Investigating STEM: Health Equity as Touchstone for the Future

Cheryl Holzmeyer

Sometime over the past decade or so, a new acronym began permeating public discourse, lumping together fields from marine biology to nuclear engineering to kinesiology to topology: “STEM,” shorthand for Science, Technology, Engineering, Mathematics. Appearing especially in federal reports and policy discussions of global economic competition, commentators argued that so-called STEM education and STEM fields held the key to future U.S. prosperity. These arguments sprang up everywhere from the business press to reports by the National Academies.[1] California’s Department of Education frames STEM in similar terms, declaring that “Through STEM education, students learn to become problem solvers, innovators, creators, and collaborators and go on to fill the critical pipeline of engineers, scientists, and innovators so essential to the future of California and the nation.”[2]

But as Rodger Bybee asks in his book, The Case for STEM Education, published by the National Science Teachers Association: “If STEM Education Seems to be the Answer, What Was the Question?”[3]

For many industry stakeholders, the primary importance of STEM education is to ensure an adequate number of qualified workers in their particular economic sectors, to foster growth and global competitiveness. Absent such supply of human capital, the logic goes, these stakeholders see a U.S. “STEM crisis” of a particular kind, even while the existence and character of this purported STEM crisis is debated.[4]

Yet these narratives of STEM education are inadequate to address growing crises of social equity, ecological sustainability, and democracy associated with current paradigms of U.S. economic growth. As an article in PLOS Biology recently put it, “Justifying STEM education through the economic imperative demands a consideration of what the limitations of this imperative might be. The purported relationship between STEM education and economic growth rests upon the questionable assumption that economic development has no ecological costs or that those costs can be eliminated through continued GDP growth….”[5] Moreover, current paradigms of economic growth exacerbate social inequalities and environmental injustices, undermining possibilities for a truly flourishing society that supports everyone’s well-being. Merely increasing the number of students and workers prepared to fill “gaps in the STEM pipeline” will not address these more fundamental, structural issues.

These issues tend to be obscured by the supposed coherency of the STEM acronym, however. Contradictions often manifest across STEM fields—such as petroleum engineering, climate science, and public health—belying monolithic framings of STEM. Different STEM fields often involve disparate definitions and approaches to innovation as well, with new social justice challenges looming as automation and artificial intelligence gain ground, even as A.I. is viewed by some STEM advocates as a holy grail.[6] Yet as President Obama reflected on the future, at the end of his term in office:

What I do concern myself with, and the Democratic Party is going to have to concern itself with, is the fact that the confluence of globalization and technology is making the gap between rich and poor, the mismatch in power between capital and labor, greater all the time. And that’s true globally. The prescription that some offer, which is stop trade, reduce global integration, I don’t think is going to work…. If that’s not going to work, then we’re going to have to redesign the social compact in some fairly fundamental ways over the next twenty years…. [A]t some point, when the problem is not just Uber but driverless Uber, when radiologists are losing their jobs to A.I., then we’re going to have to figure out how do we maintain a cohesive society and a cohesive democracy in which productivity and wealth generation are not automatically linked to how many hours you put in, where the links between production and distribution are broken, in some sense. Because I can sit in my office, do a bunch of stuff, send it out over the Internet, and suddenly I just made a couple of million bucks, and the person who’s looking after my kid while I’m doing that has no leverage to get paid more than ten bucks an hour.[7]

In California, campaigns such as Silicon Valley Rising, affiliated with Working Partnerships USA, are already grappling with these social contradictions of innovation, as analyzed in their reports on contract workers,[8] by “taking on occupational segregation and severe income inequality with a comprehensive campaign to raise wages, create affordable housing and build a tech economy that works for everyone.”[9] STEM education oriented toward health equity could dialogue with such reports and organizing work, as well as with books like De-Bug: Voices from the Underside of Silicon Valley,[10] authored by members of the San Jose-based social justice organization, Silicon Valley De-Bug.

