Introduction
Baldwin contends that focusing on understanding others can be detrimental, potentially hindering self-discovery and compromising individual well-being. His perspective can be applied metaphorically, highlighting the power of collaboration, especially within the United States, from different fields like public health, STEM, and cooperative extension to achieve positive outcomes related to social determinants/drivers of health and structural inequities. The United States continues to face an uphill battle to remain competitive with the rest of the world within multiple fields and disciplines related to science, technology, engineering, and mathematics (STEM). Subotnik et al. (2009) states that the most effective ways to inspire careers, increase knowledge, and promote learning related to STEM remain elusive. As a means to address the divide this document provides additional foci as to including the public health discipline that is designated as STEM and the nationwide, non-credit educational network known as cooperative extension.
This document serves as a literature review that presents the current knowledge and findings associated with the relationship between public health, STEM, and Cooperative Extension. Research by Rocco and Plakhotnik (2009) states that a literature review demonstrates a need for a research study. The writing of James Baldwin and its connection to health equity and wellness. These are important connections to make that go along with, not against the work surrounding STEM. Cooperative Extension Framework for Health Equity and Wellbeing (CEFHEW), created by the Extensions Committee on Organization and Policy (ECOP), acts as a guide that helps plan and implement programs with the foci of better health at the individuals, community, government, and environmental levels. STEM education allows learners to be work together, be creative, and solve problems. This helps various institutions increase their capacity and reach with highly skilled individuals at the helm in fields, like healthcare, education, cooperative extension, and science. For example, STEM research has led to the development of new vaccines for many illnesses (measles, polio, COVID-19, and countless other morbidities). ECOP, in 2020, appointed a health innovation Task Force to make revisions and update the Cooperative Extensions Framework for Health and Wellness (CEFHEW) (Braun et al., 2014). Researchers provided revisions for the framework centered around improving population health equity through a lens of three foundational themes: social determinants of health, health equity, and leveraging community and its resources. STEM education in conversation and collaboration with public health programs and equity initiatives can create positive relationships with communities, introduce a broader range of questions and comparisons involving social determinants, and increase cross-sectional efforts to minimize poor health and quality of life outcomes.
Background
On July 2, 1862, President Lincoln signed the Morrill Act, which provided land to states to fund public colleges focused on agriculture and mechanical arts. The institutions created under the act were known as Land Grant Colleges (LGU). The legislation helped create three classifications of LGUs. Those included the Morrill Act of 1862 institutions (57 institutions located in each state), The Morrill Act of 1890 institutions (19 Historically Black Colleges and Universities [HBCUs]), and the Equity in Educational Land-Grant Status Act of 1994 institutions (36 Tribal Colleges and Universities [TCU]) universities. The U.S. Cooperative Extension Services operates the LGU system in partnership with federal, state, and local governments. Dr. Rochelle Walensky (2021), the Centers for Disease Control and Prevention (CDC) Director states that:
The combined talents of many different scientists and other experts across multiple disciplines—including STEM, liberal arts, and the humanities—sparks ingenuity, leads to technologically sophisticated data-driven science, and inspires the next generation of STEM learners in public health. To prepare a highly skilled and diverse workforce for the future, it is critical for CDC to build and maintain multidisciplinary pathways into public health careers (para.1-2).
Dr. Walensky’s statement speaks to the triangulation of individuals, groups, data, and organizational backgrounds with the foundational aspects of public health that influence the
current and future educators, learners, and workforce. The talents of individuals across various backgrounds complement the tools and resources to address health behaviors, risk factors, and outcomes.
The demand for jobs in many STEM and healthcare fields is projected to grow faster than the average for all occupations in the United States (Bureau of Labor Statistics, 2019). STEM fields provide the foundation for understanding and addressing public health and Cooperative Extension challenges. An example of this interaction includes:
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scientists who develop new vaccines and treatments for diseases,
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architectures who design buildings and lots,
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engineers who design safer and more efficient water and sanitation systems,
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individuals responsible for tactile pavement and
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mathematicians who model the spread of infectious diseases.
STEM Designation
Researchers state that the meaning of STEM or significance needs to be clarified and distinct. However, it is understood that there are four disciplines. For the sake of providing an operational definition derived from the literature presented for this work, STEM is an acronym for the disciplines of science, technology, engineering, and mathematics taught and applied either in a traditional and discipline-specific manner or through a multidisciplinary, interconnected, and integrative approach to expand individual’s abilities in supporting their education that includes emphasis on critical thinking skills (Bybee, 2013; National Science Foundation (US), 2010).
