Lessons Learned From Integrating Anti-Oppression Pedagogy in a Graduate-Level Course in Epidemiology

Abstract

Despite the high burden of injury and violence globally and disproportionate burden on marginalized communities, few US schools of public health and departments of epidemiology offer classes focused on injury and violence, and even fewer are taught with an antiracist or anti-oppression framework. Recent years have brought renewed focus to incorporating antiracist and anti-oppression principles to pedagogy. Public health professionals have increasingly grappled with how we teach, conduct research, and advocate for just policies, which are shaped by interlocking systems of oppression. Although all areas of epidemiology are shaped by these structures, motivations for those who study injury and violence ought to be especially keen. In this commentary, we illustrate how anti-oppression can be integrated into course development and delivery with a case study of a graduate-level course at the University of Washington School of Public Health on injury and violence epidemiology. We include feedback from an epidemiology faculty reviewer, as well as narratives from students describing what worked and what did not. We offer our reflections and lessons learned, hoping to encourage others within public health and epidemiology to adopt an anti-oppression framework in developing classes and programs, particularly those related to injury and violence.

Editor’s note: The opinions expressed in this article are those of the authors and do not necessarily reflect the views of the American Journal of Epidemiology.

While injury and violence are among the leading causes of death globally, the burden falls disproportionately along lines of race and ethnicity, gender, sexual orientation, location, ability, and socioeconomic status resulting from historical and ongoing oppression (1, 2). Despite the high burden, most public health programs do not offer courses on injury and violence (3). Those that are offered are rarely focused on the interlocking systems of oppression that put members of marginalized groups at elevated risk of experiencing violence and injury. In addition, the lived experience of students with forms of injury and violence necessitates a trauma-informed approach (4). These 2 gaps suggest the critical importance of an anti-oppression pedagogical framework in teaching injury and violence.

In recent years, there has been increased attention to incorporating antiracism pedagogy into classroom teaching (5, 6). As educators and students change their practices and expectations in line with antiracism, including expansive anti-oppression perspectives becomes compelling. Anti-oppression pedagogy retains the focus on anti-Black racism as the root of many other systems of oppression while expanding efforts to address how other systems of oppression—such as fatphobia, xenophobia, classism, ableism, sexism, transphobia, and homophobia—contribute to inequity (7). In addition to considering how class content enables future public health professionals to address these issues, anti-oppression pedagogy attends to developing environments that foster inclusivity and student success, dismantling oppressive structures in the classroom itself (5, 8, 9).

Anti-oppression pedagogy can facilitate the training and development of researchers and practitioners attuned to inequities and possessing the skills to take meaningful action toward achieving equity (6). But cultivating anti-oppression pedagogy may be a challenge in many settings. It requires commitment to incorporating anti-oppression principles into course content (e.g., examining historical and contemporary role of oppressive structures in perpetuating disparate outcomes) as well as teaching practices (e.g., grading, structuring discussions, attendance policies). Implementation of successful antiracist or anti-oppressive pedagogy requires both formal institutional support and thoughtful investment of time and energy from the instructors involved (10). It also requires intensive sharing of resources between both instructors and institutions, including syllabi, peer and student evaluations, reading lists, and classroom activities.

With this commentary, we hope to address some of the gaps we find in this necessary sharing of resources. To illustrate how anti-oppression can be integrated into course delivery, we present a case study of a graduate-level epidemiology course at the University of Washington School of Public Health on injury and violence, developed using an anti-oppression lens for public health education (7). Lessons learned through developing and implementing this course can be applied broadly by other instructors, who may also be integrating anti-oppression principles into their courses.

COURSE DEVELOPMENT APPROACH AND STRUCTURE

We write this paper as the 2 course instructors (V.H.L., A.A.) who developed and taught the course and conduct translational and policy research on injury and violence; a doctoral candidate (J.S.) who took the course, serves on the Epidemiology Department Equity, Diversity and Inclusion committee, and designed the Department-level plan for antiracist pedagogy; and the faculty member (A.R.R.) assigned to evaluate the course for the department and whose research centrally focuses on injury and violence.

This course had been last offered in 2014. The required update presented an opportunity to reenvision the course structure, content, and assessments. Course redevelopment took place in 2021, during the second year of the coronavirus disease 2019 (COVID-19) pandemic, and the course was offered in spring 2022. The instructors’ goal for course development was to make the course as accessible as possible, focusing on equity, using a systems-level approach to discuss how to bridge research with practice and policy. Anti-oppression strategies and frameworks informed instructional choices, content delivery, classroom activities, discussion topics, and assessments to allow students to participate fully (5–9). From this, the instructors developed specific instructional priorities, including antiracism, decentralizing authority, inclusivity, interdisciplinary learning, reflexivity, student-led learning, and translation from research to practice and policy. Table 1 describes the approaches used, aligned with each priority. Prior to beginning the course, we completed a Course Development Plan (developed in part by J.S.), required by the Epidemiology Department, that included external review of the syllabus to ensure prioritization of antiracism and anti-oppression (10).

