When most of us think about health factors, we consider them from an individual point of view, around diet, exercise, and preventive care. You might even have learned about these elements in school. Sheryl Taylor, equity and access coordinator at the Martha’s Vineyard Regional High School, is helping to broaden the traditional curriculum approach to include studying contributors to health disparity — a difference in health outcomes between populations. A predictor of a health disparity can be something as specific as zip codes, which can reveal the degree to which you are more or less likely to have something such as asthma.
Taylor has a master’s degree in public health, with a concentration in health behavior and health education. “I got into public health because I was concerned about differences in racial disparities in pregnancy and infant mortality,” she explains. “As a teenager, I lived in Smith County, Texas, a pretty small place. But we had one of the highest pregnancy rates in the entire state. So even in high school, I was thinking, ‘What is it about where I live, and what are the structures that would cause this to happen?’”
Before coming to the Vineyard, Taylor worked in healthcare in various parts of the country, including Texas, California, and Florida, where she first started working in schools: “When I got here, there was a health coordinator role in the school system, which had done a needs assessment and determined a need for a standard healthcare curriculum across all Island schools. Before that, the six schools on the Island had individual curricula.”
Now, at MVRHS, Taylor, in addition to teaching a “Diversity, Belonging, Equity, and Inclusion/Social Justice” workshop, delivers a supplementary class on health disparities for 10th graders that is part of the mandatory curriculum.
In a regular health class, students might learn about asthma symptoms and how to manage them personally, by avoiding triggers and taking medicine. In Taylor’s class, students also study why some people have asthma more than others, learning about the impact of things such as where they live, how much money they have, and the quality of the air they breathe.
“This helps students understand that asthma isn’t just about personal choices, but also about where and how people live,” says Taylor. In this broader context, students also explore environmental justice, which includes issues like where factories and polluting facilities are located, leading to higher exposure to toxins in poorer neighborhoods, or the lack of inspections and repairs in housing, which can worsen asthma conditions for marginalized communities.
In a traditional health class, students might learn about the benefits of physical activity, including biking and walking, for individual health. They could discuss the importance of regular exercise in preventing diseases like obesity and heart disease.
Expanding the discussion to a population perspective, Taylor helps students explore how access to bike paths and sidewalks can impact a community’s overall health. They examine how neighborhoods with well-maintained infrastructure for biking and walking tend to have lower rates of obesity and higher levels of physical activity among residents — because walking is safer.
“When examining the Vineyard,” she says, “we look at ‘protective factors’ such as the walking trails. We can do a predictive model about miles of walking trails, and the places with more of these miles, relative to the population tend to be healthier, because people here are more likely to walk if they have safe places to do so.” Conversely, areas lacking these amenities may face barriers to exercise, contributing to higher rates of chronic health conditions. “So having safe places to walk and bike isn’t just good for us; it’s good for the whole community,” says Taylor. “In urban areas, issues of safety, public health, and increased physical activity are often intertwined, and sometimes, the perception of safety is strongly linked to the availability of adequate lighting, such as functioning streetlights, in addition to the presence of sidewalks.”
Students identify another protective factor for the Island, the lack of fast food, as well as risk factors, such as our dependence on a ferry or helicopter in case of medical emergencies.
By teasing out the relationship between protective and risk factors, Taylor’s students learn how they can be complex. Housing for health professionals can be a challenge — as a result, we might not have enough surgeons. A single hospital can be considered a risk factor. Yet we have a good transportation system, so people can get there when they need to.
Through Taylor’s class, students grasp that public health and social determinants of health are crucial supplements to focusing solely on individual health and behaviors. While personal choices certainly impact health outcomes, broader societal factors such as access to health care, socioeconomic status, education, and environmental conditions play significant roles in shaping overall health and well-being.
She says, “By examining these broader systemic influences, students gain a deeper understanding of the root causes of health disparities, and work toward implementing more effective and equitable health interventions and policies. This holistic approach not only improves individual health outcomes, but also promotes health equity and fosters healthier communities overall.”
Asked how students react to thinking about health in this expanded perspective, Taylor says, “For some, they come up against the question, ‘So what do I do now?’ They have always been taught, ‘If I eat right, exercise, and don’t engage in substances, I’m going to have great outcomes.’” While this is partially true, she says, “Students can be left wondering how to evaluate these as broad factors. Looking through a wider lens makes them think more critically about how we can work on those through advocacy, education, and systemic change.
“The standard curriculum ensures students understand that their social and emotional health is crucial. I feel lucky to work for a system that places an importance on health in a comprehensive way.”
