Health and Equity Data to Teach the Next Generation of Public Health Leaders

Abstract

The COVID-19 pandemic restructured university learning environments while also underscoring the need for granular local health data. We describe how the University of Memphis School of Public Health used the City Health Dashboard, an online resource providing data at the city and neighborhood level for more than 35 measures of health outcomes, health drivers, and health equity for all US cities with populations >50 000, to enrich students’ learning of applying data to community health policy. By facilitating students’ engagement with population needs, assets, and capacities that affect communities’ health—key components of the master of public health accreditation process—the Dashboard supports in-person and virtual learning at undergraduate and graduate levels and is recommended as a novel and rigorous data source for public health trainees.

The COVID-19 pandemic altered both the need for university-level educational resources that use different learning formats and the need to engage public health students in a deeper understanding of the social and economic drivers of health and equity. From a pedagogical perspective, students at all levels now require familiarity with diverse learning formats to remain engaged in an ever-changing university education environment. From a public health practice perspective, the pandemic has reinforced that public health education is strengthened by integration of granular geographic data that demonstrate the dynamic variation of social and health status across populations and neighborhoods.

The University of Memphis School of Public Health, accredited by the Council on Education for Public Health (CEPH), is a member of the Association of Schools and Programs of Public Health. In an effort to engage students with novel datasets and policy-making tools that prepare them for public health practice, the instructor of the Foundations of Public Health core course for master of public health (MPH) students incorporated the City Health Dashboard (www.cityhealthdashboard.com), a free online resource sponsored by the Robert Wood Johnson Foundation and developed and managed by the New York University Grossman School of Medicine Department of Population Health. ¹ The Dashboard provides data at the city and neighborhood level on more than 35 measures of health and their drivers for more than 900 US cities, mostly with populations >50 000. ² Developed using a social determinants of health emphasis similar to that of the County Health Rankings and Roadmaps, ³ and sourcing data from trusted national datasets such as the Centers for Disease Control and Prevention’s 500 Cities Project, the National Vital Statistics System, and the US Census American Community Survey, the Dashboard is a unique data resource because of its population health approach to city- and census tract–level data. Educators across the country have used the Dashboard to guide students in exploring data on health, demographic characteristics, and social determinants of health and to ground complex public health topics in examples from locales that are familiar and meaningful to students, such as their hometowns or the cities or neighborhoods in which their educational institutions are located.

Purpose

After learning of the City Health Dashboard’s launch in The Friday Letter, a weekly digital newsletter by the Association of Schools and Programs of Public Health, Dr Marian Levy, then a professor and associate dean of the University of Memphis School of Public Health, integrated its use into her Foundations of Public Health course through an assignment to develop a data-driven policy brief. The purpose of engaging with the Dashboard in the classroom was 2-fold: (1) evaluate students on their ability to assess population needs, assets, and capacities that affect communities’ health (ie, MPH foundational competency #7) ⁴ and (2) engage students with novel city-level data and resources that link social determinants of health, health outcomes, and policy development. Having a broad but curated range of relevant public health metrics available on a single website allowed students to complete the assignment efficiently, using a resource that could be carried into their professional work moving forward.

Methods

The University of Memphis School of Public Health began using the City Health Dashboard as a teaching tool for public health students in 2018 for its Foundations of Public Health course, as a requirement for all MPH students, and has since been offered as an in-person and online course. The course is usually taken the first semester of MPH study and provides a broad overview of contemporary issues and challenges of public health policy and practice. In addition to imparting foundational public health knowledge, the course helps students explore the social, political, and economic determinants of health and how these factors contribute to population health and health inequities. Students then identify and develop strategies for improving public health among economically and racially and ethnically diverse populations. We did not seek institutional review board approval nor waiver because student use of the Dashboard was for a regular classroom assignment, and student feedback was captured nonsystematically for demonstration purposes only.

The relevant assignment provided to students in Foundations of Public Health was the following:

Develop a policy brief using the City Health Dashboard to assess population needs. Students will use the website www.cityhealthdashboard.com to assess population needs, assets, and capacities that affect communities’ health. Also, students will assess the role of social and community factors in both the onset and solution of public health problems. The policy brief will identify priorities for Memphis or another metropolitan city of your choice and should be geared to policy makers.

