How Racism Affects Health: Social Determinants of Health During Jim Crow
Subject(s): U.S. History, Civics
Grade: 6-8
Keywords: racism, segregation, Jim Crow, healthcare justice, healthcare access, the Great Migration, structural racism, racism in the north, Civil Rights Movement in the north, civics
Time: 2-4 45 minute class periods
Jump Straight to Activity Plan
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Essential Questions:
- How do inequalities in other parts of society impact inequality in health?
- How does racism affect healthcare? How does it affect health?
- How have health and other related inequalities changed for Black Americans in the last 100 years? How have they stayed the same?
- SWBAT demonstrate their understanding of social determinants of health by creating a visual that describes how different kinds of inequalities were connected with health inequality during the Jim Crow era.
- SWBAT make a claim about whether health and other related inequalities have changed or stayed the same for Black Americans in the last 100 years, using evidence from three different sources (historical or contemporary).
- Extension: SWBAT research and describe how a specific historical Black nurse helped address inequities within social determinants of health during the Jim Crow era, using at least 3 different sources.
Standards:
- SS.IS.5.6-8.MdC: Identify evidence from multiple sources to support claims, noting its limitations.
- SS.IS.8.6-8.LC: Analyze how a problem can manifest itself and the challenges and opportunities faced by those trying to address it.
- SS.CV.1.6-8.MdC: Describe the roles of political, civil and economic organizations in shaping people’s lives.
- SS.H.1.6-8.MdC: Analyze connections among events and developments in broader historical contexts.
Introduction:
In this lesson, students explore the concept of Social Determinants of Health (SDoH) through the lens of life for Black people in northern cities during the Jim Crow era (although northern cities like Chicago did not have actual Jim Crow laws, racial segregation was widely enforced before legally mandated integration of the Civil Rights Act of 1965).
The second section of the course challenges students to draw comparisons and contrasts between SDOH during Jim Crow and today.
Teachers can choose to use the extension opportunity in this lesson to introduce students to the role of Black public health nurses in addressing these issues during the Jim Crow era.
This lesson can be a standalone lesson that would fit within units about Jim Crow, the Civil Rights movement in the north, the Great Migration, or healthcare justice.
Within the Teaching Care sequence, this lesson can be an introductory lesson to the entire Teaching Care unit. This lesson can also be paired with the Teaching Care lessons about the COVID-19 pandemic and the work of contemporary Black public health nurses.
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Activity Plan:
1) Introductory activity: analysis of SDOH graphic, developing questions & connections to prior knowledge.
2) Historical Context: the Great Migration and/or Jim Crow3) Historical Graphic with Gallery Walk students create their own infographic about social determinants of health for Black Chicagoans during Jim Crow.
4) Reflective Journaling: students start building connections to SDOH in their own time and place.
5) Extension: Contemporary Graphic: students create a parallel infographic about an issue in SDOH in their time/place.
6) Extension: Research scavenger hunt on Black public health nurses: students do independent research, using the Mapping Care website and create a poster/slide to share
Assessments
- Historical Graphic
- Contemporary Graphic
- Research Scavenger Hunt
Materials
- Historical Graphic Rubric
- Contemporary Graphic: research graphic organizer (with rubric)
- Research Scavenger Hunt graphic organizer (with rubric)
Historical & Conceptual Context (for Teachers, adapted from Mapping Care website)
In the early twentieth century, disease and death was increasing among Black Americans at an alarming rate compared to their white counterparts. Black people living in the rural South lived far from most medical care. Black Americans seeking new opportunities in northern cities like Chicago found themselves living in crowded, segregated communities where disease spread quickly. Black patients often could not be admitted to public hospitals or were sent to segregated wards. Most hospitals refused to train Black nurses or doctors, yet many white healthcare workers refused to care for Black patients. When they could get hospital treatment, Black people were often treated by racist white medical staff, creating deep distrust in the Black community regarding the healthcare system.The situation of Black Chicagoans in this period presents a very stark case of the impacts of Social Determinants of Health (SDOH). SDOH are the non-medical factors that impact a person’s health. When people do not have access to affordable, healthy food in their neighborhoods, do not have stable housing, have inconsistent income, or do not have reliable or affordable transportation options, their health suffers. When people live in areas where companies pollute the air or water, there are not safe outdoor walking spaces, or have high exposure to violence, their health suffers.
