The documentary as a teaching tool

Engagement is the key to effective instruction.

A direct path to engagement is simply to tell a good story.

Documentary film, done well, can engage and instruct through storytelling. Consider Ken Burns’ The Civil War. Presented to the Public Broadcasting Service audience as a niche product – a miniseries exploring at length an era most people may have had their fill of in grade school – the film surprised Burns and PBS when it became a national phenomenon.

The Civil War also found its way into the classroom. Used as a means to engage students in the topic, it provides a jumping-off point for discussion, interpretation, and further study. Burns says, in his introduction to the PBS site devoted to educational use of the film, “The series can’t replace the teacher or the classroom, but in conjunction with what you as the teacher do, it can make the era come alive in a way never before possible. In many ways, the series asks as many questions as it answers and should serve as a starting point for active learning and classroom discussion.”

Even when excellent course materials are available, the addition of documentary film to teaching brings a number of enhancements.

  • Flexibility for the instructor: A course will be structured in specific ways, and generally must be presented in its entirety and in sequence. A film can be viewed at any time and excerpted as needed.
  • Lower cognitive load for the learner: Viewing a film demands less of the audience than reading text or clicking through a course. The learner follows along with the story without conscious effort.
  • Easy sell: “Watch this” (at home, in class, on a phone) is an easy task to assign and to complete. Much easier than “read pages 148-207” or “complete Module 5.”
  • Potentially high engagement: Despite the apparent passivity of watching, visual media can lead to greater engagement with the material, which leads to high retention. Ask yourself how many good movie scenes you can recall? Now–how many good textbook passages?

In an instructional context, these factors – especially the combination of an easy sell and a high level of engagement – are very valuable.

But a film can’t stand alone as an instructional method. As noted above, watching the documentary should only be part of the process. Discussion questions and related readings need to be included in the mix to prompt reflection and to illustrate the topic more completely.

The de Beaumont Foundation’s film Public Health and Politics: Examining the Surgeon General is seeing similar application. The short documentary explores the interplay of politics with the Office of the Surgeon General throughout the Surgeon General’s history. It is built around interviews with public health officials relating the challenges of balancing science and politics through a focus on the July, 2007 Congressional hearing on improving the effectiveness of government. Since making the film available online and presenting it at screenings and film festivals, we’ve spoken with educators who have shared their ideas for using it in public health policy, ethics, and law classes.

The film was developed alongside our free learning course of the same name. We designed the course using archival footage and interviews coupled with selected readings and discussion questions – not dissimilar to the lesson plans and learning activities you can find at the PBS Civil War site and other resource links below. The film can serve as an introduction to the complex relationship between politics and public health, and as a supplement to our course and others.

Let me offer one word of caution. Take the same care when selecting a film for your classroom that you would when assigning a book. Be aware that documentary films can be made to promote a specific viewpoint, sometimes to the detriment of accuracy. While this can raise questions about the appropriateness of using a particular film in the classroom, a documentary that takes sides – even a propaganda piece – can still be of value. In these cases, watching the film and then examining the history and context behind it can provide valuable insight on the issues the film addresses. An instructor might ask students to compare the film’s position with opposing views held by other sources – and with their own.

In other instances, using Public Health and Politics as an example, the documentary may present varying positions on an issue. This is an opportunity for students to work with the complexity of the topic. A discussion can be prompted by asking students to explain where the individuals presented have differing views and where they agree.

The best films, especially for training and education, are the ones that carry us along with them to new places, the ones that have us see things with new eyes, and – without our even realizing it – the ones that enable us to think about things in new ways.


Interested in using documentaries as teaching tools?

Lesson plans, sample discussion questions, and other resources are available at the following links:

  • PBS provides clips, lesson plans, and learning activities using Ken Burns’ The Civil War: The Civil War in the Classroom.
  • PBS’s POV has free resources for educators, including online film clips connected to discussion questions and lesson plans.
  • Jessie Daniels, PhD (Hunter College and The Graduate Center – CUNY) has set up a wiki of films and resources for her Teaching Sociology through Documentary project.
  • Dr. Daniels discusses her approach to using film and other media in her courses at CUNY: Teaching and Learning with Documentaries.
  • The New York Times Learning Network Film Club offers short NYT documentaries with related discussion questions.
  • Teach With Movies offers two film study worksheets designed to help K-12 teachers quickly create lesson plans based on documentary films; one is for movies that are primarily informational and the other for films designed to persuade the viewer on a matter of political or social significance.

