In Foundations of Public Health course, the creative sparks fly

"When I am teaching online, I imagine I am having a conversation with a group of three students in my office sitting across the table—that’s the learning environment I am trying to create." – Sue Goldie

Sue Goldie uses outside-the-box teaching techniques to give students a firm grasp of a sprawling field

January 29, 2021 – Colored markers, a sketch pad, and a hefty dose of enthusiasm are some of the essential tools that Sue Goldie brings to her very popular introductory public health course.

Goldie, Roger Irving Lee Professor of Public Health and director of the Center for Health Decision Science (CHDS) at Harvard T.H. Chan School of Public Health, is passionate about giving every student a solid foundation in the principles and science of public health. She developed the first iteration of the course five years ago with Dean Julio Frenk in order to provide incoming students—who arrive at the School with a diversity of educational, cultural, and professional experiences—with a common conceptual framework for thinking about public health. That course took place over three days during fall orientation, but two years ago Goldie created a more comprehensive course, structured through self-paced online multimedia modules that students take the summer before beginning their degree programs.

Goldie cares a lot about pedagogy—which is where the markers and sketch pad come in. In the Foundations course, she focuses not just on the nuts and bolts of public health, but also on teaching it in the most effective way possible. For the latter goal, she draws on her six years as faculty director of the Global Health Education and Learning Incubator at Harvard University (GHELI), a role that has put her at the forefront of developing new pedagogical tools and instructional strategies. 

“This course is special to me not only because I’m committed to ensuring every student is equipped with the public health concepts and literacies to be successful in their graduate studies, but also because the course is a laboratory for how we can design and integrate multimodal learning experiences into conventional curricula,” said Goldie.

According to Nancy Turnbull, senior associate dean for educational programs, the course’s secret sauce may well be Goldie herself. “Sue is widely acknowledged as one of the most extraordinary teachers in the University,” said Turnbull. “I think she’s passionate and brilliant, and an innovative educator. You could not have picked anybody better to teach the course.”

Onscreen, Goldie is vibrant, frank, and personal in her delivery. At the outset, she shares her own circuitous path to medicine and then to public health. “My first love,” she admits, “was martial arts.” She encourages students to embrace “being a student” and reassures them that it’s okay to not know exactly how their degree will influence their career paths.

Allie Liss, an MPH student in health policy, admits that when she first heard about the timing of the Foundations course, she was less than thrilled. “My first thought was, ‘Really? In the middle of a pandemic? You just told me I have online classes and now you’re making me do one over the summer?’”

But that feeling didn’t last long because Liss found the course so interesting and engaging. “Not wanting to turn the class off was definitely an issue,” she said. “Sometimes I would think, ‘I wish I could spend 10 more minutes listening to the next lesson.’”

Other students were also surprised by how much they enjoyed the course.  “Even though the course wasn’t live, it felt that way because it was so engaging,” said Caroline Shannon, an architect who is earning an MPH in health and social behavior. “It became the nightly entertainment for a while this summer in our house.”

Building a foundation—with joy

Before the creation of the Foundations course, “the only common academic experience that students at the School shared was a requirement to take biostatistics and epidemiology,” said Turnbull. “Those are obviously very foundational disciplines to public health, but it was possible, depending on what program you were in, to graduate from the school with a very incomplete picture of public health.”

When the course was first offered in 2015, Frenk had already left the School to become president of the University of Miami. But he returned that year to teach it alongside Goldie. She and Frenk taught that first course in Kresge Cafeteria during orientation, over three mornings, in two sections of roughly 200 students each. “Julio and I ran around like talk show hosts,” said Goldie. “It was hysterical. Every table had markers, paper, pads.”

Julio Frenk-Sue Goldie
Goldie and former Harvard Chan School Dean Julio Frenk teaching the first version of the Foundations course in Kresge Cafeteria during orientation in 2015

Goldie felt that compressing material into three days during orientation week was not pedagogically the best way to learn. She expanded the curriculum to meet new accreditation requirements and build a course architecture that would provide students with more support and flexibility. Working with her teams at GHELI and CHDS, she designed, pilot-tested, and refined multimedia that would not only be pedagogically effective, but that would create an open and inclusive learning environment. Students now complete four online modules asynchronously over the course of the summer, followed by an in-person component when they arrive in the fall (last year that session was virtual due to the pandemic).

The course presents information in 10- to 15-minute chunks and includes Goldie’s signature colorful sketches, featuring words, numbers, simple drawings of people, animals, viruses, vehicles, cities, and more. Goldie starts with the basics, asking students to consider how they would define health, public health, and global health. She explains that public health adopts a population-level analysis, has underlying principles and values, and requires an interdisciplinary approach. She challenges students to consider the interconnections between biology, population, society, and the environment.