Black public health nurses (“visiting nurses”) often served as the sole trusted healthcare presence in many Black communities. They entered Black homes and schools, building connections with members of the community. They taught nutrition and hygiene, vaccinated schoolchildren, and visited expecting mothers in their homes.
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Introductory Activity
Show students either this graphic (without labels) or this graphic (with labels), created by the U.S. Department of Health and Human Services.Ask students to list 2 questions they have about the graphic and to hypothesize about the meaning of the graphic. Encourage students to annotate the graphic and point to specific parts of the graphic that support their hypothesis.
Explain that this graphic shows the central idea of today’s lesson: “Social Determinants of Health,” today. Have students try to guess what the phrase might mean based on the graphic. Then break down the meaning of each word within the phrase through word association. Students are likely already familiar with the words “social” and “health” - use this to help them construct an understanding of the phrase as a whole.
Prompt students to list examples of where they see SDOH in their own lives or city today.
Ask students: why is it important to think about social factors that impact a person’s health and not just their individual choices? (lead conversation towards the fact that health solutions must address societal factors)
Emphasize that by the end of this lesson, students will be able to describe how the SDOH for Black people in northern cities during the Jim Crow era and draw connections to SDOH for Black people in northern cities today.
This will help students think about a big question that historians think about: how much have things changed? How much have they stayed the same?
Historical Context (the Great Migration and/or Jim Crow)
Jim Crow:If students are not familiar with the term or concept of Jim Crow, the following resources may be helpful for providing a brief overview:
- Modified summary from Jim Crow museum (600 or 800 words)
- Jim Crow museum resources for educators to do a virtual tour of museum exhibits.
The Great Migration
If students are not familiar with the Great Migration, provide a very brief explanation that Black people left the South looking for opportunity and better conditions.
From the Encyclopedia of Chicago:
“The Great Migration, a long-term movement of African Americans from the South to the urban North, transformed Chicago and other northern cities between 1916 and 1970. Chicago attracted slightly more than 500,000 of the approximately 7 million African Americans who left the South during these decades. Before this migration, African Americans constituted 2 percent of Chicago's population; by 1970, they were 33 percent.”
- Video from Black History in Two Minutes or So.
- Data visualizations from Jacob Lawrence’s Migration series
- Historian explains push & pull factors of Great Migration
Creating a Historical Graphic with Gallery Walk
Explain to students that they will now be creating an SDOH infographic like the one from the beginning of class, but this one will represent the important factors that impacted the SDOH of Black Americans who moved to northern cities like Chicago and New York in search of a better life.
Option: ask students to make predictions about what SDOH was like for Black Americans at this time, record these on a slide or on the board and have students return to them at the end of class.
Pull up the graphic again and ask students: why do you think someone created this graphic to show SDOH instead of just writing a list? Ask students to describe aspects of the graphic that make it effective. Ask students what the creator could have added to make it more effective.
Explain that students will be creating their own graphic for what life was like for Black Chicagoans for each category in the SDOH graphic. They can also add other categories that feel important that are not included.
You might want to include a conversation about social media and the power of graphics, memes, etc. in the digital age.
Students can design this graphic however they would like (on paper or digitally), as long as key information is included.
Pre-teach: gallery walk images include “visiting nurses,” explain that these were nurses usually hired by government agencies to go to people’s neighborhoods and homes to care for them, because they did not have other access to healthcare. For many Black nurses, this was the only employment option in this era because private, white-run hospitals would not hire them.
Gallery Walk images here.
Option: ask students to make predictions about what SDOH was like for Black Americans at this time, record these on a slide or on the board and have students return to them at the end of class.
Pull up the graphic again and ask students: why do you think someone created this graphic to show SDOH instead of just writing a list? Ask students to describe aspects of the graphic that make it effective. Ask students what the creator could have added to make it more effective.
Explain that students will be creating their own graphic for what life was like for Black Chicagoans for each category in the SDOH graphic. They can also add other categories that feel important that are not included.
You might want to include a conversation about social media and the power of graphics, memes, etc. in the digital age.
Students can design this graphic however they would like (on paper or digitally), as long as key information is included.