Public Health Informatics: What’s Cooking?

Less than six months ago, I was walking across the stage at the Emory University Rollins School of Public Health, having proudly earned my Master of Public Health degree. Now, as the de Beaumont Foundation’s first Philanthropy Fellow, I continue to take steps forward, confident that the training I received at Emory has prepared me well to start my career in public health.

Like other graduates from Emory and from schools of public health across the country, my classmates and I rely upon our coursework, ranging from epidemiology to environmental health and a myriad of interesting and challenging electives, to provide the foundation for our core competencies and skills in public health. However, despite my rigorous and thorough training, it wasn’t until I attended a meeting of the Public Health Informatics Training Network (PHITN), hosted by the de Beaumont Foundation and the Public Health Informatics Institute, that I came to truly understand what informatics is and how it is relevant to my skills and interests.

This isn’t to say that the concepts were foreign to me. Not at all. In public health, data is not just our bread and butter, but the full range of ingredients we need to prepare wholesome fare to fuel public health practice. Therefore, if I take the liberty to liken my graduate program to culinary school, it’s clear as to why our priorities were focused on how to seek the highest-quality ingredients (data), how to write our recipes (methods) and prepare our dishes (studies)– and why we were less concerned with the equipment and organization of the kitchen (informatics) and the constructors and curators of our research kitchens (informaticians). Our data logisticians, knowledge architects, and information translators may often be overlooked, but informaticians are fundamental to our research, evaluation, and decision making in public health.

In my career, I aspire to engage in partnerships with other sectors to promote the health of a community as a whole and to work towards health equity by addressing the social determinants of health. But working together can only go so far if our information streams can’t connect. All of our ingredients need to make it into the same kitchen before we can start cooking. For this to be possible, I’m going to need to know how to ask the right questions, access the right data. And I realize that I am going to need help.

Each partner will bring additional complexities, such as data format, collection processes, and languages used. Informaticians can bridge these differences to allow us to find the commonalities that can lead to the most effective interventions. With the help of informatics, we are not limited by the data, but rather, we can overcome the barriers of language and fragmented structures. Research does not need to be constrained as though it were a challenge on a Food Network competition. I’d prefer to work with an informatician to understand and even influence the selection of the ingredients and equipment available and to write the menu before the shopping list, rather than limit myself to wrangling an entrée out of whatever might be in the nearest cupboard.

Public health informatics is at the heart of some of our greatest successes in public health. For example, the organization of childhood immunization data is an informatics success. These data are highly valued and rigorously collected, managed, and shared between pediatricians, clinics, health departments, and others. The impact of these data on the lives of our nation’s children is undeniable, and yet, the role of informatics goes unnoticed. Just as often, the well-stocked, impeccably-organized kitchen goes unseen and unappreciated by the dinner guests absorbed in the meal on their plates. While the guests, the consumers of this data, may not need to know how the cabinets are organized, the restaurant staff do. We rely upon informaticians and trust that their work supports a system which can reliably serve the needs of different chefs, meals, and diners. With an informatician in the kitchen, data systems can be well-utilized for a number of purposes.

the-informatics-kitchen

Despite past accomplishments and the future public health contributions of informatics, there are obstacles in the way of truly collaborating within and strengthening this field:

  • The lack of a unified message and communication strategy about public health informatics (PHI), especially around its value
  • The need for defining a purpose, scope, vision for the field of PHI and its role in the public health workforce, training/education, and academia
  • The importance of collaborations between multiple sectors, for data ownership and sharing, and how this is challenged by categorical funding, silo mentality, and competition
  • The need for defining and accessing effective PHI tools

The very invisibility of informatics is simultaneously its greatest weakness and most promising opportunity. It is as pervasive as the data that nourishes our work, and yet ignored – to the detriment of the mission of public health.

