Conceptualizing Social Ecological Model in Pharmacy to Address Racism as a Social Determinant of Health

Abstract

Racism has been declared a public health crisis. The Coronavirus Disease 2019 pandemic has highlighted inequities in the U.S. health care system and presents unique opportunities for the pharmacy academy to evaluate the training of student pharmacists to address social determinants of health amongst racial and ethnic minorities. The social ecological model, consisting of five levels of intervention (individual, interpersonal, organizational, community, and public policy), has been effectively utilized in public health practice to influence behavior change that positively impacts health outcomes. This Commentary adapted the social ecological model and proposed a framework with five intervention levels for integrating racism as a social determinant of health into pharmacy curriculum. The proposed corresponding levels of intervention for pharmacy education are the curricular, interprofessional, institutional, community, and accreditation levels. Other health professions such as dentistry, medicine, and nursing can easily adopt this framework for teaching racism and social determinants of health within their respective curricula.

Baseline Assessment of Systemic Racism Education in Pharmacy Curricula

“…Recently, several active frameworks and pedagogical approaches have been proposed which recommend ways to interweave health equity and anti-racism education across the curriculum. [35][36][37] Many of these models show that curricular mapping and longitudinal integration must play a vital role to ensure proper addition and sufficient education on antiracism and health disparities in the curriculum. One proposed framework suggests an innovative five level strategy consisting of curricular, interprofessional, institutional, community, and accreditation interventions.…”

“…More specific proposed approaches include curricular integration of structural racism as a root cause of health disparities, collaboration with community policy and law makers, adoption of institutional missions directed towards social injustice, and revision of accreditation standards for pharmacy education to include structural racism. 35 Another model suggests a stepwise five phase approach by first assessing awareness through inventory measures (Phase 1), followed by elective course offerings (Phase 2), and then mandatory coursework (Phase 3). After students are exposed to initial anti-racism education, the next phase consists of curricular integration in a longitudinal manner with repeated exposure (Phase 4).…”

Student pharmacists' perspectives on health equity following a co‐curricular activity

“…While using service learning and co‐curricular activities to foster social responsibility is commendable and important, there is growing sentiment that addressing health disparities requires more than awareness of these issues. Instead, students need to be prepared to actively engage in dismantling the structures that underpin these inequities 17‐19 . Along this line, as faculty, we were somewhat disappointed in the shallowness of some reflections.…”

“…Instead, students need to be prepared to actively engage in dismantling the structures that underpin these inequities. [17][18][19] Along this line, as faculty, we were somewhat disappointed in the shallowness of some reflections. Despite the robust interprofessional nature and target population of the HCEF, some reflections lacked critical appraisal on health equity and the SDoH.…”

Exploring the Nature of Diversity Dishonesty within Predominantly White Schools of Medicine, Pharmacy, and Public Health at the Most Highly Selective and Highly Ranked U.S. Universities

“…Redlining in healthcare encompasses spatial disparities in access to services and structural barriers that impede equitable representation and participation in healthcare professions. Addressing these multifaceted challenges requires comprehensive strategies that dismantle systemic inequities and foster inclusive environments within healthcare delivery and educational institutions (Kayingo et al 2022;Rodríguez et al 2022;Nonyel et al 2021).…”