Pre-teach: gallery walk images include “visiting nurses,” explain that these were nurses usually hired by government agencies to go to people’s neighborhoods and homes to care for them, because they did not have other access to healthcare. For many Black nurses, this was the only employment option in this era because private, white-run hospitals would not hire them.
Gallery Walk images here.
Alternative: Co-Created Gallery Walk through Online Newspaper Research
**This version of Step 3 will take significantly longer, at least 2 additional lessons.**Teachers hoping to do more active inquiry learning can have students find images and texts that describe SDOH for Black Chicagoans at this time.
- Black newspapers can be a wealth of information about the experiences of the Black community in this era.
- https://idnc.library.illinois.edu/ - The Black Newspapers Collection at the Illinois Digital Newspaper Collections provides access to many publications
- https://www.chipublib.org/chicago-newspapers-on-microfilm/ - With a Chicago Public Library card, students are able to access The Chicago Defender archives online.
- The Library of Congress has an online photo archive with lots of relevant images.
Teacher could use this as an opportunity to have students build some independent research skills on online databases:
Resources for research tips:
- Arizona State University
- Cleveland State University (includes helpful visuals)
- Scribbr.com
Recommended search terms:
- “segregated housing AND Chicago”
- “Negro housing AND Chicago”
- “segregation AND hospital”
- “hospital AND race AND Chicago”
- “jobs AND race”
- “jobs AND discrimination”
- “Negro AND church”
- “Negro children”
- “Negro AND school”
- “Negro jobs”
- “Negro health”
- “segregation AND health AND Chicago”
- “segregation AND transportation”
- “Race AND buses OR trains”
- “Race AND visiting nurses”
- “Negro AND nurse”
Reflective Journaling (Exit Ticket for Day 1/Lesson 1)
All students encounter SDOH in their everyday lives and providing time for reflective journaling helps students to think about the relevance of this lesson to their lives, as well as prepare for the second phase of this lesson.
Give students 5 minutes at the end of class to write a reflective journal response on one of the following questions:
Explain to students that in this second part of the lesson, they will be trying to answer the question:
Direct students to choose one sector of the SDOH graphic which they will focus on for today (access to healthcare, education access, economic stability, social and community context, neighborhood & built environment)
Use this graphic organizer to track their research in preparation for creating the graphic.
Students can create this graphic on paper or on the computer. Show them the graphic rubric and encourage them to find at least three examples of factors that affect this aspect of SDOH.
Option: have students sign up for different sectors of the SDOH graphic so that all sectors are covered collectively by the class and have them build a collective graphic (on paper or digitally)
Some suggested topics for each sector:
Resources for research:
Day 3:
Students wrap up their contemporary graphic and write a claim-evidence-reasoning paragraph in response to the prompt at the bottom of the graphic organizer:
How has access to quality healthcare changed for Black people in Chicago over the last 100 years? How has it stayed the same?
Day 2-3
Explain to students that now that they’ve learned about some of the injustice and inequities that existed for Black people during the Jim Crow era, they will have a chance to investigate how Black nurses worked to address these issues.
They will be creating PowerPoint presentations to share with each other about what they learned. The goal is to think about what Black nurses were able to do and what they were not able to do in terms of addressing SDOH, given the realities of their world/time period.
Present to students their options of nurses they could focus on:
Google Slides presentation.
Students could work individually or in pairs, especially if not all students have a computer/tablet. Not recommended to have more than 2 students working on this, as there will not be enough for everyone to do in a larger group.
Once students have chosen a topic, have them open the Mapping Care website (go.uic.edu/mappingcare) and complete Step One of the graphic organizer. Model for students how to find and use the search bar on the website.
Note to students that the information they are able to find may be limited. This is a normal part of historical research, especially when researching “everyday people” who were not politicians or very wealthy or powerful. Encourage students to find whatever information they can from at least three different sources.
Model Step Two for students once they have completed Step One. Step Two requires “following the footnotes” on the website. Google Slides presentation available for this explanation, though the simplest may be to project the website and go through 1-2 examples with students.
Day 3-4
Instruct students who finish Step Two to begin designing their poster/slide. Recommended to give students one full class session (45 minutes) to complete this poster/slide.
Conclude the lesson by giving students time to look at each other’s work and provide feedback, notice similarities and differences between the different nurses they studied.