Table 1.

Instructional Approaches for Course Priorities and Feedback for the Class EPI 585 Injury and Violence: A Public Health Approach, University of Washington School of Public Health, Spring 2022

Instructional Approach	Feedback Quotations From Student Evaluations, Student Co-Author (J.S.), and Faculty Evaluator Co-Author (A.R.R.) a
Antiracism
Providing historical and current context to explain disparities	This class went beyond simply describing disparities in injury and violence. It helped students gain an appreciation for its “etiologies.” (A.R.R.)
Use of equity-focused examples and articles	They were clear from the first day that systemic racism and inequity in injury and violence would be examined and they highlighted racist and sexist systemic injustice examples every week. (Student evaluation)
Abolitionist perspective	I liked that this week critically examined the reasons and rationale behind an abolitionist framework for dealing with the public health problem of police violence…. I feel that often public health takes a “systems-approach” view while often being nested in and/or collaborating with systems of oppression … and it was refreshing to learn about this framework which I knew little about. (Student evaluation)
Generous grading policies with no late penalties	The grading was very generous which in some ways can be a positive opportunity to shift focus from checking boxes for a specific point value and invite more genuine engagement with course material but I also felt like we could have been held to a higher standard of work. (Student evaluation)
Decentralizing authority
Setting class norms collectively	Setting class norms as a group contributed to de-centralizing authority in the classroom, an important antiracist pedagogical practice. Clinicians, public health practitioners, social workers, and those who have spent years in academia all have different methods of interacting with texts, new knowledge, and one another, so bringing us together for this was very helpful. (J.S.)
Acknowledging expertise of students	Both professors did a great job of emphasizing bidirectional learning and that many people in the class were experts in this field and that we had a lot to learn from one another. (Student evaluation)
Continuous feedback and adaptation of course	This is the only class I’ve ever taken where the instructors deliberately and transparently developed curriculum and class norms using an antiracist framework so I learned a lot about what that means and can look like too. (Student evaluation)
Inclusivity
Creating a safe space	Every topic in injury and violence epi is very sensitive and they somehow managed to deliver content, methods, etc. in an academically meaningful way while also creating (and maintaining!) an environment that felt safe and appropriately sensitive to the content being discussed. (Student evaluation)
Acknowledgement of sensitive topics and encouragement to step away when needed	The instructors practiced these throughout the quarter with grace and kindness. It was clear that the students felt that the instructors truly cared for them and saw them. (A.R.R.)
No attendance requirement	Avoided penalizing students for times when we could not engage with the class meaningfully, when we felt the topic would be too emotionally draining; prioritized the work that furthered our learning rather than simply checking off a box for attending class. (J.S.)
Use of microphones for instructors/students (for virtual attendees and recording)	It was easier for me to discuss topics on zoom than in person because of my hearing. (Student evaluation)
Virtual panel days and supported virtual synchronous attendance when in person	Zoom is almost always a harder format to engage on/with than in person. So it was sometimes harder to stay as actively engaged during those sessions, but I also very much appreciated the flexibility to be able to have both options (especially as we continue to be in a pandemic and current surge). (Student evaluation)
No camera requirement for virtual sessions	Not allowing cameras on allowed students to retain privacy while attending class virtually, which can be a helpful practice for students who struggle to find a place to study or who feel unable to physically prepare themselves in a way that meets the traditional, biased academic standards of professionalism. (J.S.)
Interdisciplinary learning
Recruiting students from different schools/departments with no prerequisites	I learned a huge amount—I am not an epi person, but I felt able to keep up with the methodology and share my more policy-centric mindset. (Student evaluation)
Setting up peer feedback for assignments from students in other departments/programs	Was a great opportunity to see how people in other fields approach constructing research questions or proposing policies; I saw much more creativity of thought than I typically do in this type of exercises in other epidemiology courses, with a really exciting range of ideas and methods. (J.S.)
Reflexivity
Student power mapping and self-reflection	Power mapping! I had never been exposed to this concept prior to this class and I absolutely love it/find it so helpful as a way to think about/frame all of the systems, groups, and individuals that contribute to the work I hope to do. (Student evaluation)
Self-reflexive discussion about instructors’ own prior work	Instructors’ sharing their own prior work and demonstrating true vulnerability via highlighting its limitations was remarkably refreshing and powerful. It set a phenomenal model for the students. (A.R.R.)
Student-led learning
Allowing students to pick their final project topic and format	Allowing students to pick their own project topic and format is not unique to this course; however, the way in which the students genuinely took the ownership of their project and were so committed to its success was certainly unique to this course and a reflection of the instructional strategies used in the course throughout the quarter. (A.R.R.)
Scaffolding assignments to build toward final project with continual review and feedback	This really helped, especially toward the end of the quarter, since we all had successfully met several deadlines at that point and had received important feedback on our work. (J.S.)
Weekly schedule mix of lecture, methods, activity, and panel	The main components of the class (lectures and guest panels) worked in conjunction to provide foundational knowledge about different spaces and methods in injury research and then to invite discussions between researchers, practitioners, and students. With the panels the teaching team did a great job of moderating discussions as well as inviting student inquiries. Each week there was information shared and questions raised that I would continue to think about and have shared with others beyond the class and incorporated into my thesis work. (Student evaluation)
Translation from research to practice and policy
Systems-level focus for all discussions including risk and protective factors	This course allowed me to take a step back and look at things from a system level. For example, I normally think of transportation as just the physical aspect of accessibility (i.e., are all people able to physically access transportation) and mobility (i.e., are there enough routes for people to easily get from place to place)—but transportation incorporates so much more than that. (J.S.)
Inviting panelists from practice and policy and focusing questions on translation	I think the mix of folks from academia and those not in academic was great. I really enjoyed listening to the discussion from both parties and hearing how research can (and should) focus more on what the members who we are trying to serve need and want, and how we can focus our work towards social justice. All of the presenters were really engaged in the panel, which made the conversation much more lively. (Student evaluation)

