The Deliberative Pedagogy (DeeP) Faculty Collaborative consists of 15 faculty from Davidson College and five other Associated Colleges of the South institutions who are committed to learning and implementing new ways to improve and deepen the quality of their class discussions. Throughout the 2021-22 academic year, these faculty, who come from a wide array of disciplines, studied and discussed different deliberative pedagogy methods, shared their ideas and questions with one another, and worked to embed deliberation in their classrooms. In this special blog series, members of the Collaborative describe and reflect on their experiences developing and teaching their deliberation-involved courses.
Public Health Ethics is a seminar now offered annually in the Davidson College Department of Public Health. The course is explicitly applied, endeavoring to make public health ethics relevant and accessible to students with an array of academic and other backgrounds and goals. It emphasizes praxis through case studies, with Davidson College undergraduates in mind, some of whom might not have experience with public health or public health ethics (a premise that was upended, sometimes in unexpected ways, by COVID-19). While future public health and health professionals comprise an important audience for the class, in many ways it is those students who pursue other paths or never take another public health class that constitute its most important audience, which is part of the reason there is no prerequisite for the course.
If the COVID-19 pandemic has taught us nothing else, it is that many incompletely understand their role and stake in public health problems. Many of us, including students, particularly at the beginning, struggle with the fact that the “right” answer or course of action in public health is rarely clear or definitive, and whatever course is chosen involves trade-offs about which people may, sometimes vehemently, disagree. It can be quite shocking to some when they realize that public health is as much about considerations of values as anything else.
The fact that potential solutions to public health problems frequently require collective and sometimes controversial action, begs for more inclusive and productive forms of public health and public health education. It also calls for increased commitment to and innovation in engaging affected communities in the development, implementation, and assessment of the effects of public health policies and other interventions. Both democratic deliberation and deliberative pedagogic theory and techniques offer possible means of advancing those aims as students grapple with these issues and others’ positions in the classroom and their communities. The Deliberative Pedagogy (DeeP) Collaborative provided a structure to consider and learn more about how I might better integrate deliberative approaches in a public health ethics seminar, a course whose subject matter and case-based approach seems well-suited.
Framing the seminar is an examination of how public health gives rise to distinct ethical issues. The ethical dilemmas related to and contentious debates about public health policy arise, in part, from key features of public health problems and the practical, conceptual, and ethical underpinnings of public health work. Public health challenges disproportionately affect marginalized and vulnerable groups and addressing them usually requires governmental action.
Public health focuses on groups, often discordant with dominant models of the causes of and solutions to ill health, particularly in biomedicine. In addition, focus on communities or populations is part of the source of the tensions that arise between individual freedoms and public health interventions. The ideal field of action in public health is often poorly understood and met with skepticism, in its emphasis on prevention (public health successes are the problems that don’t happen); upstream causes of ill health, e.g., systemic racism; and public goods about which there may not be consensus.
Emergencies like the 2014-2016 Ebola virus disease epidemic in west Africa and the COVID-19 pandemic make public health visible to those who do not routinely pay attention to it, skewing their perceptions, including those of policymakers. Yet such emergencies are, in essence, public health (as well as societal and global) failures, reflecting inadequate investment in and commitment to the core business of public health and its foundational ethical commitments, including those relating to security, good governance, solidarity, and justice.
Careful considerations of these dimensions of public health emergencies is particularly important for the current iterations of the public health ethics course, as the students themselves are living through and experiencing trauma related to a global public health emergency. This can and has both dampened and heightened some students’ ability to identify and critically analyze public health ethics issues and to engage in effective deliberation.
The central work of the public health ethics seminar involves familiarizing students with ethics concepts, theoretical approaches, and frameworks, and applying them to analysis and discussion of cases. Case topics include immigrant health, public health police powers, vaccine policy, colonialism and global health, and obesity stigma, among others. Cases are drawn and adapted from varied sources including:
- H. Barrett D, W. Ortmann L, Dawson A, Saenz C, Reis A, Bolan G, editors. Public Health Ethics: Cases Spanning the Globe [Internet]. Cham (CH): Springer; 2016. PMID: 28590613. (Open access)
- Educational materials from The Presidential Commission for the Study of Bioethical Issues (Bioethics Commission), an advisory body to President Barack Obama, where I served as Associate Director. My experience at the Bioethics Commission, and in particular my role in their work on the 2014-2016 west African Ebola virus disease epidemic, was part of the impetus for me to participate in the DeeP Collaborative.
- The Columbia University Case Consortium
- Cases from the American Medical Association Journal of Ethics
Students participated in discussions of all cases and led two, in pairs. They had considerable latitude in how they facilitated case studies and were encouraged to be creative and incorporate deliberative and other techniques, e.g., role playing. While the questions didn’t have to take this form, they were asked to incorporate these domains:
- What is your gut reaction to the case?
- Who are the stakeholders in this scenario?
- What are their interests? What do they have at stake? How is the issue perceived from different perspectives?
- What are the relevant facts/information?
- What facts/information are unknown? Why are they unknown?
- What ethical concerns or issues are raised by this scenario?
- What ethical issues are in tension?
- What options are possible in this scenario?
- What ethical concepts, tools, or frameworks are useful to help analyze the scenario?
I view the integration of deliberative pedagogy and the discussions from the DeeP Collaborative to be a work in progress, with initial steps and lessons learned as part of the Spring 2022 public health ethics course. Both the democratic deliberation and deliberative pedagogy materials, such as those that described public deliberative processes relating to COVID-19 policies (e.g., Scherer, Maya MPH; Kamler, Alexandra MPH; Weiss, Linda PhD; Blacksher, Erika PhD; Jeavons, Jessica JD, MA; Gold, Marthe R. MD, MPH Using Public Deliberation to Set Priorities: The Case of COVID-19 Vaccine Access in New York City, Journal of Public Health Management and Practice: January/February 2022 – Volume 28 – Issue 1 – p 86-94) were resonant for some students, reflected in their contributions to class discussions and their choice to write about deliberation as part of short writing assignments.
Consistent with class themes, students were particularly interested in how to meaningfully include voices less likely to be highlighted in deliberative processes and the potential role of democratic deliberation in transparency, accountability, and trust, important concepts in public health ethics. We discussed how democratic deliberation and other public engagement processes can both foster and undermine trust, depending on how they are conducted, who they include, and how they relate to public health policies and action.
The integration of deliberative approaches in student-led cases studies was incomplete. In large part, this was a result of too much material including too many cases, exacerbated by a COVID-19 shortened semester. In general, it takes time for students to become comfortable with discussing and even more so leading cases, which includes integrating initially unfamiliar and complex ethics theories, concepts, and tools as well as public health topics and methods new to them. Classes cohere in different ways, and I was impressed with how case presentation and discussion improved over time, and the deliberative material likely contributed to this in subtle ways.
I plan to take some time to reflect on how to better highlight the deliberative material and make it more explicit in case discussions in the future. I am going to reduce the number of cases and include more structured role-playing exercises focusing on deliberation. I am appreciative most of all for the opportunity the DeeP Collaborative provided to engage with colleagues from different disciplines at Davidson College and other institutions, whose insights and experiences will undoubtedly enrich my pedagogy for years to come.