A Hidden Barrier to Health Equity
Imagine two children learning about health and science. One sees scientists and doctors who look like them in their books and lessons, feeling a sense of belonging and possibility. The other encounters mostly unfamiliar faces, unconsciously receiving the message that certain fields aren't for them. This isn't just about representation—it's a public health issue with far-reaching consequences.
Racial disparities in children's health are not accidental; they're woven into the very fabric of our systems, including the educational materials and literature that shape young minds. From medical textbooks to children's storybooks, unequal representation persists, creating what experts call a "hidden curriculum" that reinforces inequality 1 . The stakes are immense: these early experiences influence not only children's health outcomes but also their future career paths and their trust in healthcare systems. The good news? Researchers and educators are developing innovative approaches to tackle this problem at its roots.
The "hidden curriculum" in educational materials reinforces racial inequality by underrepresenting certain groups in health and science content.
Children's literature, particularly science and health books, predominantly features white main characters 1 . This lack of diversity creates a silent narrative that excludes children of color from seeing themselves in health-related roles. When lectures, textbooks, and case studies consistently underrepresent certain racial groups, they perpetuate a cycle where minority children struggle to imagine themselves as future doctors, researchers, or scientists.
This representation gap forms part of the "hidden curriculum" in medical and health education—the uncritical aspects of training that include unequal representation in educational materials 1 . Just as this occurs in medical schools, it also happens in children's literature, shaping perceptions from an early age.
Data based on analysis of popular children's science books 1
The consequences of racial disparities in health begin early and persist throughout life. Research shows that early childhood health is a critical determinant of adult wellbeing, influencing physical and mental health outcomes decades later 3 . The racial disparities observed in childhood don't merely disappear; they often widen over time.
Black children have the highest reported prevalence across multiple health indicators 2
Black-white disparities in conditions like asthma have grown significantly larger over time 2
Children from marginalized racial groups often experience clusters of health and developmental problems 3
To address these disparities, a team from the University of Southern California partnered with nonprofit publisher Room to Read to create the STEAM Powered Careers book series, including a specific oncology book designed to combat racial disparity in health education 1 .
The project employed several innovative approaches:
The methodology was deliberately crafted to practice culturally relevant pedagogy. As the researchers noted, they created the characters "to represent the students we wrote the books for," developing three main protagonists: Cora as a Black female, Jae as an Asian male, and Mia as a Latina female 1 .
Demographic breakdown of schools participating in the oncology book project 1
The oncology book addressed cancer symptoms, uncontrolled cell division, metastasis, prevention, treatments, and how to support someone with cancer 1 . It also debunked myths about cancer and featured various oncology treatments, including chemotherapy, surgery, and radiation 1 .
The response from educators was telling. One second-grade teacher shared a powerful testimony about losing a first-grade student to cancer and struggling to explain the illness to the class. She described the oncology book as a "full circle moment" that presented cancer in a "student-friendly way that allows the child to understand the science" 1 .
The project demonstrated that diverse representation in educational materials serves multiple purposes: it educates about health topics while simultaneously encouraging children from underrepresented backgrounds to envision themselves in health science careers.
Racial disparities in public health education extend beyond literature to encompass the entire educational system. Research reveals that school funding inequities often leave districts with predominantly Black and Hispanic students with significantly fewer resources 5 8 .
These disparities manifest in multiple ways:
The COVID-19 pandemic exacerbated these existing inequalities, with Black and Hispanic students experiencing greater learning loss and facing technological barriers to remote learning 5 8 .
Addressing these deep-rooted disparities requires comprehensive strategies. Evidence points to several effective approaches:
Studies show that Black students randomly assigned to at least one Black teacher were 9 percentage points more likely to graduate high school 5 .
Incorporating diverse perspectives and materials into curricula increases engagement and achievement among students of color 8 .
Advocating for more equitable funding policies at federal, state, and local levels can address resource disparities 5 .
Replacing punitive discipline with restorative justice approaches reduces disproportionate disciplinary actions 8 .
Percentage point increases in educational outcomes for Black students with at least one Black teacher 5
Combating racial disparity in children's public health education and literature requires more than just good intentions—it demands deliberate action and systemic change. The oncology book project demonstrates the power of representative educational materials, while broader research highlights the need to address funding inequities, disciplinary practices, and teaching methodologies.
True progress toward health equity means creating an ecosystem where every child can see themselves in the story of health and science. It requires acknowledging that the obstacles are not just in textbooks but in the very structures of our educational and healthcare systems. As the research shows, the work must begin early—addressing disparities in childhood can have lifelong benefits for individual health and for creating a more diverse, inclusive healthcare workforce.
The challenge is significant, but the path forward is clear: through collaborative efforts between educators, researchers, publishers, and policymakers, we can build a future where every child has the resources, representation, and opportunity to pursue their potential in health and science.