STEM education could also engage with public health research shaped by problem-frames and evidence from both credentialed scientists as well as community-based “street science.”[11] Silicon Valley De-Bug, for example, frames community organizing as a kind of science – a science for building community power, whether to mitigate power inequities in the criminal justice system or to fight displacement and gentrification. Through such STEM education, students would not only have opportunities to assess a wider array of evidence and evidentiary standards in the course of their inquiries; they could also pursue a broader range of questions about STEM fields and social values, the politics of research agenda-setting and policy-making, and the social relations and economic development paradigms toward which STEM fields are – and are not – directed.[12] Many engaged with the April 2017 Marches for Science articulated inspiring visions along these lines.[13]

Health Equity as Touchstone for Innovation and STEM Education

While Silicon Valley symbolizes the end of the metaphorical STEM pipeline for many, in California and beyond an array of organizations and a burgeoning body of research offer a touchstone for STEM education that is innovative on different terms: on behalf of health equity. Health equity emphasizes social justice and “attainment of the highest level of health for all people” as the foundation of a flourishing society, in which all people are valued equally.[14] As the American Public Health Association elaborates, achieving health equity entails that, “We optimize the conditions in which people are born, grow, live, work, learn and age. We work with other sectors to address the factors that influence health, including employment, housing, education, health care, public safety and food access. We name racism as a force in determining how these social determinants are distributed.”[15] Health equity initiatives strive to end the unnecessary, unjust suffering of so many people—particularly people of color and of low-income—experiencing premature death and illness in a country and state with vast economic and scientific resources. Health equity initiatives do not subscribe to a false binary between values—such as equity and social justice—and science. Rather, they draw on an extensive body of STEM research—variously referred to as social epidemiology or social determinants of health research—that examines population health and health inequities, with wide-ranging ethical implications. While this research is well-known within the public health field, it is too often unfamiliar to those in other fields of STEM research and education, from biotechnology to computer science. At the same time, the insights and causal relations surfaced by this body of research are often highly familiar to environmental justice activists, who have long been attuned to the ways in which the places and circumstances in which people “live, work, learn, and play” underpin public health and health equity.

In brief, social determinants of health are the resources and opportunities available to people in their daily lives, which in turn affect their health and well-being. Good jobs that pay a living wage, affordable housing, clean air and water, freedom from racism and discrimination – these variables are most important to promoting health and health equity for all, as demonstrated by a plethora of social epidemiology and social determinants of health research. The Director-General of the World Health Organization’s Commission on Social Determinants of Health, Dr. Margaret Chan, noted at the release of the commission’s 2008 final report (“Closing the gap in a generation: Health equity through action on the social determinants of health”): “This ends the debate decisively. Health care is an important determinant of health. Lifestyles are important determinants of health. But… it is factors in the social environment that determine access to health services and influence lifestyle choices in the first place.”[16] Recognizing these upstream, root causes of health inequities, the report called for “improv[ing] daily living conditions” and “tackl[ing] the inequitable distribution of power, money, and resources” as integral, necessary, and urgent to achieving greater health equity, in the U.S. and beyond. An array of multidisciplinary research syntheses complement and reinforce these conclusions.[17]

Environmental justice and health equity organizations have deep expertise and familiarity with these issues, whether explicitly or implicitly engaged with social determinants of health research. California-based organizations and coalitions[18] collectively offer a crucial touchstone to orient STEM fields toward the type of innovative economy that all Californians, and people everywhere, deserve.

These reference points are all the more valuable given the challenges of responding to climate change and the relevance of environmental justice organizations and social determinants of health research in doing so. Extreme heat, drought, declining air quality, more frequent wildfires, and other environmental and economic upheavals tied to climate change are all impacting and poised to further impact public health and health equity for Californians. As environmental justice advocates and social determinants of health research demonstrate, it is vital to not only reduce greenhouse gas emissions to prevent additional climate change, but also to contest and mitigate communities’ unequal access to resources and vulnerabilities in the face of climate change—to close the “climate gap”[19] and work toward just transitions away from fossil fuel dependency and toward green job creation.[20] Accordingly, California’s Climate Change and Health Equity Program observes:

Climate change and health inequities share similar root causes: the inequitable distribution of social, political, and economic power. These power imbalances result in systems (economic, transportation, land use, etc.) and conditions that drive both health inequities and greenhouse gas (GHG) emissions. As a result, we see communities with inequitable living conditions, such as low-income communities of color living in more polluted areas, facing climate change impacts that compound and exacerbate existing vulnerabilities. Fair and healthy climate action requires addressing the inequities that create and intensify community vulnerabilities, through strategically directing extra investments in improving living conditions for and with people facing disadvantage.”[21]

However, even as many concerned with STEM fields decry U.S. students’ rankings on standardized math and science tests compared with students in Finland or Japan, and sound alarm bells about global economic competition, these STEM discussions tend not to simultaneously highlight the U.S.’s global outlier status as a wealthy country with high levels of poverty, preventable morbidity, infant mortality, and health inequities. This is an underappreciated STEM crisis—a failure of economic and political decision-makers to learn from and act on social determinants of health research. As elaborated in a 2013 report from the National Research Council and Institute of Medicine, while the U.S. is among the wealthiest countries in the world, it is far from the healthiest. Indeed, the report—the first comprehensive comparison of the U.S. and 16 peer countries in terms of multiple diseases, injuries, and behaviors across the life span—found that the U.S. is “at or near the bottom in nine key areas of health: infant mortality and low birth weight; injuries and homicides; teenage pregnancies and sexually transmitted infections; prevalence of HIV and AIDS; drug-related deaths; obesity and diabetes; heart disease; chronic lung disease; and disability.”[22] The report ultimately argued that, “Without action to reverse current trends, the health of Americans will probably continue to fall behind that of people in other high-income countries. The tragedy is not that the United States is losing a contest with other countries but that Americans are dying and suffering from illness and injury at rates that are demonstrably unnecessary.” More specifically, other researchers have noted that, “[U.S.] public investments in broad, cross-sectoral efforts to minimize the potential effect of such foundational drivers of poor health as poverty and racial residential segregation are pitifully few in comparison with those of other countries.”[23] Health equity is an innovative touchstone for STEM education in part because, despite pertaining population patterns of well-being, life, and death, social determinants of health research is not widely familiar in the U.S. or in California, nor have these been at the forefront of advocacy for STEM education and science literacy.

If STEM Education Seems to be the Answer, What Was the Question?

Attention to health equity and social determinants of health research suggests the need to reframe conventional STEM education narratives, with an eye to the kinds of economic growth that serve equitable prosperity, ecological sustainability, and democracy. Such a reframing, centered on social determinants of health and the crucial intersections of race, class, and place, is also needed to achieve existing STEM education goals, from closing achievement gaps to supporting underrepresented students in STEM fields. As one STEM education analyst commented on the “Sisyphean Task” of STEM equity and diversity, “While educators continue to do their part to improve the K-16 STEM learning and teaching environment, our efforts may be out-weighed by inaction or counter-productive conditions in other domains.”[24] Yet another possibility is that these efforts may be aided by action in other domains,[25] especially action by researchers, public health professionals, and activists working to promote health equity and environmental justice through multi-sectoral, system-oriented problem-solving.

In this era of proliferating assertions about STEM fields as sources of prosperity and problem solving, it is crucial to question what is meant by “STEM.” How does the public health field fit into the STEM landscape, particularly amid California’s combination of enormous wealth juxtaposed with deep health inequities? How might research on social determinants of health and health inequities reshape this landscape? How could all California STEM stakeholders contribute to the vision embodied in the California Office of Health Equity’s recent report to the California State Legislature?[26] Conversely, how might some STEM discussions obscure rather than illuminate key puzzles of social prosperity and innovation—even or perhaps especially while flying the banners of curiosity, inquiry, innovation, disruption, and challenging the status quo? What is missed when challenges are framed as grand, global and national—rather than regional, or attuned to particular zip codes and neighborhoods? How do the questions asked, and not asked, shape the possible answers—the ways people puzzle through and piece together worlds? California’s vibrant environmental justice and health equity communities offer cogent and inspiring starting points for future STEM inquiries.

