Population Thinking Instruction in High Schools: a Public Health Intervention with Triple Benefits

  • Emily M. D’Agostino
  • Nicholas Freudenberg


America faces a series of intersecting problems that relate to health inequities, failing schools, and an inadequate science, technology, engineering, and math (STEM) workforce, particularly in cities and among low-income Black and Latino youth. Here, we propose a solution, namely reforming secondary school education to include mandatory exposure to population thinking instruction to address these overlapping issues. Public health education has expanded in recent decades in undergraduate education, though it has yet to become an integral component of high school curricula. In this paper, we make the case that all youth should gain exposure to the skills of population thinking through public health education initiated in high school. We further provide a rationale for this approach drawn from multiple youth development frameworks and the community schools movement for honing youth critical thinking skills and problem solving relating to individual and community health, policy, and activism.


Activism Critical thinking Community schools Education Empowerment Epidemiology Health disparities Participatory action research Public health STEM Youth 



Science, technology, engineering, and math



  1. 1.
    Fine PEM, Goldacre BM, Haines A. Epidemiology—a science for the people. Lancet. 2013;381(9874):1249–52.CrossRefGoogle Scholar
  2. 2.
    Bracken MB. Epidemiology as a liberal art: from graduate school to middle school, an unfulfilled agenda. Ann Epidemiol. 2014;24(3):171–3.CrossRefGoogle Scholar
  3. 3.
    Hollm-Delgado MG. Educating epidemiologists throughout the life course: moving from conversation to action. Ann Epidemiol. 2014;24(3):169–70.CrossRefGoogle Scholar
  4. 4.
    Keyes KM, Galea S. Current practices in teaching introductory epidemiology: how we got here, where to go. Am J Epidemiol. 2014;180(7):661–8.CrossRefGoogle Scholar
  5. 5.
    Hlaing WM. Regarding “educating epidemiologists”. Ann Epidemiol. 2014;24(7):558–9.CrossRefGoogle Scholar
  6. 6.
    St. George DMM, Chukhina M, Kaelin MA. Training teachers to teach epidemiology in middle and high schools. Int Q Community Health Educ. 2017;38(1):65–9.CrossRefGoogle Scholar
  7. 7.
    Cordell RL, Cordeira KL, Cohen LP, Bensyl DM. Building the pipeline: programs to introduce middle school, high school, medical, and veterinary students to careers in epidemiology and public health. Ann Epidemiol. 2017;27(11):752–5.CrossRefGoogle Scholar
  8. 8.
    D’Agostino EM. Public health education: teaching epidemiology in high school classrooms. Am J Public Health. 2018;108(3):324–8.CrossRefGoogle Scholar
  9. 9.
    Balfanz R, Legters N (2004) Locating the dropout crisis. Which high schools produce the nation’s dropouts? Where are they located? Who attends them? Center for Research on the Education of Students Placed at Risk. (Report 70)Google Scholar
  10. 10.
    Museus SD, Palmer RT, Davis RJ, Maramba D (2011) Factors in K–12 education that influence the success of racial and ethnic minority students in the STEM circuit. In: Racial and ethnic minority student success in STEM education: ASHE higher education report. Vol 36(6). New Jersey: John Wiley & Sons; 27–52.
  11. 11.
    Kiviniemi MT, Mackenzie SL. Framing undergraduate public health education as liberal education: who are we training our students to be and how do we do that? Front Public Health. 2017;5(9):1–5.Google Scholar
  12. 12.
    Tsui E, Bylander K, Cho M, Maybank A, Freudenberg N. Engaging youth in food activism in New York City: lessons learned from a youth organization, health department, and university partnership. J Urban Health. 2012;89(5):809–27.CrossRefGoogle Scholar
  13. 13.
    Fraser DW. Epidemiology as a liberal art. N Engl J Med. 1987;316:309–14.CrossRefGoogle Scholar
  14. 14.
    Bass SB, Guttmacher S, Nezami E. Who will keep the public healthy? The case for undergraduate public health education: a review of three programs. J Public Health Manag Pract. 2008;14(1):6–14.CrossRefGoogle Scholar
  15. 15.
    Fischer K, Glenn D (2009) 5 college majors on the rise. Chron High Educ August 31. Accessed 28 May 2019.
  16. 16.
    Leider JP, Castrucci BC, Plepys CM, Blakely C, Burke E, Sprague JB. On academics: characterizing the growth of the undergraduate public health major: US, 1992–2012. Public Health Rep. 2015;130(1):104–13.CrossRefGoogle Scholar
  17. 17.
    Association of Schools and Programs of Public Health. Data center: the source for public health education data. Updated 2018. Accessed November 29, 2018.
  18. 18.
    Marantz PR. Epidemiology 101: toward an educated citizenry. Am J Prev Med. 2008;35(3):264–8.CrossRefGoogle Scholar
  19. 19.
    Stroup DF, Thacker SB. Epidemiology and education: using public health for teaching mathematics and science. Public Health Rep. 2007;122(3):283–91.CrossRefGoogle Scholar
  20. 20.
    Wallerstein NB, Duran B. Using community-based participatory research to address health disparities. Health Promot Pract. 2006;7(3):312–23.CrossRefGoogle Scholar
  21. 21.
    Arcidiacono P, Aucejo EM, Hotz VJ. University differences in the graduation of minorities in STEM fields: evidence from California. Am Econ Rev. 2016;106(3):525–62.CrossRefGoogle Scholar
  22. 22.
