from around the globe that are relevant to public health practitioners in the U.S. Both textbooks are also clearly written, with chapter ranging from introductory discussions of key concepts to in-depth explorations for more advanced students..

Barrett et al. (2018). Public Health Ethics: Cases Spanning the Globe. https://link.springer.com/book/10.1007/978-3-319-23847-0

Hwanhng and Kaufman. (2024). Global LGBTQ Health Research, Policy, Practice, and Pathways. https://link.springer.com/book/10.1007/978-3-031-36204-0#toc

Student access:  All materials are available to students on the internet. In addition to the OER textbooks, most of the assigned readings and media are available at no-costs to the public, however a few journal articles and videos are available for free only to faculty, staff, and students through the CSULB University Library.

Provide the cost savings from that of a traditional textbook.  The previously required textbook for this course (Smalley, K. B., Warren, J. C. & Fernandez, M. I. Editors. (2024) Health equity: A solutions-focused approach, 2nd edition. Springer Publishing Company. ISBN-10: 0826149510, ISBN-13: 978-0826149510) costs $95 paperback and $90 for digital access.

License: The curated list of course readings and supplemental media for this course (see HSC 407 Course Topics Readings and Media Matrix.pdf) includes a mix of open licensed, creative commons licensed, and copyrighted materials.

OER/Low Cost Adoption Process

Motivation for Zero-Cost Course Materials. The textbook previously used in this course was often dated with insufficient discussion of cross-cutting issues such as intersectionality and the social construction of race and gender. Students frequently reported finding the text opaque and abstract as chapters tended to summarize large amounts of research about health disparities in specific population groups with little context and few concrete case studies.  While no single replacement textbook was found, the curated collection of materials provides a mix of summary materials and case studies, and integrates peer-reviewed research, popular media reports and videos to support student learning. Assuring that all readings and other media were accessible to students at no-cost also meets the University’s goal of reducing cost barriers to students’ education.

How did you find and select the open textbook for this course? Materials were identified with assistance of the university librarian assigned to the health science department, other instructors, review of OER sites (including but not limited to OpenStax), and internet searches.

Sharing Best Practices: Unfortunately, few OER exist for this course’s topic, with the exception of a number of materials designed specifically for nursing students. This was surprising since courses on health equity/social justice could be taught in a number of different disciplines. Early consultation with a librarian familiar with public health teaching resources was a big time-saver. Videos and reports from the leading public health professional group in the U.S., the American Public Health Association, provided crucial, easily accessible cross-cutting connections between the disparate topics discussed in this class.

Describe any key challenges you experienced, how they were resolved  and lessons learned. (see Best Practices above)

Brian Cole, DrPH  I am an Assistant Professor in the Health Science department at California State University, Long Beach.   

[faculty page]

Courses that I teach I teach undergraduate and graduate courses in:
Environmental Health
Health Equity
Policy Analysis
Public Health Research Methods.

Teaching philosophy and research interests

In my teaching, I aim to inspire inquiry in my students, encouraging them to investigate the origins of social and health issues and to collaboratively develop solutions for these challenges in their lives, communities, and globally. My current research centers on community engagement for environmental and climate justice, inter-sectoral collaboration in community-based climate adaptation initiatives, and health impact assessments (HIA).