As Heather Howard, a lecturer in public affairs, was planning for her fall course “Health Care for Vulnerable Populations in the U.S.,” she considered not one but two pandemics. And she knew she had to retool the course, which she has taught since 2018, to seize the moment.

“We had two pandemics converging: Covid-19 and the reckoning with racial injustice,” said Howard, who is also the director of State Health and Value Strategies with Princeton’s Center for Health and Wellbeing (CHW). “Students were hungry to bring these issues into the classroom.”

With a grant from Princeton’s 250th Anniversary Fund for Innovation in Undergraduate Education, Howard redesigned the course curriculum to examine the intertwining dynamics of Covid-19 and systemic racism — shifting the focus from general state health policy to policy specifically addressing health disparities exacerbated by the pandemic.

The course fulfills a requirement for students who are concentrating in the Princeton School of Public and International Affairs (SPIA), allowing juniors to explore inequities within the American health care system and propose policy solutions for the state of New Jersey.

Restructuring a Course in Real Time to Reflect Ongoing Events

As a central theme of the course, students investigated how the pandemic has disproportionately affected communities of color. They studied how states have responded to Covid-19 — from expanded access to testing and health insurance to supporting struggling “safety net” providers — along with the role of federalism, or federal-state relations.

To reflect the evolving nature of the pandemic, Howard — a former commissioner of health and senior services for New Jersey — developed innovative strategies that would work in a virtual learning environment. Each week, students tackled a specific topic through robust discussion, debate, and exercises. For example, they took a shot at balancing California’s budget to further their understanding of fiscal constraints facing states. And they analyzed state, county, and local Covid-19 data to uncover racial and ethnic disparities in disease outcomes.

Each student also pursued independent research on a policy issue related to Covid-19 or health equity in New Jersey, culminating in group policy proposals, which the class presented to more than a dozen officials at the New Jersey Department of Health through Zoom.

“I am so proud of the work they did,” Howard said. “Each topic was compelling, and I was impressed by their ability to dive deep and grapple with the challenges and tradeoffs in implementing health policy, especially during a pandemic.”

Researching the Impact of Covid — from Migrant Workers to Black Mothers

Emma Davis, a member of the Class of 2022 and a SPIA concentrator who is also pursuing a certificate in gender and sexuality studies, delved into the problems affecting nursing homes and other long-term care facilities, from staff shortages to care requiring close contact and lack of personal protective equipment.

“The lack of a strong federal response allowed states to shape policies according to their populations and resources, but it also led to avoidable mistakes,” Davis said. “There is clear evidence, for example, that if these facilities were warned earlier about the threat of Covid-19, actions could have been taken sooner to prevent spread.”

Looking ahead, Davis has lined up a summer internship at the State Department and is considering a career in policy to help the nation’s vulnerable populations.

Jacob Barber, a member of the Class of 2022 and a SPIA concentrator who is also pursuing certificates in global health and health policy and statistics and machine learning, researched a topic of personal interest. “My family is quite involved with the food movement, so I focused my project on how the pandemic has affected agriculture, food insecurity, and migrant labor in New Jersey,” he said.

He found that New Jersey mandated Covid-19 testing in long-term facilities, for both staff and residents, but farms could opt out of testing their workers. His policy recommendations included a compulsory Covid-19 testing program for New Jersey farms, educational materials related to the pandemic that account for language and literacy barriers, and enforceable safety measures and quarantine procedures.

Turquoise Brewington, a member of the Class of 2022 and a SPIA concentrator who is also pursuing certificates in Spanish and African American studies, focused on Covid and birth equity. Her proposals sought to improve outcomes for Black mothers by expanding Medicaid coverage for home births and midwives to make them more affordable and accessible.

“Black women in New Jersey are seven times more likely to die in childbirth than white women,” she pointed out. “And the pandemic has only worsened this crisis.”

Brewington plans to expand on her research for her senior thesis. “The course definitely clarified my interest in combatting health disparities, particularly within the area of maternal health,” she said.

Editor’s note: For the full version of this story, visit the Center for Health and Wellbeing website.