As public health professionals, we have the power to strengthen the recognition of the role of informatics. Our field only stands to benefit if we can identify and become familiar with informatics during our training and early in our careers. Only then can we begin to generate the understanding, appreciation, and demand among our future public health leaders necessary to realize the potential impact of this often overlooked resource.

Informatics may not yet be widely considered a hot field, but the temperature is rising. While we can still stand the heat, let’s get into the kitchen.

Lessons From APHA 2016

In an election year that laid bare significant divisions in our country, the 2016 Annual Meeting of the American Public Health Association (APHA 2016) in Denver was an important reminder that the work of public health touches all Americans and that much of public health enjoys wide bipartisan support. The de Beaumont team returned from a successful week at APHA 2016 just a week before the election. Many of our partners in public health and other sectors, including Don Bradley from the Practical Playbook, joined us. As always, this meeting was a great opportunity to connect with the field and get a pulse of what’s happening across the U.S.

APHA 2016 reinforced my impressions from last year’s gathering of the public health world – a continuing, growing focus on “upstream” social determinants of health; a pivot to cross-sector partnerships, specifically the importance of using public health approaches to help inform and add value to policy and program choices in a variety of areas; and a continuing search for practical approaches for making this happen.

Because of the size and breadth of APHA, this meeting reflects a field struggling with significant challenges and considerable opportunities. Even before the election, public health leaders faced a transforming landscape – dramatic shifts in healthcare coverage and delivery, public health agencies shifting away from serving as a “safety net” provider of health services, and an emerging role in stimulating and influencing health-related initiatives across sectors. An evolution of thinking in the public health community is reflected by new paradigms for public health agencies, serving as a community’s “chief health strategist” as information hubs for communities and as cross-sector leaders addressing broad health-related issues.

At the same time, APHA 2016 was a reminder of the depth and extent of the work public health agencies perform in more traditional areas. These functions are critical not only to protecting health of communities, but also to maintaining and amplifying the credibility of public health agencies. Without performing traditional functions with excellence, public health leaders will have little opportunity to assert broader influence on policy and program choices that are important to their communities.

For many agencies at the state and local level, pivoting to new approaches, such as those described in PH 3.0, remains out of reach due to resource constraints, lack of adequately trained staff, and challenges in adopting new technologies and approaches. Public health agencies deal with the reality of daily crises and the need to execute on existing functions. It’s sobering to see how difficult it is to free up the needed resources, people, and talent to fully embrace new approaches, such as providing value to the broader community as a chief health strategist.

Fortunately, APHA 2016 served as a clearinghouse for public health leaders seeking ideas and practical solutions.  Many approached us with examples of how they have used the resources of the Practical Playbook to good effect. Multiple sessions featured successes of BUILD Health Challenge grantees. They focused on the significance of constructing partnerships to address a community’s unique needs and put emphasis on hospitals, among the “anchor agencies” of these partnerships. Creating the necessary trust among competing hospitals isn’t always easy, but as the BUILD Health Challenge grantee in Des Moines showed, it’s possible for them to work together towards a shared purpose.

A session featuring the de Beaumont Foundation and ASTHO highlighted success stories of how Medicaid and public health agencies have worked together. They spoke on the importance of building relationships to create change. The Medicaid-Public Health Library can act as a valuable resource for Medicaid and public health agencies trying to do so.

APHA 2016 also provided some interesting insights into how public health is defined and how we communicate beyond the public health world. At the de Beaumont exhibit, we asked meeting participants to tell us how they described public health. The answers covered the wide spectrum of APHA members: prevention, equity, access to care, community health, partnerships. APHA Executive Director Georges Benjamin provided one broad view, and de Beaumont’s Brian Castrucci provided another in interviews on APHA TV.

Finding better ways to communicate about the value of public health is critical and will be a growing focus of the de Beaumont Foundation in the years ahead.

Truth, Justice, and the American Way: Advancing the Public’s Health in the Real World

Decision-making in the real world relies on a complex mix of inputs, and public health policy is no exception. Because I write this as the de Beaumont Foundation is releasing our first documentary short (Public Health & Politics: Examining the Surgeon General) and because we need a variety of superheroes in public health, I’ll call these inputs Truth, Justice, and the American Way.

