Written by: Rachel A. Yoho, Eric Coker, and Elizabeth A. Wood (Department of Environmental and Global Health, College of Public Health and Health Professions, University of Florida).
Introduction
Introducing the Global Public Health Course to a room full of undergraduate students in early January 2020 felt much like the beginning of any other semester. As the class started, the World Health Organization (WHO) released news on the disease outbreak and recommendations on an isolated public health response for a “pneumonia cluster” (World Health Organization 2020). Quickly, we realized that this topic, not yet classified a pandemic until the time of our spring break, was a very applicable issue to the Global Public Health course and evolving in real time. The 16 week semester of our Global Public Health courses tracked alongside the changing situation and the rapid development of a global pandemic. As the three faculty members teaching over 100 undergraduates in predominantly pre-health professions career paths, we reflect on the implications of teaching and learning for global health during ‘the pandemic semester.’
The context of the course began with the importance of understanding the need for a global public health framework and infrastructure. Naturally, this focused on the “hook” of defining a pandemic and discussing key pandemics through recorded human history, such as the 1918 Spanish Flu and HIV pandemics. Unfortunately, following this first class session, the situation escalated to living a pandemic, while also teaching an undergraduate-level broad overview of global public health. From this experience, we provide several recommendations for a thoughtful and critical approach to teaching global health during a burgeoning - or now, ongoing - pandemic.
The outbreak of the COVID-19 pandemic while teaching global health led to several key considerations: (1) strategies for addressing emerging global health issues, (2) awareness of the challenges of integrating the situation into course content in what was a fluid event; and (3) the rapid change in the ‘identity’ of public health.
COVID-19 as an Emerging Issue
Changing in real time, our class observed the potentials established for large-scale observation of public health interventions, whether these were attempts to control the spread or initial considerations for developing herd immunity in populations (Been and Sheikh 2020). The restrictions on the movement of people also showed our students the staggering implications on lowering emissions and improved air quality, another important course topic, in key regions worldwide. Some have commented on this reduction of air pollution as a “silver lining” of this devastating pandemic (Been and Sheikh 2020; University of Florida OneHealth Center of Excellence 2020). By the third week of the semester, the developing situation in China was taking over discussion in the public sphere and media. We showed key updates, such as WHO data, headlines on major business changes, and prior stock market impacts for pandemics (Bartash 2020). The projected minimal impact (Bartash 2020) quickly morphed into feeling the impacts of the stock market losses strongly even in our own retirement accounts. The changes were happening rapidly on a daily basis, creating challenges in applying the content to course topics. The rapid shift from an isolated “pneumonia-like” illness to a global pandemic forced the widespread “educational pivot” for schools and universities across the country and around the world (Yoho 2020).
The transition to remote teaching happened, quite literally, overnight. We moved the classes from a traditional, in-person university classroom, to synchronous meetings from the safety of our own homes. This rapid maneuvering was difficult for higher education and for our class. The class faced many issues with this shift, from internet connections, to maintaining engaging teaching strategies, to even figuring out how to manage a large class and group activities on Zoom (Yoho 2020). However, the pandemic shifted not only our style and strategies, but changed our approach to integrating the evolving situation into global public health course content.
Applying Course Content in Real Time
After making the transition from campus to entirely online, many of the remaining lectures covered timely topics, like One Health, Mental Health, (Re)Emerging Infectious Diseases, Neglected Tropical Diseases, Changing Disease Patterns, and Global Health Ethics. For example, course adaptations involved updates to the One Health lecture and bringing in content from the campus’s One Health center to provide the most up-to-date content publicly available. For example, discussions were centered around whether the case-fatality rate of COVID-19 was inflated due to lack of testing as well as the potential gender disparities among those who contracted the disease, as had been reported widely. Students were able to experience in real-time what a pandemic was, compare across countries the difference in public health preparedness and strategies, and witness the lack of a panacea for stopping a pandemic.