Notes

• Thank you to the editors and anonymous peer reviewers at Boom for their helpful comments on an earlier draft of this article.

[1] Committee on Prospering in the Global Economy of the 21^st Century: An Agenda for American Science and Technology, Rising Above the Gathering Storm: Energizing and Employing America for a Better Future (Washington, D.C.: National Academies Press, 2007), http://www.nap.edu/catalog/11463/rising-above-the-gathering-storm-energizing-and-employing-america-for; Members of 2005 “Rising Above the Gathering Storm” Committee, Rising Above the Gathering Storm, Revisited: Rapidly Approaching Category 5 (Washington, D.C.: National Academies Press, 2010), http://www.nap.edu/catalog/12999/rising-above-the-gathering-storm-revisited-rapidly-approaching-category-5.

[2] http://www.cde.ca.gov/pd/ca/sc/stemintrod.asp.

[3] Rodger Bybee, The Case for STEM Education: Challenges and Opportunities (Arlington, VA: National Science Teachers Association, 2013).

[4] Michael Teitelbaum, Falling Behind? Boom, Bust, and the Global Race for Scientific Talent (Princeton: Princeton University Press, 2014); Yi Xue and Richard C. Larson, “STEM crisis or STEM surplus? Yes and yes,” Monthly Labor Review, U.S. Bureau of Labor Statistics, May 2015, https://www.bls.gov/opub/mlr/2015/article/stem-crisis-or-stem-surplus-yes-and-yes.htm.

[5] Brian M. Donovan, David Moreno Mateos, Jonathan F. Osborne, Daniel J. Bisaccio, “Revising the Economic Imperative for US STEM Education.” PLOS Biology 12 (2014): 3, http://journals.plos.org/plosbiology/article?id=10.1371/journal.pbio.1001760.

[6] Lance Ulanoff, “Bill Gates: AI is the Holy Grail,” Mashable, 1 June 2016,

http://mashable.com/2016/06/01/bill-gates-ai-code-conference/#oogN_u01Jmqw.

[7] David Remnick, “Obama Reckons With a Trump Presidency,” 28 November 2016, http://www.newyorker.com/magazine/2016/11/28/obama-reckons-with-a-trump-presidency.

[8] Connie M. Razza and Louise Auerhahn, “A Hidden Crisis: Underemployment in Silicon Valley’s Hourly Workforce,” The Center for Popular Democracy & Working Partnerships USA, April 2016, http://www.wpusa.org/Publication/A_Hidden_Crisis.pdf; “Tech’s Diversity Problem: More Than Meets the Eye,” Working Partnerships USA, 2014, http://wpusa.org/Publication/Tech_Diversity_Report_2014.pdf.

[9] http://siliconvalleyrising.org/.

[10] Raj Jayadev and Jean Melesaine, De-Bug: Voices from the Underside of Silicon Valley, (Berkeley: Heyday Books, 2016).

[11] Jason Corburn, Street Science: Community Knowledge and Environmental Health Justice, (Cambridge, MA: The MIT Press, 2005); Jason Corburn, Toward the Healthy City: People, Places, and the Politics of Urban Planning (Cambridge, MA: The MIT Press, 2009).

[12] Brian Martin, “Strategies for Alternative Science,” in Scott Frickel and Kelly Moore, eds., The New Political Sociology of Science: Institutions, Networks, and Power (Madison, WI: University of Wisconsin Press, 2006): 272-98, http://www.bmartin.cc/pubs/06Frickel.html.

[13] Indigenous scientists, agency professionals, tribal professionals, educators, traditional practitioners, family, youth, elders and allies from Indigenous communities and homelands all over the living Earth, “Let Our Indigenous Voices Be Heard,” Indigenous Science March for Science Letter of Support, https://sites.google.com/view/indigenous-science-letter;

Science for the People editorial team, “Which Way for Science?” 18 April 2017, https://scienceforthepeople.org/2017/04/18/which-way-for-science/.