“One of the features of our field is that we don’t just identify the problems and investigate them,” she tells the students. “We also ask, ‘How do we respond to them?’”

Goldie emphasizes that understanding public health challenges requires consideration of both health conditions (diseases, injuries, and physiologic states like pregnancy, etc.) and the “conditions” for health (social, economic, political, and environmental factors that influence health). To help students visualize these tightly linked concepts, she draws a diagonal line bisecting a rectangle, with one of the triangular sections representing “health conditions” and the other representing “conditions for health.” Said Shannon, “Having a diagram that clarifies the concept is so powerful. The image of the diagram keeps me from having to memorize things.”

Goldie uses simple line drawings—she calls them “cognitive organizers”—to introduce students to public health concepts

Russell Simons, who’s working on both an MPH in health policy at Harvard Chan School and an MD at the University of Chicago, said that Goldie found an incredibly accessible way to get across the tough-to-grasp concept of “disability-adjusted life years,” or “DALYs”—a population measure that captures both morbidity and mortality. To illustrate the concept, Goldie sketches a line representing the timeline from birth to death in a country with the highest life expectancy in the world. She overlays a simple narrative example, tracking a person over the course of their life, describing an unfortunate taxi accident at age 37, resulting in several years of disability, and then a fatal heart attack at age 65. She identifies two zones on the illustration: the years of healthy life lost due to disability (YLDs) after the accident, and the years of life lost due to premature mortality (YLLs) from the heart attack. Once students grasp that these are the two main components of DALYs, and that they represent the “gap” between the best countries can achieve and what is actually achieved, she discusses the methods and assumptions behind the concept.

Goldie’s visual representation of the concept of “disability-adjusted life years,” or “DALYs”

Goldie finds that drawing sketches is much more effective than simply talking about a concept. “People learn better from words and pictures than from words alone,” she explains. “We have separate channels in our brains for visual and verbal information, and both have limits on how much can be processed at one time.” She says conceptual diagrams help students organize material into a coherent structure, while the process of drawing allows for information to be presented piece by piece, avoiding what is referred to as “cognitive overload,” which can impede learning. She encourages students to take notes in a similar way, sketching along with her. “In addition to being consistent with the science of how we learn, I think that the upbeat design of our studio classroom puts students in a different mindset,” she says, adding, “I find people smile a lot more when we have colorful markers out.”

Reaching out

Goldie says it can be challenging to reach students from a wide range of backgrounds—they could be physicians or recent college graduates, journalists or architects. “How do you find a way to invite that entire heterogeneous community into your room and ensure that each and every one of them is able to meaningfully engage with the content?” she asks. “It’s tough to do.”

The pandemic only made it tougher. To offer context to existing course videos, Goldie recorded more than two dozen additional videos last spring, many of which drew from the health crisis unfolding in real time. “Trying to leverage what is real in your everyday life and what is most salient to you is one of the most effective ways for someone to learn,” she said. She jury-rigged a home studio by placing an iPad in front of her, to film her speaking, and mounting her iPhone overhead, to capture her drawing. She is quick to credit her staff at both GHELI and the CHDS Media Hub, where experimentation and prototyping of pedagogical tools is the daily work. “The pandemic is a stark example of why ongoing innovation and pedagogical experimentation in the digital space is so important,” she says.

At home, Goldie uses an iPad mounted in front of her and an iPhone mounted overhead to capture her drawing in action

For Goldie, the Foundations course is a work in progress. She recently completed a series of videos on pandemic risk and is working on new materials focusing on climate, environment, and health for the summer 2021 version of the course. In addition, Goldie is considering a number of course models in which opportunities for engagement could continue during the academic year. Even now, the “classroom” portal within Canvas—the online platform where Harvard Chan students can access their course websites—provides a whole host of resources curated for students to use all year, ranging from glossaries and tip sheets to resource packs from the GHELI repository.

Goldie was disappointed that she didn’t have a chance to meet her students in person this fall. While she admits that it is hard to recreate the energy of a dynamic classroom in an online environment, she insists that faculty should be striving to create digital “learning spaces” that promote social connection without physical presence. “When I am teaching online, I imagine I am having a conversation with a group of three students in my office sitting across the table—that’s the learning environment I am trying to create,” she says. “When I talk to the students, I want them to feel I am present, and that I’m speaking with them from the heart.”

Karen Feldscher

photos courtesy Sue Goldie