Ethics in global public health and infectious diseases are clear examples where course content became more relevant and sensible to talk about in a classroom environment. Students clearly observed the relevance of what are typically perceived as esoteric and theoretical ethical considerations in public health. Ethical issues in global health around xenophobia and stigma, resource allocation, quarantine, and public health priority setting, were all laid bare throughout the early stages of the pandemic and were easily recognizable and discussed in the classroom setting.
Public Health Identity
The evolution of the COVID-19 pandemic made the core global health concepts taught throughout the course highly relevant and tangible. As a consequence, the role of the public health approach and the various professions in public health formed an identity that is often difficult to concretely understand (Fried 2010), especially for students. Most of the core roles in global health, such as social and behavioral health, environmental health, health education and communication, health surveillance, laboratory sciences, and epidemiology, all became regular topics in popular culture (e.g., sports and entertainment), social media, politics, and the news media. Such unprecedented exposure to the field of global public health helped motivate class discussions and presentations around several core competencies in global health, such as the global burden of disease, health implications of travel and migration, social and economic determinants of health and health disparities, population access to environmental resources (e.g., water for hygiene), globalization of health and healthcare (e.g., WHO coordination of global response), healthcare in low-resource settings, and ethics in public health.
Recommendations for Teaching and Learning
The development of a societal crisis shaped the semester into one of experiencing collective trauma. As such, it became necessary to modify course content and reanalyze the presentation of information and integration of COVID-19 content. Reflecting on the semester, the integration of global health practices and principles and our own past educational training shaped our teaching and learning of Global Public Health during a pandemic. As a result of the key considerations outlined, we propose the following recommendations for the teaching of global health during a developing or ongoing pandemic:
● Implement crisis-responsive and emotionally-heightened teaching strategies.
Empathy and understanding should be even further heightened (Head 2020) for teaching global health during a pandemic. A developing and uncertain situation creates challenges for students and educators (Field 2020), and as such, greater understanding and compassion can be beneficial on all sides.
● Maintain classroom “culture” and be accessible for students.
We created an adjusted normal by focusing on key course content and having synchronous class sessions to promote student-faculty interaction. For students who may face new scheduling or connection challenges (Field 2020), we also recorded the lectures. The class also had the benefit of a previously developed in-person culture. We worked to maintain that with communication and develop mutual understanding of our changing situation.
● Cover, but limit, “application” of the pandemic-related content.
While the growing pandemic provided a relevant application of course content, we also focused on limiting some of this discussion. As the pandemic developed, we quickly became bombarded with this in our daily lives. As such, a balance was necessary to focus on previously planned global health content, as well as appropriately and accurately integrate pandemic discussion.
● Recognize explicit and implicit challenges during a pandemic.
Teaching under suboptimal circumstances creates unique burdens in timing, facing collective trauma (Kingsley 2020), and mental health impacts not common under “ordinary” circumstances. For example, COVID-19, as well as the continued physical distancing, job losses and economic insecurity, and social upheaval, likely caused ongoing collective trauma and a search for meaning (Hirschberger 2018). In applying the theoretical framework of collective trauma, we focused on key leadership needs (Tcholakian et al 2019). As such, we also made increased efforts to promote support services to students, including university and mental health programs.
Conclusion
Wrapping up the course from behind our webcams in early May 2020 revealed a ‘new normal’ in our daily lives and in our teaching. Worldwide, our lives had been reshaped by the very real presence of global public health principles during a growing pandemic. COVID-19 may have been a tangible application of our Global Public Health course content, but it also reinforces not only the obvious infrastructural needs within our healthcare system, but teaching and learning for global health as well. As instructors, we need to actively reflect on the teaching and learning of global health during the outset and likely future waves of this and future pandemics. The public profile of global health continues to rise, and as such, our teaching of global health must be responsive to and reflective of the ongoing pandemic.
Author Note
The three instructors’ reflections cover two similar sections of the Global Public Health course at the University of Florida in the Spring Semester of 2020. As such, reflections include both sections and may have minor differences in timing or topics. Individual differences are considered insignificant to the purpose of the article and, for the sake of brevity, are not highlighted.
References
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