*Note: this activity easily connects to the Teaching Care lesson on contemporary public health nurses.
Give students 5 minutes at the end of class to write a reflective journal response on one of the following questions:
- How do different inequalities in my city today impact inequality in health?
- How have I seen social determinants of health impact the health of people in my family or my community?
- How have social determinants of health impacted my health?
Contemporary Graphic (Day 2-3)
Day 2:Explain to students that in this second part of the lesson, they will be trying to answer the question:
- How have social determinants of health changed for Black people in Chicago over the last 100 years? How have they stayed the same?
Direct students to choose one sector of the SDOH graphic which they will focus on for today (access to healthcare, education access, economic stability, social and community context, neighborhood & built environment)
Use this graphic organizer to track their research in preparation for creating the graphic.
Students can create this graphic on paper or on the computer. Show them the graphic rubric and encourage them to find at least three examples of factors that affect this aspect of SDOH.
Option: have students sign up for different sectors of the SDOH graphic so that all sectors are covered collectively by the class and have them build a collective graphic (on paper or digitally)
Some suggested topics for each sector:
- Economic stability: barriers to employment (criminal record, childcare, educational requirements), wages not growing, workplace injuries, unstable work hours
- Education access & quality: drop out rates, need for preventative mental health care in schools, need for early childhood education access, increasing college access/attendance/graduation
- Neighborhood & Built Environment: safe drinking water, unhealthy air, corporate toxic pollution, lead in homes, mold in homes, adequacy of public transportation, access to internet, safety of streets/sidewalks for people with mobility issues, rates of gun violence, access to healthy food in the neighborhood
- Social and Community Context: health literacy, access to mental health resources, mass incarceration, police violence, rates of civic engagement (voting, contact with public officials, community organizations)
- Health Care Access & Quality: health insurance issues (affording prescriptions, lack of providers who accept Medicaid), relationship with primary care provider, preventative screenings & healthcare, access to contraception & family planning services, children having access to early interventions, improving communication between providers and patients
Resources for research:
- Health.gov provides a great entry point for students once they have chosen a sector, because it breaks down different factors that contribute to that element of SDOH: https://health.gov/healthypeople/priority-areas/social-determinants-health
- Local newspapers without paywalls:
Day 3:
Students wrap up their contemporary graphic and write a claim-evidence-reasoning paragraph in response to the prompt at the bottom of the graphic organizer:
How has access to quality healthcare changed for Black people in Chicago over the last 100 years? How has it stayed the same?
Research Scavenger Hunt: Black Public Health Nurses
Note: for this activity, the teacher will have to decide how students will create their presentation and share their research with each other. The easiest options are likely:- Google Slide
- Physical poster (this option may require printing if you will require students to include historical images)
Day 2-3
Explain to students that now that they’ve learned about some of the injustice and inequities that existed for Black people during the Jim Crow era, they will have a chance to investigate how Black nurses worked to address these issues.
They will be creating PowerPoint presentations to share with each other about what they learned. The goal is to think about what Black nurses were able to do and what they were not able to do in terms of addressing SDOH, given the realities of their world/time period.
Present to students their options of nurses they could focus on:
Google Slides presentation.
Students could work individually or in pairs, especially if not all students have a computer/tablet. Not recommended to have more than 2 students working on this, as there will not be enough for everyone to do in a larger group.
Once students have chosen a topic, have them open the Mapping Care website (go.uic.edu/mappingcare) and complete Step One of the graphic organizer. Model for students how to find and use the search bar on the website.
Note to students that the information they are able to find may be limited. This is a normal part of historical research, especially when researching “everyday people” who were not politicians or very wealthy or powerful. Encourage students to find whatever information they can from at least three different sources.
Model Step Two for students once they have completed Step One. Step Two requires “following the footnotes” on the website. Google Slides presentation available for this explanation, though the simplest may be to project the website and go through 1-2 examples with students.
Day 3-4
Instruct students who finish Step Two to begin designing their poster/slide. Recommended to give students one full class session (45 minutes) to complete this poster/slide.
Conclude the lesson by giving students time to look at each other’s work and provide feedback, notice similarities and differences between the different nurses they studied.
*Note: this activity easily connects to the Teaching Care lesson on contemporary public health nurses.