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Grace E. Gugerty ’19 wasn’t too nervous when she first met the refugee family who she would be learning about over the span of the spring semester.
“It was more of a lot of buildup in my head. I thought ‘I hope they like me; I hope they don’t think I’m too invasive,’” says Gugerty, an anthropology major and medical anthropology minor.
She and an Upstate Medical University medical student were teamed up in the course Refugee Health Advocacy to learn about certain aspects of the family’s life and work with them to find solutions to potential issues surrounding health and well-being.
“This is really important because you are actually interacting with people,” Gugerty says. “You don’t get caught up in reading articles and writing papers for a class. It’s so invaluable to just be able to talk to the family members and learn about them as people.”
Gugerty’s experience is inherent to a model of learning for health professionals—developed by Sandra Lane, professor of public health in the David B. Falk College of Sport and Human Dynamics—that involves community-based research and problem solving with community members to better understand the social determinants that lead to disparities in health and health care. The social determinants of health are defined as the economic, cultural, social and political conditions that shape a person’s life.
The class and its experiential framework is one initiative of the Route 90 Collaborative, a growing effort among a group of faculty members at several New York state universities and colleges to improve the integration of social determinants of health into professional health education.
Lane organized the collaborative and helped develop the Refugee Health Advocacy course with Drs. Andrea Shaw and Telisa Stewart from Upstate Medical University.
The collaborative bolsters the idea that educating health professionals—in partnership with community members—about what myriad factors can shape a person’s health can contribute to more effective ways to improving well-being across underserved communities.
CARE model
The effort developed through Lane’s longstanding work on a model for community-based scholarship, CARE (Community Action Research and Education), which Lane and Robert A. Rubinstein, Distinguished Professor of Anthropology and professor of international relations at the Maxwell School, created in 2008. CARE projects have highlighted such issues as food deserts in Syracuse, lead poisoning in rental property, health of the uninsured, and neighborhood trauma and gun violence.
Sandra Lane
“We put together teams on a CARE project with students and community members as equal partners,” Lane says. “We spend a lot of time talking to students—what are their options in responding to a community, what do they need to do to conduct research, etc. And then the students communicate with faculty and the community members. The community members and faculty are teaching the students, but then the students take over the project.”
In this student-community partnership, students better understand the challenges faced by patients. Patients can become better equipped to deal with difficulties as they seek solutions to their needs and contribute to research that is informing the next generation of community health care workers.
Lane’s work with CARE projects led to an invitation to chair a global committee of experts—the Committee on Educating Health Professionals to Address the Social Determinants of Health—convened by the Institute of Medicine of the National Academies of Sciences, Engineering and Medicine. The committee was asked to develop a high-level framework for such health professional education.
Framework for health professionals
The committee proposed a model for those in the education and health sectors to partner with communities in its 2016 report, “A Framework for Educating Health Professionals to Address the Social Determinants of Health.” The goal was to encourage innovative education with hands-on experiences with students being prepared to reflect on those experiences once they go into the classroom.
The Route 90 Collaborative is bringing the framework to life.
“In the Route 90 Collaborative, we help each other with implementing the framework in the curriculum, sharing evaluation materials and how to develop student assignments to learn about social determinants of health,” says Lane, who presented on the collaborative to the National Academies of Sciences, Engineering and Medicine in November. “It’s about students being active learners.”
Those in the Route 90 Collaborative are Syracuse University, involving the areas of public health, marriage and family therapy, and anthropology; the University at Buffalo, social work; Upstate Medical University, medicine, bioethics and humanities; Le Moyne College, physician assistant program; and The Sage Colleges, nursing and medical respite for the homeless (doctoral faculty initiative).
“Each faculty partner in the Route 90 Collaborative is committed to trying to implement these ideas in the classroom,” says Lane, a Laura J. and L. Douglas Meredith Professor of Teaching Excellence and research professor in the Department of Obstetrics and Gynecology at Upstate Medical University. “Five of us have made substantial inroads in doing so; some are more elaborate and can take longer to implement.”
Route 90 partners
For example, a colleague at Le Moyne College implemented a requirement for students to use social determinants of health in a patient’s medical assessment and tasked with developing a medical plan for the patient; at Upstate Medical University, bioethics and humanities colleagues used the framework to organize a university-community workshop with community activists and members of the Street Addiction Institute Inc.; Lane and other colleagues at Syracuse University integrated the framework into the courses Reproductive Health and Global Health; and the Department of Marriage and Family Therapy established a course using the framework to have community members share with students the impact of losing family members to violence.
In the Refugee Health Advocacy course, students were asked to produce three assignments that included mapping out the family’s journey to the United States and issues of resettlement; shopping or making a recipe with the family to ask about the cultural aspects of their diet; and putting together a budget that predicts their monthly needs.
During their first meeting with their family, Gugerty and her classmate met with the mom from the Democratic Republic of the Congo and her four girls and learned about their situation, why they came to the United States, and got to know a little bit about them. The family had fled from war and other crises in their home country.
“In the class, we talked a lot about the social determinants of health—the way that someone’s environment is influencing their health,” Gugerty says. “We see how people live their day-to-day lives, so if they have a chronic condition or illness, we could design a plan to help make the best changes in their life to improve their situation.”
As with other CARE model courses, students in the latest course will be interviewed two years after the course to see if this type of research and community work made a difference in their education.
Obstacles to obtaining insurance
Alumnus Bernard Bush ’09, G’12, who graduated with degrees from the School of Education, says his work with Professor Lane directly influenced him to pursue a public health degree from New York University.
In a graduate course on epidemiology while at Syracuse, Bush and the other students in Lane’s class worked with patients at the Amaus Health Services, a free community clinic, to determine the barriers or obstacles families may face in obtaining insurance.
Bush says they found many similarities among the participants, such as a family history of chronic disease that strained family resources, which then led to issues getting insurance and sometimes a distrust of the health care system.
“Sometimes people don’t know how to get coverage or the resources available to them, even when there are numerous resources,” says Bush, who works at Lourdes Memorial Hospital in Binghamton, New York. “Health care practitioners and community health workers need to be more proactive in linking patients with the health care resources available to them.”
For Bush, the entire course was “eye-opening.”
“To actually work with actual people and not just numbers, it puts things into perspective and really makes you focus on the ‘whys’ instead of your results,” Bush says.
Becoming a partner with a patient showed Gugerty how health care practitioners can become an advocate for community members.
“This model is centered on interacting with people,” Gugerty says. “It might be slower than implementing broad policy changes, but if you’re interacting with people one-on-one, treating them as individuals. It can make a huge impact.”