[14] Healthy People 2020: https://www.healthypeople.gov/2020/about/foundation-health-measures/Disparities.

[15] American Public Health Association on Health Equity: https://www.apha.org/topics-and-issues/health-equity.

[16] Margaret Chan, “Launch of the final report of the Commission on Social Determinants of Health,” World Health Organization, 28 August 2008, http://www.who.int/dg/speeches/2008/20080828/en/.

[17] These research syntheses include: Jack P. Shonkoff and Deborah A. Philips, From Neurons to Neighborhoods: The Science of Early Childhood Development (Washington, D.C.: National Academies Press, 2000), http://www.nap.edu/catalog/9824/from-neurons-to-neighborhoods-the-science-of-early-childhood-development; Nancy Krieger, Epidemiology and The People’s Health: Theory and Context (Oxford: Oxford University Press, 2013); Kate Pickett and Richard Wilkinson, The Spirit Level: Why Greater Equality Makes Societies Stronger, 2d edition (London: Bloomsbury, 2011); and research into the life-long ramifications of Adverse Childhood Experiences (or ACEs), e.g.: https://www.samhsa.gov/capt/practicing-effective-prevention/prevention-behavioral-health/adverse-childhood-experiences.

[18] For example, California Environmental Justice Coalition: https://cejcoalition.org/; Communities for a Better Environment: http://cbecal.org/; Greenaction for Health & Environmental Justice: http://greenaction.org/; the Center on Race, Poverty & the Environment: http://www.crpe-ej.org/; Public Health Awakened: http://publichealthawakened.com/; among many others.

[19] Rachel Morello-Frosch, Manuel Pastor, Jim Sadd, and Seth Shonkoff, “The Climate Gap: Inequalities in How Climate Change Hurts Americans & How to Close the Gap,” 2009, https://dornsife.usc.edu/pere/climategap/.

[20] See Our Power Campaign: http://www.ourpowercampaign.org/about.

[21] California Climate Change and Health Equity Program: https://www.cdph.ca.gov/Programs/OHE/Pages/CCHEP.aspx, emphasis in original.

[22] Steven H. Woolf and Laudan Aron, eds. U.S. Health in International Perspective: Shorter Lives, Poorer Health (Washington, D.C.: National Academies Press, 2013): http://www.nap.edu/catalog/13497/us-health-in-international-perspective-shorter-lives-poorer-health.

[23] Ronald Bayer and Sandro Galea, “Public Health in the Precision-Medicine Era,” The New England Journal of Medicine, 2015 Aug 6;373(6):499-501, https://www.ncbi.nlm.nih.gov/pubmed/26244305.

[24] Douglas Haller, “STEM Equity & Diversity: A Sisyphean Task,” Huffington Post, 22 September 2013, http://www.huffingtonpost.com/douglas-haller/stem-equity-diversity-a-s_b_3634985.html.

[25] Emily Zimmerman and Steven H. Woolf, “Understanding the Relationship Between Education and Health,” Institute of Medicine Discussion Paper, 2014, https://pdfs.semanticscholar.org/e009/90cdb938751c718d74934ff1d3d8fad907a1.pdf.

[26] California Department of Public Health Office of Health Equity’s Report to the Legislature and the People of California, “Portrait of Promise: The California Statewide Plan to Promote Health and Mental Health Equity,” August 2015, http://www.cdph.ca.gov/programs/Documents/CDPHOHEDisparityReportAug2015.pdf.

 

Cheryl Holzmeyer lives in the San Francisco Bay Area and is a postdoctoral fellow with the Fair Tech Collective at Drexel University. She conducts research and outreach for Air Watch Bay Area, a project focused on frontline community monitoring of air pollution from regional oil refineries. She completed her sociology Ph.D. at UC Berkeley and has taught courses on “Science, Technology, and Environmental Justice” at Stanford.

 

Copyright: © 2017 Cheryl Holzmeyer. This is an open-access article distributed under the terms of the Creative Commons Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/