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Equity and Justice in Health Education

This is an excerpt from Essentials of Teaching Health Education 2nd Edition With HKPropel Access, The by Sarah Benes & Holly Alperin.

Both globally and in the United States, people experience negative health outcomes due to inequitable conditions that prevent them from being able to fulfill their potential. There are deep-rooted, pervasive factors that contribute to and enable these unjust conditions. As health educators, we have an opportunity—we would even suggest that we have a duty—to address these issues in our health education classrooms. We need to increase awareness of injustices and help students develop skills to effect social change and minimize or eliminate health barriers so that everyone, without exception, has the opportunity to fulfill their potential and thrive.

We begin with definitions. We cannot engage in dialogue without having a common understanding of terms and concepts. The language we use matters, and this chapter will inform your practice and provide the language to support your ability to integrate social justice into your teaching. We also hope that it inspires and encourages you to do this work. We could never cover all that needs to be covered in one chapter, but our goal is to lay a foundation for you to build, grow, and advance your practice.

Let’s begin by considering the definition of health we presented in chapter 1. We intentionally included a broad, holistic perspective on health with the space to consider the concept from various viewpoints. This definition should challenge us to consider the variety of messages we and our students are getting about what health or being “healthy” is and what it looks like. We illustrate this with two examples that show different aspects of this challenge from a social justice and equity frame. The first example: In your health education class, you are in your self-management unit and are focusing on personal health habits and hygiene. You describe how you should wash your hair every time you shower and that you should shower once a day. Now, consider that you might have a student experiencing homelessness who might not have access to a shower. Or you have Black students whose hair care needs are different than those of White students. Both of those students don’t fit the definition of health you have provided because their reality doesn’t fit the mold you have described.

The second example is related to social emotional learning (SEL) competencies and also highlights broader issues we must consider. Jagers, Rivas-Drake, and Borowski (2018) highlight areas of concern related to the ways that social and emotional competencies (all of which are found in the health education curriculum) can be problematic because many schools prioritize the “prevailing, middle-class American culture” norms that often promote materialism and “acquisitive individualism” (pp. 4-5). We need to recognize that norms are socially and culturally derived and shaped by those who surround us. Whether something is “normal” depends on who has defined the behavior or expectation. We should also consider if we are asking students to conform to a set of expectations or if we are supporting their ability to flourish and develop social and emotional skills in ways that are culturally relevant and sustaining.

Additionally, the United States has pervasive norms that emphasize the individual. This is, in part, a result of our individualistic culture as a country. Many believe that it is an individual responsibility to solve or address a problem and that if each person “works hard enough,” inequity issues will be solved. The United States has the highest individualism score compared to other countries that are also more individualistic, including Australia, the United Kingdom, New Zealand, and the Netherlands. It is on the opposite end of the spectrum from countries like Ecuador and Guatemala, which have strong collectivist cultures (“Clearly Cultural,” n.d.). Students who come to the United States from more collectivist countries or whose culture and heritage are collectivist find these individualism norms in contrast to their norms and the way they have learned to understand how the world works. In this instance, social and emotional learning can serve to regulate and oppress students; it can force students to have to “conform or restrict their identities and not address their fullest and most authentic selves” (Kaler-Jones, 2020, para. 2).

As this chapter will describe, we must reflect on our own understandings of health and well-being, how different identities shape these understandings, and how other countries and cultures define these concepts. We will then have a broader perspective of health and well-being and in turn help our students develop these perspectives as well.

Health Disparity and Health Inequity

Health disparity represents a difference in health between populations. It is often used to describe disease burden and other negative health outcomes socially disadvantaged groups face (Meyer, Yoon, Kaufman, & CDC, 2013). Interestingly, the term health disparity is used mainly in the United States. Other countries use terms such as health inequity and health inequalities (Carter-Pokras & Baquet, 2002). Health inequity is defined as a “subset of health inequalities that are modifiable . . . associated with social disadvantage, and considered ethically unfair” (Truman et al., 2011, p. 3). Both terms acknowledge the presence of “difference” in health, but referring to these differences in outcomes for socially disadvantaged groups as inequities implies an unfairness and may resonate with people’s ideas of justice (or in this case injustice). As Barr (2014) states, “it is well within the capability of industrialized societies to provide the minimum level of resources required to live adequately and to pursue the opportunity to participate fully in society” (p. 250). It is unjust that some people, due to certain characteristics such as racial or ethnic group; religion; socioeconomic status; gender; age; mental health; cognitive, sensory, or physical disability; sexual orientation or gender identity; geographic location; or “other characteristics historically linked to discrimination or exclusion,” are experiencing unnecessary and avoidable differences in health (HealthyPeople2020, 2020, para 5).

Key Points

  • There is a lot to understand about health and the way that our identities, environment, and experiences shape our understandings of it.
  • We need to engage in critical inquiry and reflection to support social justice and equity work and be deliberate about how we approach this work in the classroom.