  • Truth, because policy should be informed by solid evidence, and public health professionals strive to find the best evidence to inform decisions.
  • Justice, because the field of public health is guided by the mission to make people safer and healthier, including addressing underlying social determinants of health that disproportionately limit opportunity in many populations.
  • The American Way, because, well, that’s the way we make public policy decisions in the uniquely American system that has evolved since 1776. Importantly, there are many competing values and considerations in policy-making.

Public Health & Politics’ examination of the role of the US Surgeon General reinforces how important it is to have a clear, unambiguous voice speaking on behalf of science and public health evidence – in effect, someone to anchor us to truth – in this mix.

Real World Decision-Making: The American Way

The US system of government is almost designed to ensure conflict: it is pluralistic, relies on multiple levels of government, has checks and balances built into every level of decision-making, and needs to balance public and private interests in important decisions. The American version of democracy encourages a rough-and-tumble exchange of ideas and interests, in which truth and justice don’t always hold the upper hand.

Spoiler alert:  political discourse sometimes has a tenuous relationship with the truth.

Public health professionals, particularly those in government, need to understand these competing forces and seize the opportunity to bring public health values and evidence into this dialogue. My recent commentary “Politics and Public Health: Engaging the Third Rail” discusses concrete strategies for public health officials to bridge the divide between the political system and governmental public health.

Truth

Public health seeks justice but is grounded in science. As public health seeks to engage in the policy process, it is essential that it bring clear, unadulterated evidence into the ring as it grapples with the political decision-making process.

I developed my appreciation for unadulterated evidence as an official with the CDC’s National Center for Health Statistics, where we aspired to be in the truth business. Like our counterparts producing unemployment statistics or economic indicators, our mission was to produce unbiased data – regardless of where the chips fell. Not only were we guided by professional standards, but we had the weight of OMB guidelines and federal laws regulating government statistics to protect the integrity of the system. Our ideal outcome was to stimulate a debate over the implications of the evidence, but not the truth of the findings.

A Surgeon General occupies this same space, but with different tools and audiences. Speaking on a broad range of health, medical, and policy concerns, the Surgeon General must be viewed as authoritative and knowledgeable – and must always be viewed as source of advice untainted by politics and other influences. The Surgeon General should speak with clarity and credibility to the American People while demonstrating the strength and credibility to speak truth to power. Other government health officials must be held to high standards as well, but few have jobs where their singular role is to be the voice of evidence and science.

As important as evidence is in seeking the “truth,” it’s also important to recognize the limits of public health science and to communicate those limits. Data is limited by many factors, beginning with choices we make in what to measure; because of methodological limitations, research is often suggestive but not definitive. Even more broadly, our understanding of the “truth” is influenced by our values and perspectives; one person’s truth may be another’s heresy, particularly when facts are interpreted in the context of overarching values. This reinforces the need for public health officials to be objective, forthcoming about the limits of public health evidence, and respectful of how different audiences interpret evidence.

Who do you trust?

Our new documentary short explores the complexities of the role of the Surgeon General as it has evolved over time. (See the trailer.) As an official whose term overlaps Presidencies, the Surgeon General has the rare ability to operate outside the constraints imposed on most Presidential appointees. Nonetheless, Surgeons General can’t escape the fact that they work inside government, regardless of who controls the White House, and have experienced a variety of direct and indirect pressures and even challenges to their independence as a result.

With the 2007 House hearing on politics and the Surgeon General as a backdrop, this documentary explores how Surgeons General have grappled with these complexities over time. We draw on the experience and reflections of Surgeons General Koop, Satcher, and Carmona, with additional perspective from American Public Health Association President Georges Benjamin.

Public health needs superheroes at all levels, as our goals are larger than any one position or leader. We need truth tellers to be assured that we have an independent Surgeon General at the national level and trustworthy health officials at the federal, state, and local levels. We need to stay focused on our mission to improve health across the entire population. And we need to engage in dialogue with policymakers, helping to ground decisions in evidence as we navigate the real-world dynamics of the American system.