    Hurtado S, Newman CB, Tran MC, Chang MJ. Improving the rate of success for underrepresented racial minorities in STEM fields: insights from a national project. New Dir Inst Res. 2010;(148):5–15.Google Scholar
  23. 23.
    Xu YJ. Gender disparity in STEM disciplines: a study of faculty attrition and turnover intentions. Res High Educ. 2008;49(7):607–24.CrossRefGoogle Scholar
  24. 24.
    Jackson DL, Starobin SS, Laanan FS. The shared experiences: facilitating successful transfer of women and underrepresented minorities in STEM fields. N Dir High Educ. 2013;(162):69–76.Google Scholar
  25. 25.
    Freire P. Education for critical consciousness, vol. 1. London: Bloomsbury Publishing; 1973.Google Scholar
  26. 26.
    Delp L, Brown M, Domenzain A. Fostering youth leadership to address workplace and community environmental health issues: a university-school-community partnership. Health Promot Pract. 2005;6(3):270–85.CrossRefGoogle Scholar
  27. 27.
    Flicker S, Maley O, Ridgley A, Biscope S, Lombardo C, Skinner HA. E-PAR: using technology and participatory action research to engage youth in health promotion. Action Res. 2008;6(3):285–303.CrossRefGoogle Scholar
  28. 28.
    Wang CC. Youth participation in photovoice as a strategy for community change. J Community Pract. 2006;14(2):147–61.CrossRefGoogle Scholar
  29. 29.
    Strack RW, Magill C, McDonagh K. Engaging youth through photovoice. Health Promot Pract. 2004;5(1):49–58.CrossRefGoogle Scholar
  30. 30.
    Cole AG. Expanding the field: revisiting environmental education principles through multidisciplinary frameworks. J Environ Educ. 2007;38(2):35–45.CrossRefGoogle Scholar
  31. 31.
    Gavin LE, Catalano RF, Markham CM. Positive youth development as a strategy to promote adolescent sexual and reproductive health. J Adolesc Health. 2010;46(3):S1–6.CrossRefGoogle Scholar
  32. 32.
    Shaman J, Knowlton K. The need for climate and health education. Am J Public Health. 2018;108:S66–7.CrossRefGoogle Scholar
  33. 33.
    Phelan JC, Link BG, Tehranifar P. Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. J Health Soc Behav. 2010;51(1_suppl):S28–40.CrossRefGoogle Scholar
  34. 34.
    Frohlich KL, Potvin L. Transcending the known in public health practice: the inequality paradox: the population approach and vulnerable populations. Am J Public Health. 2008;98(2):216–21.CrossRefGoogle Scholar
  35. 35.
    English PB, Richardson MJ, Garzón-Galvis C. From crowdsourcing to extreme citizen science: participatory research for environmental health. Ann Rev Public Health. 2018;39:335–50.CrossRefGoogle Scholar
  36. 36.
    Coburn J, editor. Street science: community knowledge and environmental health justice. Cambridge: MIT Press; 2005.Google Scholar
  37. 37.
    Ballard HL, Dixon CG, Harris EM. Youth-focused citizen science: examining the role of environmental science learning and agency for conservation. Biol Conserv. 2017;208:65):75.Google Scholar
  38. 38.
    National Research Council, editor. A framework for K-12 science education: practices, crosscutting concepts, and core ideas. Washington, DC: The National Academies Press; 2012.Google Scholar
  39. 39.
    National Research Council (2013) Appendix F: science and engineering practices in the NGSS. In: The next generation science standards: For states, by states. Washington, DC: National Academies PressGoogle Scholar
  40. 40.
    Wallerstein N, Bernstein E. Empowerment education: Freire’s ideas adapted to health education. Health Educ Behav. 1988;15(4):379–94.Google Scholar
  41. 41.
    Novak JD. Meaningful learning: the essential factor for conceptual change in limited or inappropriate propositional hierarchies leading to empowerment of learners. Sci Educ. 2002;86(4):548–71.CrossRefGoogle Scholar
  42. 42.
    Ritchhart R, Church M, Morrison K. Making thinking visible. Hoboken: Jossey-Bass; 2011.Google Scholar
  43. 43.
    Duckworth E. The having of wonderful ideas and other essays on teaching and learning. New York: Teachers College Press; 1996.Google Scholar
  44. 44.
    Diamond C, Freudenberg N. Community schools: a public health opportunity to reverse urban cycles of disadvantage. J Urban Health. 2016;93(6):923–39.CrossRefGoogle Scholar
  45. 45.
    Harkavy I. Engaging urban universities as anchor institutions for health equity. Am J Public Health. 2016;106(12):2155–7.CrossRefGoogle Scholar
  46. 46.
    Jackson MJ, Helms MM. Student perceptions of hybrid courses: measuring and interpreting quality. J Educ Bus. 2008;84(1):7–12.CrossRefGoogle Scholar
  47. 47.
    Pellegrino JW (2006) Rethinking and redesigning curriculum, instruction and assessment: what contemporary research and theory suggests. Commission on the Skills of the American Workforce, Chicago. 1–15. Accessed 28 May 2019.
  48. 48.
    Riga F, Winterbottom M, Harris E, Newby L (2017) Inquiry-based science education. In: K. S. Taber & B. Akpan, ed. Science education: an international course companion. The Netherlands: Sense Publishers; 247–261.Google Scholar
  49. 49.
    Marmot M. Post-truth and science. The Lancet. 2017;389(10068):497–8.Google Scholar

Copyright information

© The New York Academy of Medicine 2019

Authors and Affiliations

  1. 1.Family Medicine and Community Health DepartmentDuke Univeristy School of MedicineDurhamUSA
  2. 2.City University of New York School of Public Health and Health PolicyNew YorkUSA

Personalised recommendations