The Department of Homeland Security (DHS) maintains a list (Designated Degree Program List) of STEM designated degree programs that includes all fields of study that DHS considers to be science, technology, engineering, or mathematics (STEM). STEM-related fields also include those that involve innovation, research, or the development of new technologies using engineering, computer science, mathematics, or the natural sciences (e.g. Public Health, Veterinary Preventive Medicine, Epidemiology, Horticultural Science, Engineering, and Animal Breeding) (Jones et al., 2019; United States Department of Homeland Security, n.d.). This list is essential for individuals who need to clarify STEM classifications.
Public Health
The Centers for Disease Control and Prevention and other researchers define public health as the science of protecting and improving the health of people and their communities through research, prevention of morbidity and mortality, detection, and promoting healthy lifestyles (Centers for Disease Control and Prevention (CDC), 2014; Winslow, 1923). An editorial for the Lancet states that “Education and health and wellbeing are intrinsically linked. The evidence behind the importance of education as a determinant of health is amongst the most compelling” and calls education “a neglected social determinant of health” (July, 2020). Social determinants of health, like education and economic environment, often create a multifaceted web, where deficits in one area can intensify challenges in others, creating a ripple effect on health outcomes. The World Bank has stated that “poverty is a significant cause of ill health and a barrier to accessing health care when needed. This relationship is financial: the poor cannot afford to purchase those things that are needed for good health, including sufficient quantities of quality food and health care” (World Bank). The World Health Organization (WHO) writes that “unsafe and substandard housing” creates a “health burden” (WHO Housing and health guidelines - Executive summary).
Cooperative Extension National Framework for Health Equity and Wellbeing
The purpose of Cooperative Extension is to empower communities of all sizes, farmers, and ranchers to meet the challenges they face, navigate new technology, improve food safety and nutrition, health and wellness, prepare and respond to emergencies, and protect the environment (National Institute of Food and Agriculture, n.d). For example, Cooperative Extension program agents may teach classes on physical activity, nutrition, stress management, vaccine information, or communities developing healthy food systems.
Through partnerships, grants, community resources, and other methods, Cooperative Extension serves as a conduit for public health and STEM through initiatives such as The Extension Collaborative on Immunization Teaching & Engagement (EXCITE) project. The EXCITE project is an interagency agreement with the United States Department of Agriculture, the National Institute of Food and Agriculture (NIFA), and the Centers for Disease Control and Prevention (CDC) that funds Cooperative Extension system interventions that help address health disparities among rural and other underserved communities concerning immunization education. Agricultural Policy Specialist Genevieve Croft (2022) states that the Hatch Act of 1887 (24 Stat. 440), Evans-Allen Act of 1977 (P.L. 95-113, §1445), and provisions of the Agricultural Research, Extension, and Education Reform Act of 1998 (AREERA, P.L. 105-185) provide the framework for funding research at land-grant institutions. The National Framework for Health Equity and Wellbeing offers a tool to systematically address the programmatic area of health and wellness at the individual, community, policy, and environmental levels (Burton, et al., 2021; National Academies of Sciences, Engineering, and Medicine, 2017). The diagram lists many of the root causes of structural inequality, established norms, policies, and practices, social determinants of health, the work of Cooperative Extension, and the centerpiece of improving population health and achieving equity in health status with Health Equity. (Figure 1)
Root Causes of Structural Inequity
The World Health Organization (WHO) says that “Clean air, stable climate, adequate water, sanitation and hygiene, safe use of chemicals, protection from radiation, healthy and safe workplaces, sound agricultural practices, health-supportive cities and built environments, and a preserved nature are all prerequisites for good health” (Environmental Health, n.d.). It is easy to understand the connection between these social determinants of health and health itself. Experts, scientists, and other authorities have touted the benefits of these determinants. Why do so many people not have access to them? The answer to this question is complicated and has to do with the previously mentioned (outer ring of the framework) ableism, ageism, xenophobia, racism, homophobia, classism, and sexism. Biases, both implicit and explicit, often hinder or stop groups of people from getting resources altogether. For example, a person with a disability may be denied access to various building and offices due to physical barriers or insensitive staff attitudes. This lack of access to resources and lack of inclusive behavior may fall under the notion of ableism.
Ableism negatively impacts the health of people with disabilities. Janz (2019) found that medical professionals consistently underestimate the quality of life of people with disabilities. This is dangerous and insidious because it is often disguised as “common sense.” Armour et al. (2018) and Nowakowski (2023) found that widespread discrimination against people with disabilities persists in hiring and academia. Additionally, Healthy People 2030 (n.d.) reports that people living in poverty (including many people with disabilities) are more likely to live in homes with reduced access to healthcare, healthy foods, and opportunities for exercise. These factors can exacerbate physical and mental health problems.
