By Donald Gilpin

Facing the daunting challenges of remote teaching during the pandemic, Princeton School of Public and International Affairs (SPIA) Lecturer Heather Howard, who is also director of state health and value strategies with Princeton University’s Center for Health and Wellbeing, not only managed to engage the students in her course, Health Care for Vulnerable Populations in the U.S., she also led them in a collaborative effort to help New Jersey Department of Health Officials (NJDOH) combat COVID-19 and systemic racism.

“We had two pandemics converging: COVID-19 and the reckoning with racial injustice,” said Howard. “Students were eager to bring these issues into the classroom.” Or at least into the Zoom sphere.

Former commissioner of health and senior services for New Jersey and a former Princeton councilwoman, Howard described the class assignment that started the discussion and led her students to create detailed proposals that they eventually presented to a  Zoom gathering of a dozen senior staff at the NJDOH.

“We started this by asking: ‘Is COVID an equalizer or a magnifier?’’ said Howard in a February 6 phone interview. “Usually you think that a communicable disease is an equal opportunity infector. It doesn’t know class, race, or other traditional boundaries. But we ended up concluding that the pandemic was not an equalizer but instead was magnifying and preying on inequalities, so that class and race and privileges protected people and COVID was preying on those inequities.”

Howard, who redesigned her course curriculum in shifting the focus from state health policy generally to policy addressing health issues in the pandemic, called on her class of 11 juniors majoring in SPIA and working on their 25-page junior papers to work towards health policy solutions for the state of New Jersey.

“Making the subject matter so current and relevant was really helpful,” she said. “It’s that much more engaging when you’re talking about something that is so topical, especially bringing in the reckoning on racial justice. Students have been living in the same moments we’ve all been living in with this reckoning, and bringing that into the classroom and applying that was really meaningful.”

Howard acknowledged the difficulties in making connections on Zoom, but she carried out two strategies that helped. First, she was able to hold office hours in her backyard during the fall months for students who lived in the area or were staying with friends in nearby rented houses. “Even sitting 10 feet apart with masks is still connecting in a way that you can’t connect electronically,” she said. 

“Also, I’ve gotten better at Zoom, and the University has been very helpful,” she added. “Princeton has done a lot of training for the faculty, and we’ve found some ways to make the most of the technology.”

Howard described some of the students’ proposals. “One student looked at how New Jersey was faring compared with other states at depopulating jails and prisons and came up with proposals for the most efficient and fair ways to depopulate jails and prisons,” she said.  “One of the course themes was that people in congregate living situations are at greater risk for COVID. We know that from long-term care settings, but also from prisons and for migrant farm workers.”

She cited another student who investigated ways to protect migrant farm workers, who tend to live in dormitories or other very close quarters and because of their immigration status are reluctant to interact with the health care system. “He found that Michigan was doing a very good job of protecting migrant farm workers and recommended that the state of New Jersey learn from Michigan,” she said.

Two of Howard’s students worked at long-term care (LTC) centers, investigating, among other issues, what can be done to create isolation wards for people who have been discharged from the hospital and tested positive for COVID. She noted that about 40 percent of COVID-related deaths have been at LTCs. 

Another student in Howard’s class researched the subject of inequity in addressing the Black maternal mortality crisis, which has been a focal point for New Jersey Gov. Phil Murphy.  Howard pointed out that Black women are five times more likely to die from pregnancy-related causes than white women, and Howard’s student investigated how the pandemic might have affected that situation. 

The student developed a perspective on ways that the state could support at-home birthing as a possible means of promoting safer birthing options during the pandemic. She proposed expanding Medicaid coverage for home births and midwives to make them more affordable and accessible.

“I am so proud of the work they did,” said Howard. “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.”

She went on, “The health department officials were very impressed with how thoughtful and specific the students’ research was. One of the staffers even asked to follow up with one of my students to find out more about their research, and they asked to read the students’ final papers, so I shared the papers with them.”

Howard noted that on many of these issues the NJDOH was already doing many of the things that were proposed, but they were limited by time and budget constraints. New Jersey was one of the first states hit by the pandemic, and officials had to learn on the job. “The tragedy of learning by doing,” Howard said.  “In many instances they responded to the students’ proposals saying, ‘Yes, we’re going to be doing that.’”

Delving into problems affecting LTCs, including staff shortages, lack of personal protective equipment, and care requiring close contact, Emma Davis, a junior and SPIA concentrator, studied the data, pored through newspaper articles, and conducted interviews. 

“The lacking federal response wasn’t bad at its root because states could shape policies according to their populations and resources, but it led to avoidable mistakes,” she said.  “There is clear evidence, for example, that if these facilities had been warned earlier about the threat of COVID-19, actions could have been taken sooner to prevent spread.”

Her proposals to the NJDOH included targeted testing and isolation of sick patients, higher wages to bolster staffing, and a prioritized vaccine protocol for staff and patients.

“The highlight of the course for me was presenting our research topics and policy recommendations to New Jersey health officials and discussing barriers to policy implementation into communities,” Davis wrote in an email. “Understanding the complex structures in place, such as states balancing their budget at the end of each fiscal year, was by far the most valuable learning experience for creating effective policies.”

Additional funding to assist Howard in redesigning the course came from Princeton’s 250th Anniversary Fund for Innovation in Undergraduate Education.