Advancing Health Care Equity in Sacramento - Quarter at Aggie Square
“Achieving more just futures through leadership, inquiry and collaboration.”
For more than a year, staff at the Feminist Research Institute have collaborated with feminist faculty from around the campus to develop a health care learning experience for students as part of Quarter at Aggie Square, the immersive new educational hub for UC Davis students in Sacramento. Students who enroll in "Advancing Health Care Equity in Sacramento" (AHCE) in Winter 2021 will not just receive credit for classes taken in Science & Technology Studies and Religious Studies. They’ll also benefit from an integrated curriculum aimed at rooting out the systemic causes of health disparities, as well as access to a quarter-long health care-focused internship with a local program or organization.
Below is an interview with three of the AHCE's founders, FRI Associate Director Sarah McCullough, Program Manager Anna Ward and Emily Merchant, assistant professor in Science & Technology Studies.
Where did you get the idea for this curriculum/program? How did the project team come together?
Sarah McCullough: At the heart of the Quarter at Aggie Square project call was a desire to see new forms of collaborative teaching. One of FRI’s strengths is creating and facilitating new collaborations, and we also believe that research should be inclusive and integrated into undergraduate education. In conversation with Emily Merchant, we came up with the theme Advancing Health Care Equity and the goal of providing a more expansive perspective on health care. Emily’s expertise in the history of medical technology and the sociotechnical nexus of health care made her an ideal initial partner. We were lucky to recruit Meaghan O’Keefe, Lindsay Poirier and Marina Crowder as additional faculty collaborators. Meaghan brought an expertise in bioethics, Lindsay provided critical knowledge of data studies, and Marina is a trained biologist with a strong interest in the sociocultural side of medicine. This gave us a dynamic and generous team with deep expertise in both our topic of interest and undergraduate teaching.
What is Quarter at Aggie Square? What made you want to get involved in it?
Anna Ward: Quarter at Aggie Square is a quarter-long immersive educational experience for undergraduate students based in Sacramento. It’s similar to a Study Abroad program in many ways—except students are just travelling over the causeway or from their homes in the Sacramento area. Students in the program devote an entire quarter to taking classes organized around a theme or topic. What makes the Advancing Health Care Equity experience particularly unique is that these courses were planned side-by-side. We spent last summer and fall hammering out every last detail, identifying the learning outcomes for the curriculum, aligning the syllabi, and identifying partnerships for the internship and speaker series components. This really is a case where the whole is greater than the sum of its parts.
I live in Sacramento and I’ve had my eye out for ways to connect what FRI does on main campus with UCD Health and the larger community of Sacramento. I’m also an educator and the immersive, topically-focused Quarter at Aggie Square structure represents, to me anyway, one of the directions that undergraduate education is heading. As an interdisciplinary scholar, I’m always interested in finding ways to introduce students to the benefits of engaging in issues from multiple perspective and using a range of methods.
What does “advancing health care equity” mean?
Emily Merchant: Advancing health care equity means promoting access to quality care for everyone, prioritizing those who have historically lacked access or received lower-quality care.
What are some current examples of health care inequities or disparities? Does it go beyond access?
Emily: The current Covid pandemic has brought so many examples to the surface. The disease is taking its most devastating toll among people who have jobs that make them more vulnerable to exposure and simultaneously less access to health care, which translates into more pre-existing conditions, more severe complications, and higher death rates. Access is a major issue in the United States, where health care is a business and access is allocated on the ability to pay prices that have become exorbitant. But it isn’t the only problem. Even among those who have access to care, the quality of care is uneven.
How do social differences like race, sex, class and sexuality come to matter in health care?
Emily: These are the basic divisions structuring American society, so they also structure access to health care. We know that stress takes a physical toll on the body and that discrimination and marginalization are stressful experiences. As a result, people who are under the most stress and therefore need more care often have the least access to care. But even when people get in the door (so to speak), they do not receive the same quality of care. Historically, medicine has developed to meet the needs of white men, with less attention paid to the concerns of other people. Until the 1990's, drugs were tested primarily on white men, so it was impossible to determine whether people needed different dosages, or whether the drugs would work the same way on people living under very different circumstances. Women are more likely to survive a heart attack if they are treated by a woman doctor, as the symptoms are very different for women than they are for men. African American women have much higher rates of maternal mortality than white women, even when they have more education and higher incomes. So beyond needing better access to health care, we need a health care system that takes seriously the needs of a diverse population.
Briefly describe your vision for a more equitable approach to health care.
Anna: Start with the most marginalized members of our communities. Start there every single time. Assume people have multiple positionalities and health care needs.
Emily: A more equitable approach needs to begin with a single-payer system with universal coverage. Health care will never be equitable if it continues to run as a business. Beyond that, we need a diverse group of practitioners who are attuned to the different needs of different segments of the population and who take seriously those needs and their role in meeting them.
How can UCD undergraduates hope to apply this learning in their careers? What impact will the program have on them, ideally?
Emily: We have several types of students in mind for this program, and the program will likely impact them differently.
One type of student is the one who intends to go on to a career as a health care practitioner. We hope that this program will make those students more attractive to medical schools and other professional programs by giving them an immersive hands-on experience in the medical humanities and social sciences, balancing their STEM education. In their eventual careers, we believe they will be better health care practitioners if they understand all of the ways in which the world beyond the doctor’s office affects the patient-provider interaction.
For students interested in health care policy or advocacy, we expect that this program will give them a set of conceptual tools with which to think through the problems they will encounter in those careers and help them address those problems in more equitable ways. Students who intend to go on to a career in research in the medical humanities or social sciences will get an introduction to the scholarship in that area as well as hands-on experience that will give them a broader perspective in their future research.
The final type is the student who just wants to know more to be a better citizen. This program will help them see health care and the problems surrounding it through lenses that are not widely available in the media or public discourse.
Describe the internship experience and who is involved.
Anna: We’re thrilled to collaborate with eight different Sacramento-based partners, all offering students involved in the program unique insights into the many challenges of health care access and equity. The internship experience is an opportunity for students to see firsthand how these challenges are addressed every single day by people who care deeply about the health of our communities.
Issues like health care access and equity can sometimes seem too big to solve, it can be overwhelming. But there are people all around us doing incredible work and it’s important that students see that up close and get ideas for what roles they want to play in facing these challenges head on. That’s part of why we chose to collaborate with different types of organizations and programs, from community organizations focused on direct services like the Sacramento LGBT Center to policy-focused organizations like UC Davis’ Center for Healthcare Policy and Research. We want students to have a range of opportunities to choose from that all emphasize different ways of getting at the issues of health access and equity. We’re also really excited to partner with the California Department of Health’s Office of Health Equity.
While a quarter-long internship has its challenges in terms of brevity, students who wouldn’t normally be able to commit to a full academic year internship because of work or childcare responsibilities will have a chance to do so with this Quarter at Aggie Square experience. And, of course, we hope that some of these internships will turn into ongoing relationships for some students.