Mapping Care Project: The History of Black Nurses in Chicago

Lesson 7: Addressing Health Inequities: Perspectives from Black Nurses

Standards (AACN entry and advanced)3.3a Describe access and equity implications of proposed intervention(s). (Entry-Level)
3.4b Describe the impact of policies on population outcomes, including social justice and health equity. (Entry-Level)7.2b Recognize the impact of health disparities and social determinants of health on care outcomes (Entry-Level).
7.3d Recognize internal and external system processes and structures that perpetuate racism and other forms of discrimination within health care. (Entry-Level)

Associated Nursing History Framework
Essential Questions (student and faculty guide)

Learning Objectives 
  1. Examine the Role of Black Nurses in Addressing Health inequities:
    Students will explore how Black nurses in public health historically and currently work to mitigate health disparities by providing culturally relevant care and advocating for policy changes.(AACN 3.4b)
  2. Differentiate Between Upstream and Downstream Approaches to Health Inequities:
    Students will be able to distinguish between upstream (policy, systemic changes) and downstream (individual care, patient education) approaches to addressing health disparities, and understand the importance of integrating both in nursing practice (AACN 3.3a, 7.3d).
  3. Evaluate Strategies for Reducing Health inequities in Public Health:
    Students will assess various strategies used by Black nurses and public health professionals to address health inequities, with a focus on community involvement, policy advocacy, and holistic patient care (AACN 7.2c).
 

Introduction (Faculty)

This lesson provides students with a comprehensive understanding of the role Black nurses play in addressing health disparities, both historically and in modern public health contexts. Students will examine how Black nurses have worked to mitigate health inequities through both upstream (policy and systemic change) and downstream (individual care and education) approaches. They will also learn to differentiate between these approaches and understand their integration in nursing practice. By the end of the lesson, students will evaluate various strategies used by Black nurses and public health professionals to reduce health disparities, with an emphasis on culturally relevant care, community involvement, and policy advocacy.
This lesson centers on public health nursing in Chicago and then has them engage with oral histories and case studies of Black nurses working in public health. The concluding assessment of the lesson asks students to apply and demonstrate their understanding of public health either through a specific local public health issue or specific proposed solution. 

Historical/Conceptual Background (for teachers) (adapted from Mapping Care website)
Public health nursing has historically been a critical avenue for Black nurses to address health disparities in marginalized communities. Despite the systemic racism and limited career opportunities they faced in the early 1900s, Black public health nurses became key healthcare providers in underserved areas. Their work went beyond individual care, focusing on the broader social determinants of health—such as housing, nutrition, and access to medical services—issues that directly contributed to health inequities. These nurses were instrumental in bridging the gap for communities that lacked access to doctors and hospitals, advocating for both systemic change (upstream) and providing direct care and education (downstream).
Today, Black nurses continue this legacy, integrating community involvement, policy advocacy, and culturally relevant care to reduce health disparities. As essential healthcare figures in many Black communities, they work to address systemic barriers, build trust, and offer holistic care that meets the physical, mental, and social needs of patients. By exploring this history and the ongoing role of Black nurses in public health, students will understand how these nurses mitigate both upstream and downstream inequities, ultimately working to reduce health disparities through comprehensive public health strategies.
This lesson’s focus on public health nursing underscores the importance of examining how Black nurses historically and presently provide culturally relevant care, navigate systemic challenges, and advocate for policies that address health inequities. Through critical analysis and reflection, students will explore how these strategies can be applied to modern public health practice.

For more resources on this subject, see: 
Black Public Health Nurses in History
Black Nurses in Public Health Today

Read/Watch/Listen (Resources from The History of Black Nurses in Chicago website)Oral Histories from the Mapping Care collection:
Supplemental Resources (version with hyperlinks, version for print)
Books/publications 
Activities Summary: The following is a brief summary of activities included in this lesson. Faculty are encouraged to pick and choose the activities that work best for their students and course. Faculty may also modify activities through adding readings or changing learning modalities, instructions, or evaluation criteria as they see fit.
 
  1. Examine the Role of Black Nurses in Addressing Health Inequities:
    Students will participate in reflective journaling and group discussions to explore how Black nurses have historically and currently worked to reduce health disparities through culturally relevant care and advocacy.
  2. Differentiate Between Upstream and Downstream Approaches to Health Inequities:
    Students will analyze case studies of Black nurses and identify upstream and downstream strategies to address health disparities, presenting their findings in small groups.
  3. Evaluate Strategies for Reducing Health inequities in Public Health:
    Students will engage in a structured debate and develop visual presentations to propose comprehensive public health solutions that integrate both upstream (policy advocacy) and downstream (community involvement) approaches.


Activity Plan 1: Examine the Role of Black Nurses in Addressing Health Inequities (Individual, in-class, reflective journaling, or small group discussion)

PreparationAssign students reading material Black Public Health Nurses in History, 
Black Nurses in Public Health Today highlighting the historical and modern contributions of Black nurses in public health, focusing on their roles in mitigating health inequities. If necessary, you may want to consider assigning the supplemental readings regarding upstream and downstream public health concepts. These readings will help students prepare for in-depth analysis before the session and  understand the historical context of how Black nurses have worked in marginalized communities.