^a Feedback was collected from weekly short reflections (i.e., what did they learn, what did they like, and questions that remain) and the final course evaluation. Specific quotations were selected to represent the breadth of student experiences and multiple perspectives, including existing critical feedback. We attempted to ensure that all themes represented in the feedback were highlighted in at least one of the quotations selected for this table, and that the range of opinions on the component of interest was fairly represented.

As this course was housed within the Epidemiology Department, one analytical method (e.g., survival analysis) was highlighted each week with a minilecture on applying that method to the week’s substantive topic to encourage applied learning. Analytical methods minilectures served as a starting point for students interested in diving deeper into methods while remaining accessible to students without a background in epidemiology. To optimize engagement, the 80-minute class sessions were split into 20- to 30-minute sections (minilectures, in-class group, or individual activities) with short breaks. Most weeks also included a panel session with academic and nonacademic guests to discuss the week’s substantive topic through curated question-and-answer session, where students were responsible for asking questions (Table 2 highlights the structure of selected weeks).

Table 2.

Selected Weekly Course Topics, Structure, and Activities for the Class EPI 585 Injury and Violence: A Public Health Approach, University of Washington School of Public Health, Updated for 2022

Week a and Topic	Session 1	Session 2
1. Introduction	Class norm setting	Systems-level thinking: “3 lists” activity to generate discussion of vast array of policy and programs to influence injury and violence (12)
	Background on field of injury and violence	Minilecture on data sources for injury and violence
	Haddon’s matrix example for students to fill out (13)
3. Police violence	Prerecorded minilecture on police violence (for students to watch ahead of class)	Panel: 1 academic faculty member, 1 researcher at a public health advocacy nonprofit
	In-class activity with small-group discussions on preassigned articles that use police recorded data or examine police violence
	Methods minilecture on surveillance data sources and bias for police violence
4. Child maltreatment	Minilecture on child maltreatment	Panel: 1 academic faculty member, 1 state policy specialist from a child maltreatment prevention think tank
	In-class activity mapping policy and systems-level approaches for preventing child maltreatment
	Minilecture on trajectory modeling for child maltreatment
6. Drowning	Minilecture on drowning and water safety	Power mapping (11) and self-reflection activity adapted from community mobilizing work to increase student awareness of using their power and relationships to push for change
	In-class large-group discussion on equitable strategies for drowning prevention	Peer feedback on draft of final paper
	Minilecture on qualitative methods applied to drowning

^a Not all weeks in the class schedule are included.

The course was well received. The final course evaluation (response proportion = 80%) had a combined median rating of 4.9 (0 = lowest, 5 = highest). The faculty evaluator ranked the course as outstanding (highest rating possible) for all areas, including scope, format, organization, learning expectations, grading approaches, instructional materials, and teaching effectiveness. Students resonated with our course development priorities, especially using an anti-oppression framework, commitment to systems-level thinking, and focus on translation to practice and policy for maximizing public health impact.

INSTRUCTIONAL APPROACHES AND LESSONS LEARNED

For each of the aforementioned instructional priorities, we utilized multiple approaches. Student and faculty reviewer feedback for each strategy, collected from weekly short reflections (i.e., what did they learn, what did they like, and questions that remain) and in the final course evaluation, are included in Table 1. Below we briefly describe our strategies and reflections for each instructional priority.

