Lab course on race and health equity teaches interdisciplinary advocacy

Students at a junior high school in Cicero, Illinois—part of an industrial corridor in Chicago’s western suburbs—have long complained of headaches, rashes, and other debilitating symptoms. Queries to the city council have gone mostly unaddressed. As part of an innovative Loyola University Chicago School of Law lab course, Loyola law, pre-med, and public health students team up to explore possible reasons for the children’s symptoms—and develop advocacy resources for a community partner.

Debuting this past spring and open to JD students at all levels, Health Justice Lab: Race and Health Equity explores the relationship between racism and medicine, public health, and law in the United States. This interprofessional, experiential course examines how structural racism harms health and provides insight on the roles that medical, public health, and law professionals can play in advocating for change.

“The time demands it”

“This course is overdue, and the time demanded it. In public health, we often talk about social determinants’ role in health, but we usually don’t dive too deeply into it,” says Abigail Silva, PhD, assistant professor of public health sciences, who coteaches the lab with Maya Watson, LLM, director of Loyola’s Maywood Medical-Legal Partnership, and Kate Mitchell, JD, director of Loyola’s Health Justice Project. “The three of us have worked together and learned from each other, and we felt this was a great opportunity to collaborate on this topic for our students.”

During the first part of the semester, students receive a historical grounding in how systemic racism has affected the legal, medical, and public health professions. A primary text is Medical Apartheid: The Dark History of Medical Experimentation on Black Americans from Colonial Times to the Present by Harriet A. Washington. “Next, we move into discussions about modern-day health inequities that arise out of racial discrimination,” says Watson. With readings and guest lecturers, students explore racial disparities in epigenetics, maternal mortality rates, policing, the carceral system, the educational system, women and children’s health, comorbidities, mental health, and COVID-19, among other topics.

In the latter part of the semester, the course’s focus shifts to advocacy. Students divide into interdisciplinary teams that include at least one representative from each of the cohorts enrolled in the course: JD students, MPH students, and MPH/MD students. “Each team is assigned a real health issue in a Chicago-area community west of the city, working with a community partner to explore the issue and present a proposal,” says Watson. Professor Kate Mitchell says that an essential course purpose is for students “to see how the elements of social determinants of health and racism function in communities and how to engage in anti-racism and health equity advocacy in a community-centered way.”

Intro to interprofessional advocacy

Among the health issues various teams explored this spring were the high cost of one suburb’s water, suicide attempts among area young people, and the policing of individuals with intellectual disabilities in Black and Brown communities.

Anu Dairkee, a physician who’s now earning her law degree, and Stazi Prost, an MD/MPH student, were part of the team that explored the Cicero students’ health complaints. Their topic was a suggestion from their community partner engaged in environmental justice advocacy. The group also worked closely with Sasha Adkins, MD, MPH, a lecturer in Loyola’s School of Environmental Sustainability.

“Cicero has been a factory town for a very long time, well before there were many regulations on dumping waste,” Dairkee says. “Our focus was to understand which companies might have been the source of the problems—where their waste had gone and which specific areas it might have affected—then look at legal options and other next steps.”

Although Cicero is about 90 percent Latinx, its city council is overwhelmingly white, “so we also tried to home in on reasons for the town not following up on multiple constituent complaints about the health of students at the school,” Dairkee adds.

Adkins thought the students’ health issues might be traced to vapor intrusion, a migration of volatile chemicals from contaminated groundwater or soil into an overlying building. The team analyzed numerous documents from the Illinois Environmental Protection Agency, which had done some remediation at the school. “We figured out the most likely geographical source and what the [toxicants] might have been based on the factories that were there,” Dairkee says. Based on the team’s recommendation in its final proposal, Adkins and the public health students are now testing for those potential toxicants.

“We want our students to understand how their professions are implicated in and perpetuate racism in health care, so they see the role they can play as they start working in the real world.”

Gaining invaluable interprofessionalism

For students in the lab course, the chance to work with professionals-to-be in other fields is perspective-expanding. Working in interdisciplinary teams “allows students to appreciate what skills others bring to the table and exposes them to the logistical and personal challenges of interprofessional working relationships,” Silva says.

MD/MPH student Stazi Prost, who wants a career that combines clinical work with advocacy and policy, “really appreciated how the law students on my team could identify legal points, including coming up with the idea of doing a legal memorandum as our deliverable,” she says. “Everyone had multiple strengths they brought to the project.”

Law student Anu Dairkee adds, “Working with Stazi and other public health students helped me better understand how to serve our population. They under- stand counseling, how to approach the community, and what questions to ask”—for instance, how to establish trust with parents who are hesitant to discuss their children’s health problems because members of the family are undocumented, she says.

At the course’s end, students not only have a solid grasp of racial inequities and the social determinants of health; they’ve also deepened their ability to engage with community stakeholders and developed tools to advocate professionally and personally.

“It’s not sufficient just to know; it’s also important to do and to act,” Silva says. “We want our students to understand how their professions are implicated in and perpetuate racism in health care, so they see the role they can play as they start working in the real world.” –Gail Mansfield