In her article “Necroeconomics,” Skeggs states that a journalist for the conservative Telegraph newspaper wrote, “From an entirely disinterested economic perspective COVID-19 might even prove mildly beneficial in the long term by disproportionately culling elderly dependents” (2021). Louise Hayes et al. wrote in their 2019 article “Age-related inequalities in colon cancer treatment persist over time” that a study found older patients with colon cancer had worse outcomes than younger patients. While the possibility that certain treatments would be too rough on elderly patients is noted, the paper also states that there are no guidelines for age in colon cancer treatment, and there is very little research on colon cancer in the elderly.
The Organization for Economic Co-operation and Development OECD, Health and Work, n.d. an international organization devoted to improving policies, states that “Healthy people are more likely to be employed, have a good job and retire later, while people experiencing health issues or disabilities are more likely to see their labor market chances deteriorating, lose employment and struggle in finding a new job.”
Expounding upon the issue of structural inequities, ageism is not the only inequity that limits access to resources and negatively influences health. Xenophobia, the fear or dislike of people from different cultures, and racism, the prejudice based on race and power dynamics, also create significant barriers. All three forms of these inequities can lead to social isolation and adverse health outcomes, ultimately impacting the mental and physical well-being of persons.
The CDC has put forth racism as a public health crisis (Racism and Health, 2023). The COVID-19 pandemic has worsened xenophobia, particularly towards Asian migrants. A systematic review found that half of the included studies reported health consequences, such as anxiety, isolation, and depression (Silva et al., 2022).
Sociologist Eduardo Bonilla-Silva (1997) defined racism as an organized system that is premised on the categorization and ranking of societal groups into races. He also considered it to be a structural phenomenon where the behaviors and practices that maintain racism are embedded within the system itself.
Homophobia and transphobia can also affect where one is allowed to live, work, and receive healthcare. Research currently estimates that youth in the LGBTQ community are between 20 and 40 percent of homeless young adults (Jama et al., 2018). Children tend not to learn LGBTQ topics, and over 35% of parents in a 2018 survey said they would be uncomfortable if their child learned about LGBTQ people (Moorhead, 2018). The CDC writes that men who have sex with men have a more difficult time getting jobs and healthcare (2016).
Beyond homophobia and transphobia, the additional root cause of structural inequity associated with classism impacts health and well-being. Classism, for example, disproportionately disadvantages lower-income individuals. Studies show that, on college campuses, first-generation students are often seen as lower class, which leads many other students to believe that they are “low brow” and do not value education (Lee, 2017). This belief that the “lower class” does not care about education tends to make those in authority (such as doctors) less likely to listen to what they have to say. Scrambler (2019) writes that even though “Class has lost a degree of its salience for identity-formation in the individualized, ‘liquid’ or relativized culture of contemporary financial capitalism, but it has lost none of its structural force.”
Gender bias also affects healthcare. In 1977, women of “childbearing age” were excluded from phase I and II trials due to the thalidomide incident [(in Canada and Europe, women were given the sedative thalidomide, which caused congenital disabilities and in men it can cause sexual dysfunction and gynecomastia (an increase in amount of breast gland tissue in boys or men)]. Studies about drugs’ effects on women were not required for funding until 1994 (NIH). Until a report in 2001, most diseases were thought to have the same symptoms and effects on both men and women, which is untrue. Studies of symptoms were primarily based on people assigned male at birth (Caboral, 2013).
These are only a few of the ways that ableism, ageism, xenophobia, racism, homophobia, classism, and sexism can affect access to healthy food, supportive infrastructure, social environment, employment, physical environment, health systems and services, public safety, education, income and wealth, and housing. For example, trans-masculine people of color experience racism, sexism, and transphobia, which makes it difficult to access both physical and mental health care (Agénor et al., 2022). Often times, determinants combine into something more. The misogyny, racism, and sexism that Black women face is an example of one such topic.
Conclusion
STEM fields, CEFHEW, and public health complement one another in many ways. For example, Cooperative Extensions programs help to translate STEM research into practice and deliver it to communities in a way that is accessible and relevant to their needs. Public health professionals use data and research from STEM fields to identify and address public health priorities. STEM research leads to innovative public health interventions. These paragraphs have also broken these determinants into stand-alone, siloed instances when everyone is at the intersection of multiple identities. Future research should consider the amount of funding each of the LGU’s receive to conduct their missions, increased education of the CEFHEW, more qualitative and quantitative method studies surrounding the awareness, influencing factors, and relationship between CEFHEW, STEM, and public health.
Author Note
We have no conflicts of interests to disclose.