Antiracism

We provided historical and current context to understand existing racial disparities, used equity-focused examples and articles, and employed an abolitionist perspective. These approaches framed course lectures and discussions. We used generous grading policies (many credit/no credit assignments) with no late penalties as we recognized that employment, illness, disability, family, and other responsibilities sometimes interfere with schoolwork—with late penalties disproportionately impacting marginalized students. This strategy was generally well-received and helped shift student focus away from points and toward individual engagement with material, although a few students expressed a desire to be held to a higher standard for grading.

Decentralizing authority

We did collective norm setting, acknowledged expertise of students in our discussions, and employed continuous feedback for ongoing adaptation of the course. Continuous feedback was solicited through weekly short reflections and a mid-quarter evaluation, with regular reporting of results and modifications back to the class. This approach was critical given the new course format, and it allowed real-time feedback and changes.

Inclusivity

We prioritized creating a safe space for students by acknowledging sensitive topics (e.g., intimate partner violence) and giving encouragement to students to step away when needed. To that end, we did not require attendance so students could easily step away from emotionally difficult material. Students mentioned how excited they were to speak up and engage with the course, more so than several other courses. We also used a semihybrid format with 1 day a week in person, with support for synchronous Zoom virtual attendance, and 1 day a week fully virtual to support continued engagement even when students were unable to attend in person (e.g., due to COVID-19). This combination allowed flexibility and resulted in consistent attendance through the quarter, with a greater proportion of students attending virtually later in the quarter. Our virtual sessions were primarily guest panels; this format supported participation of panelists from across the country. One future priority would be providing honoraria for panelists, which would require department or university support. Some panelists—especially those outside academia—were unable to participate without honoraria. Honoraria would also support inclusion of colleagues, advocates, community leaders, and practitioners of color and from marginalized backgrounds in guest panels.

Interdisciplinary learning

Students from different schools and departments chose to enroll, supported by the lack of prerequisites (2 schools and 5 departments represented among enrolled students). This blend of student perspectives enriched discussions and strengthened peer feedback. In the future, we would work with departments to cross-list the course or count it for preapproved electives, as some students had to drop the class as it did not meet their degree requirements. We also included specific opportunities for peer feedback from students in other programs to encourage interdisciplinary discussion.

Reflexivity

To support self-reflection, we used activities like power mapping, where students conceptualized their sphere of influence through their relationships and networks to facilitate social change (11). We also led self-reflexive discussions about our own prior work to highlight growth and model critical self-reflection.

Student-led learning

Students picked their final project topic and format (research proposal or policy brief), and assignments were scaffolded through the quarter to build toward the final project, encouraging deeper engagement and emphasizing continuous learning rather than mastery. For multiple assignments, feedback came from both instructors and peers from other departments and programs. Our mix of activities and learning techniques (lectures, reflections, small- and large-group discussion, interactive question-and-answer panels) created space for students with varied backgrounds to share their expertise and contribute in different ways.

Translation from research to practice and policy

We focused discussions on systems-level approaches and prioritized inviting panelists from practice and policy organizations for our guest panels, where we then focused questions on how they used and translated research in their own work.

There were some approaches that we would not include in future offerings. To encourage student engagement, we relied most on group discussion and in-class activities, but we also had collaborative class notes and required real-time questions for panelists. Students felt strongly that we should not repeat the collaborative class notes, as students did not find value in them. We would also allow submission of questions for panelists ahead of time to reduce pressure. In some weeks, we made use of prerecorded minilectures for students to watch before class to devote class time to discussion and activities. While this strategy worked well for some students, we would use this sparingly, as many students indicated this felt burdensome alongside the readings and assignments.

CONCLUSIONS

Our course development was facilitated by departmental support for an anti-oppression approach. The University of Washington Department of Epidemiology is engaged in continuous reflection related to antiracism and anti-oppression, formalized by a course development process that involves review of syllabuses every quarter, and support from the Curriculum and Equity, Diversity, and Inclusion Committees. Without that formal commitment, as well as support from leadership, instructors, and students, the Department atmosphere might not be as conducive to this type of work. We urge others to see the efforts described here as part of a greater whole rather than an independent effort.

Even so, in reflecting on the instructional approaches, we noticed that most approaches were implemented at the classroom level. Even without changes at a department or university level, the instructors had latitude to create the desired inclusive environment, highlighting how future instructors can implement such approaches. We also acknowledge that some principles and strategies may be relatively easy to implement in any existing course, while others may require more effort. For example, practicing reflexivity and acknowledging students’ expertise were important tone-setting components of the course and could be easily incorporated in an existing course. Given the current national gap in injury and violence coursework (3), we hope our lessons learned can meaningfully inform the development of additional injury and violence prevention courses. More broadly, we hope these reflections support the adoption of anti-oppression and systems-level perspectives within existing and future courses.