What’s Your Take: Michael Fraser, ASTHO

What’s Your Take is an interview series with interesting individuals – leaders, practitioners, academics, policy makers – whose work touches on public health, philanthropy, or related topics.

Name: Michael Fraser, PhD CAE FCPP
Organization: Association of State and Territorial Health Officials (ASTHO)
Title: Executive Director

How did you become interested in public health?

I came to public health through academic work in sociology and graduate school research looking at the social determinants of health from a sociological versus public health perspective.  Sociologists have been working on health equity and social determinants for decades – and it is good to see public health making that connection too!  My doctoral dissertation committee had faculty from both sociology and public health and that got me hooked on the public health and the need to look at both the clinical and the community factors that contribute to health and wellness.  My first job in Washington was at the National Association of County and City Health Officials (NACCHO).  While I didn’t know much about governmental public health, those first few years at NACCHO really opened my eyes to the many ways that public health agencies protect and promote health nationwide. So, I became interested in public health both as a student and then as an advocate for public health agencies. While I do not have an MPH, I think my journey underscores the many ways that we find our way into public health and bring diverse training and experience to the our public health work.  That diversity is what makes public health so interesting, important, and instrumental as well look to address health equity and promote optimal health for all.

Tell us about one organizational partner you’ve had and how you’ve worked together. Extra credit if they’re in another sector!

Our ASTHO’s President’s Challenge focuses on public health approaches to substance misuse and addiction.  I recently had the chance to meet with the National Association of Attorneys General and learn more about how Attorneys General and law enforcement agencies have approached the topic.  There is a lot to do with this sector to understand how law enforcement and legal minds think about substance misuse and its antecedents.  I was surprised to see a great deal of interest in thinking about addiction in different ways, including the destigmatization of addiction and moving upstream to prevent substance misuse.  It was refreshing to know that our Attorneys General colleagues are eager to learn more about the work of public health and how public health connects to their priorities in the states.

Another area where I think there is tremendous opportunity is the public health connection to the health care delivery system.  New federal legislation to move health care delivery from “volume” to “value” means that public health agencies are positioned to add value to health care systems in new and exciting ways.  The term that is used in many health care delivery circles is “population health” – that to me is just public health described in a slightly different way.  There is increased recognition and understanding by the delivery system that health outcomes are influenced not only by what happens in the exam room but also by what happens outside the exam room and in the community.  Working with health care delivery partners, public health agencies can not only contribute to improving health outcomes but also save states money as we move “upstream” to prevent illness and address the social determinants of health.  I think the future of public health will require us to better understand the health care delivery system and the ways that public health can work together with health care partners to improve health outcomes in a much more coordinated clinical and community approach.

What’s the biggest opportunity you see for impact in your work?

Our work at ASTHO has many opportunities for impact.  We are privileged to work with all states, territories, and freely-associated state members.  Our direct connection to the governmental agencies responsible for the public’s health in these 59 jurisdictions gives us access to health leaders nationwide and the opportunity to impact policy and practice across the country.  As we develop public health leadership, share best practices, promote learning between states, advocate for public health improvement and investments in core public health services, ASTHO is well positioned to have direct influence and impact on health status nationwide. Our work prepares and supports state and territorial health agencies to do great things!

What’s the number one thing public health can improve on?

We talk to ourselves too much and wring our hands because “no one understands us.”  We have to stop engaging only those we know in conversations about health and reach out farther to make connections to new partners in the public health system.  This means truly practicing what we preach when it comes to “health in all policies.”  Instead of getting others to think like us, we have to think like others and walk a mile in their shoes.  Why would housing agencies want to work with us?  Why would health care delivery systems want to work with us?  Do we know their language, do we understand their incentives and pain points?  Do we know enough about them to help them solve their problems while also advancing our public health priorities?  I think this is the crucial challenge for public health – how to move beyond conversations with each other and widen the circle to understand the perspectives and experience of others that might also have an impact on health.

The statements above are shared as written by the interview subject. They do not necessarily reflect the views of the de Beaumont Foundation.