Targeting COVID-19 disparities in local ESL classrooms

At an institution as strong as UCSF in health disparities research, it came as no surprise to see San Francisco’s Latinx community disproportionately represented among the city’s COVID-19 caseload.

Well-documented health disparities, such as higher rates of diabetes and asthma, are risk factors for serious COVID illness. The risks of exposure are also higher because Latinx people are overrepresented among the ranks of low-paid workers who are now deemed essential. As such, few were surprised to see COVID-19 hit San Francisco’s Latinx community hard.

San Francisco needs effective health messaging to help Latinx individuals and families minimize their risks. This presents particular challenges given that many are English language learners. Among recent immigrants, particularly those with limited schooling, processing the overwhelming deluge of public health guidelines, some of which is contradictory and poorly written, is a huge challenge.

Margaret Handley, PhD, saw a way to turn these challenges into opportunities. Handley, who works to link public health and primary care interventions to address health disparities, recognized that many English language learners could be reached through ESL classes. A half a million students take low-cost state-sponsored ESL classes in California. The students could become sources of quality health information in their social networks – a proven way to reach hard-to-reach populations.

Many ESL classes build English skills by crafting lessons around various real-world contexts, such as shopping or work, that students often need help navigating in English. Students drive the focus of the course by bringing questions they have.

“A lot of what students in the Bay Area bring up are health questions, either their own or because they are the health navigators for their families,” Handley said.

Handley has been collaborating with Maricel Santos, EdD, at SF State since 2005 to provide quality health-literacy content for ESL instructors to include in their classes. In recent months, Handley and Santos began to create a COVID-19 modules with their ESL teacher colleague Maria Jose Bastias, and were awarded $25,000 for it through the University of California Office of the President. They hope the project will lay the groundwork for non-English speaking Latinx and other language groups to make sense of  health information and help shape effective public health messaging on COVID-19.

Students will be asked to survey their friends and neighbors about what they are doing to remain healthy during the pandemic, for instance. Then in class, they will display their results in various types of charts. Seeing their work represented in these common visual media will increase their literacy with data, sometimes called “numeracy.” Flattening the curve is not a simple idea. Many of us who now understand it have benefitted from at least high-school math education as well as a number of infographics in national media outlets, while many recent immigrants have not completed higher education. ESL courses can help English learners access these widely used forms of information as well. 

Existing health-focused ESL lessons include myth-busting activities to help recent immigrants navigate advertising and misinformation. New COVID lessons will address the snake oils being peddled as cures and misunderstandings that may be pervasive in the students’ communities. Students then develop accurate COVID-prevention messages that they think will work well.

Handley knows she may not walk away with robust data from this survey to identify how English learners are or are not protecting themselves from COVID-19 or to magically improve their health outcomes. But the data will be actionable. The surveys students conduct will include quantitative measures. And the data the students provide in can provide further research with a good idea of where to start to try to reduce risk in non-English speaking communities.

Students are likely to share data visualizations and health messages they have helped develop. Their input will help guide public health to find the most effective ways of communicating nuanced health messages into students’ languages and social networks.