Main activity: Reflective JournalingProvide students with the Lesson 7 Reflective Journal Prompts and encourage students to deeply and critically analyze the historical context reducing health inequities in public health. Conduct the activity in a quiet, reflective classroom setting and allow students sufficient time to think and write their responses to the journal prompts.Ask students to write an initial discussion post answering the reflection questions and citing their references.

Discussion and Feedback Students break into small groups to discuss their reflections, covering each of the journaling prompts. They will explore how Black nurses’ roles in public health have evolved or remained consistent, and connect these examples to modern public health practices, particularly in applying upstream and downstream health strategies.
Encourage students to share examples from the material they reviewed and connect it to modern public health practices.
 Facilitate a class-wide discussion where each group summarizes their discussion, providing insights into the unique challenges and strategies Black nurses have used to address health disparities.Ensure that all students can articulate the main points discussed and reflect on their learning journey.Ask students to read and respond to two or three of their classmates' initial posts and to connect the historic challenges and solutions to modern-day challenges and potential solutions. 

EvaluationEvaluate the reflective journaling by assessing students' critical thinking on Black nurses’ historical and modern roles, their connection to social determinants of health (SDOH) in addressing health inequities, and the depth of their reflection, using the Lesson 7 Reflective Journal Rubric. 


Activity Plan 2: Differentiate Between Upstream and Downstream Approaches to Health Inequities (Individual, in-class or online, Case study analysis, and Group presentation)

Preparationto gain understanding of the upstream and downstream concepts in public health approaches. 
 Encourage students to review this article for understanding the concepts and examples of upstream and downstream approaches in public health.
Gehlert, et al. (2008). Targeting health disparities: A model linking upstream determinants to downstream interventions. Health Affairs, 27(2), 339–349. https://doi.org/10.1377/hlthaff.27.2.339 

Provide students with case studies where Black nurses addressed health disparities using both upstream (policy, systemic changes) and downstream (individual care, patient education) approaches from Mapping Care website Black Public Health Nurses in History, Black Nurses in Public Health Today
 Honoring Ms. Jessie Sleet Scales | UIC
Eunice Rivers, RN: The Myth of “The Only Woman” in the Tuskegee Study | OJIN
Main activity: Case Study and Group presentation
Discussion and Feedback Facilitate a class discussion and encourage student groups to share their findings and insights from the case studies, comparing and contrasting the different challenges and approaches by various nurses throughout the historical period. During the discussion, faculty can use these guided questions on how integrating both approaches is essential in modern public health nursing and how Black nurses navigate these dual responsibilities. Online modification: Ask students to submit their group Case Studies on a class discussion board. Ask students to review all of the group’s submissions and to integrate the findings among the different cases. Students can then return to their group to discuss the questions above, and submit a summary of their discussion for evaluation. 

Evaluation

Activity Plan 3a: Evaluate Strategies for Reducing Health Inequities in Public Health (Group, in-class/online, In-class debate) 
** Students must complete Activity Plan 2 as a prerequisite before starting Activity Plan 3a/b. 

PreparationFacilitate the debate using general debate guidelines and ensure equitable participation from both teams and encourage the use of historical examples and modern applications to support arguments.
Debate facilitation preparation resources for Faculty:
Main activity: Structured DebateDebate Structure Example:
  1. Opening Statements (10 minutes): Each team presents their argument using examples from the assigned case studies.
  1. Counter-Arguments (10 minutes): Each team responds to the opposing side’s argument, identifying the weaknesses in the alternative strategy and supporting their own position with evidence from the case studies.
  2. Rebuttals (5 minutes): Each team has a final opportunity to strengthen their argument and rebut the opposing team’s points.
  3. Closing Statements (5 minutes): Summarize the main points of the argument, using historical and modern examples of Black nurses' contributions.

Evaluation 
Activity Plan 3b: Evaluate Strategies for Reducing Health Inequities in Public Health (Group, in-class/online, presentation) 
** Students must complete Activity Plan 2 and 3a as a prerequisite before starting Activity Plan 3b. 

Preparation 
Main activity: Solution Proposal (Visual presentation)
Solution Proposal- Visual Presentation Activity: Step 1: Identify a modern public health challenge (e.g., mental health access, chronic disease management, maternal health, etc.) that disproportionately impacts marginalized communities.
Step 2: Develop a plan using examples from the readings, case studies, and outside references to address the challenge through both upstream and downstream strategies. This plan should be specific to the students’ community and include community involvement (e.g., health education, outreach) and policy advocacy (e.g., lobbying for systemic change, influencing public health policy).
Step 3: Present the proposed solution to the class, explaining how it effectively integrates both approaches to reduce health disparities.

Online Modification: Ask students to post their poster with a brief explanation on the course discussion board.

Discussion and Feedback:Facilitated Discussion Questions:Online Modification: Ask students to respond to other student’s posters, answering the questions above. 

Evaluation 
Evaluate the debate by assessing the following criteria: Content Quality, Visual Design , Integration, and Use of Evidence by using the Solution Visual Proposal Rubric.

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