The Dashboard is briefly introduced to students during a syllabus review in the first class. Approximately 3 weeks prior to the due date, the instructor reviews the assignment in detail, conducts a virtual tour of the website, and uses student suggestions to showcase locations of interest across the United States and the range of variables available across 5 domains: health outcomes, social/economic factors, health behaviors, physical environment, and clinical care. In addition to providing experience working with real-world metrics related to community assessment and public health surveillance, the exercise reinforces the role of social determinants in health outcomes that may be amenable to local change.

Student performance on the assignment is assessed through a 10-point rubric that measures the following: critical analysis of population needs; inclusion of relevant social determinants of health; identification of priorities, geared to policy makers’ perspectives; logical, persuasive content; and professional format.

Outcomes

Completed student assignments included policy briefs focused on third-grade reading levels, excessive housing costs, income inequality, food access, tobacco control, diabetes, obesity, and other measures of health and equity, with some students using advanced features to draw comparisons between cities and identify relationships between 2 metrics. Student performance on this assignment reflected the issues about which students were most passionate or what drove them to enter the field of public health. Students presented strong calls to action via policy related to a variety of topics. In addition to providing students an avenue for accessing data for cities across the nation, this assignment reinforced the role of social factors in driving health disparities and helped them gain experience in using data to shape policy recommendations.

The School of Public Health applied for CEPH reaccreditation in 2020, with the City Health Dashboard assignment as part of MPH competency #7, “Assess population needs, assets, and capacities that affect communities’ health.” The School achieved official reaccreditation in March 2021, with the CEPH accreditation process confirming that this assignment met the requirements for MPH competency #7.

In addition, 5 students in the 2019 Foundations of Public Health course were offered the opportunity to provide written feedback via a structured online format on their views of the classroom use of the City Health Dashboard website. Student comments focused on the Dashboard’s ease of use, ability to compare cities and metrics, and range of engaging data visualizations. One student stated, “I appreciated that the data could be explored in a variety of formats, including scatter plots, GIS maps, and in comparison to other areas or the US more broadly.” Another student added, “The accessibility of the information makes it understandable to myself (as a beginning public health graduate student) as well as to the general public. The fact that City Health Dashboard provides such a diverse collection of resources (community partners, policies, and grant opportunities) all in one place is invaluable.”

Lessons Learned

Public health education often requires access to well-defined and curated datasets on public health issues of importance. The City Health Dashboard offers locally grounded data in an easily accessible format with built-in comparison and visualization features that facilitate students’ understanding of complex issues. As one student noted, “In exploring the City Health Dashboard, I had about a million research ideas. It allowed me to visualize the needs of my community, and identify comparable communities to set realistic goals.”

In the first year the assignment was introduced, it became apparent that some students needed more specific guidance with the technology; therefore, future iterations included an instructor demonstration session, conducted 3 weeks before the assignment was due, so that students could become familiar with the Dashboard.

Because of the range of metrics available through the City Health Dashboard, its integration into classroom learning and assignments can be adapted to focus on an array of health and health equity issues that are grounded in data from any US city with a population of 50 000 or larger. With the Dashboard being freely accessible online, instructors and students can easily maintain access during virtual or hybrid learning. This feature of the Dashboard is particularly relevant in the pandemic-influenced learning environment of higher education, allowing instructors to incorporate real-world data in asynchronous or synchronous online courses, hybrid settings, or in-person classroom settings. While online learning can widen disparities between students based on access to equipment and technology, ⁵ the freely accessible Dashboard resources require no specialized software or subscriptions, only an internet-enabled device. This assignment has been used successfully in a course that is delivered in online and in-class formats. (The CEPH accreditation review report is available upon request.) The data are also updated regularly and downloadable, allowing students to engage with the Dashboard’s data in ways that evolve during the course of a single class, a multiyear training program, and into their professional careers. Grounding learning about health-related priority setting and policy making in data specific to cities with which learners are familiar allows students to connect real urban health issues to actionable policies.