Objects in the Mirror are Closer Than They Appear: The Global Health Threat of International Conflict

This unit was created by Amy Frontier, a high school english educator in Ann Arbor, Michigan, as part of the 2024 Pulitzer Center Global Health Teacher Fellowship program. It is designed for facilitation across two to three days.

For more lessons created by Pulitzer Center Teacher Fellows in this cohort, click here.

Lesson Overview:

This lesson helps students understand the ways that anti-microbial resistance is growing during conflicts around the world and imagine approaches to advocate for soldiers to receive testing and treatment. This lesson also explores how to raise awareness in order to prevent future global health crises.  

Why teach this lesson?

This lesson offers students an extremely relevant topic since they all have a memory of the impacts of the global health crisis brought on by COVID-19.  In addition, students will have a vested interest in connecting distant historical stories about disease brought on by war to a global health story that is more current and has the potential to impact their lives. The lesson will offer students both an understanding of an underreported story that they are likely not familiar with, but also a way to take action to prevent a future global spread of infectious disease. 

What skills and themes are explored during this lesson?

Students will read about an important global health threat - AMR - and increase their understanding of what it is and why it matters. They will activate prior knowledge about infectious disease during wartime conflicts and in refugee settings, and consider whether these are concerning global health issues and participate in discussions about their findings. Students will also have an opportunity to make connections to other texts, history, and topics that they have previously experienced. Finally, students will synthesize their previous knowledge and the Pulitzer Center global health story into an advocacy letter, an informational flyer, or an informative video.

What is the pedagogical vision?

As students learn about historical events, one lens through which they can view history is a global health lens. This lesson will allow students to learn about the health impacts of war in the past and present, and also learn how they can use their understanding and voice to advocate for more action to prevent the global spread of AMR. 

In this lesson, students explore how an international conflict can impact global health and explore advocacy approaches to raise awareness about this issue.

Essential Questions

• What are the public health impacts of war on soldiers and refugees in regions of conflict?  
• How can disease emerging in war zones have a global health impact?  
• How can we raise awareness about the potential for a global health crisis resulting from disease borne out of war and conflict?

Performance Task(s):

Students choose one of the three options.

Option A: Students will draft a letter or email to an appropriate recipient that synthesizes the texts they are reading with the global health story.  The letter will advocate for more attention to the global threat of AMR, especially cases that originate in conflict zones. It will also allude to historical conflicts, stories of war, and the ways that a changing world demands more attention to this global health threat.  Students will utilize a letter template that is a modified version of the Pulitzer Center’s Local Letters for Global Change template. 

Option B: Students will develop a flyer with an infographic, quotes, and images to raise awareness about the ways that wartime conflict afar is contributing to the spread of AMR and how their peers can take action to alert appropriate people in power.  Their flyer will also allude to historical conflicts, stories of war, and the ways that a changing world demands more attention to this global health threat. 

Option C:  Students may develop a short video story to inform others about AMR, the fact that it is an increasing global threat, and what their audience can do to raise awareness and combat this problem before it becomes a crisis.   The video will also allude to historical conflicts, stories of war, and the ways that a changing world demands more attention to this global health threat. 

Assessment:

Use the Global Health Advocacy Mini-Project Rubric[.docx][.pdf] to assess student work. 

Notes on Context & Content Advisory:

This lesson was taught while reading Between Shades of Gray, a novel by Ruta Sepetys.

This lesson will address how infectious diseases and antimicrobial resistance spreads during war and in conflict zones.  As some students have personal connections to the story (ie, refugees from Ukraine, Afghanistan, or other parts of the world), special attention should be taken for those students or those with close connections to folks who have had military injuries or health impacts as a result of time served.

This lesson was designed for an 12th grade Contemporary World Literature class. Facilitation is suggested across two to three days This lesson plan includes pacing, texts and multimedia resources, teacher-created resources, suggestions for implementation, and rubrics for assessment.

Teacher Reflection

When I first considered the best way to integrate a contemporary global health article into a 12th-grade World Literature unit on World War II, I was concerned students might find it to be a bit of a stretch.  After all, I was asking them to examine the brief references to illness during the deportation of Lithuanians in 1941, then step outside of the text and into a different century with a very different illness landscape. But I was hopeful that they would be willing to make this leap, especially since their memory of life during a pandemic continues to occupy their minds.  

Since most of my students, 17 and 18-year-old students in Ann Arbor, Michigan, spent an entire school year learning in isolation at home, then wore masks to school for the next year of in-person school, I thought they might be able to make the leap. More than any other generation for over a century, these students know the impacts of a pandemic. They understand the fear of illness, the loneliness and isolation of lockdowns, and the long-lasting global impacts of a pandemic. So I decided to draw the proverbial dots between our 1941 Lithuanian text and the 2024 Pulitzer Center article. As I hoped, they connected the dots and embraced the concept of reading the World War II text Between Shades of Gray through a global health lens. Their reading of the Pulitzer Center story “Could a Conflict-Borne Superbug Bring on our Next Pandemic?” indeed hit close to home, and they eagerly got to work raising awareness and advocating that more attention and funding be allocated to this issue.  I also knew that many of my students plan to go into science or health-related fields of study after high school, and I imagined that reading literature through a global health lens would tap into their interests and areas of expertise.  

The lesson itself was fairly straightforward. After previously emphasizing that Between Shades of Gray novelist Ruta Sepetys sought to bring light to underrepresented history, I eased into the idea that we would continue to explore underreported stories via the Pulitzer Center’s work. Once we reached the point in the novel where characters began to suffer the health consequences of deportation and work camps, I introduced the concept of reading through a global health lens. Students brainstormed infectious diseases that are most likely to spread during conflicts, reviewed excerpts from the novel in which disease is present, read blog posts about infectious disease spread during conflicts, and studied maps of contagion.  Next, they read the Pulitzer Center article, answered content-related questions, and reflected using critical thinking prompts.  Finally, I introduced a global health advocacy project and asked them to bridge the divide between conflict-borne disease from the past with that of the present, as mentioned in the article. 

Their reflections offered immediate insight into the power of the article’s story.  One student reflected, “One concern I have is that people or officials won’t take this issue seriously until it is too late. AMR is a threat, and I believe that people who suffer from it or have loved ones who suffered should speak out.”  Another student wrote, “I realize that I still have a lot to learn about the world of medicine and how war affects it.  Just because a country “won” a war doesn’t mean that the country doesn’t bear the effects of the war.  I learned that disease can escape war and lead to widespread infection if not addressed immediately.”  Many students also reacted with fear, using phrases like, “I am concerned,” “this is scary,” and “it sounds very dangerous.”  While fear and concern were common reactions to the article, many concluded their reflections with calls to action.  One student wrote, “more needs to be done,” and many others commented on the importance of AMR awareness, screening, and preventative work.   

"Just two weeks later,  I introduced a more involved research project during which students identify and research a person who is making a difference in the world.  As I walked around the class, several students shared that they planned to choose a person who is making a difference by advocating for global health in their home country."

Amy Frontier, HS ELA Teacher

As we moved from education to advocacy, students were offered the option to compose a letter, design a flyer, or record a video.  Students worked alone or with a partner, and their products reflect their knowledge, personality, and area(s) of expertise.  One student, upon learning that she could use Canva to create an infographic-style flyer, said, “Oh, this is going to be so much fun.  I love creating flyers.”  Another student said, “I felt that writing a letter best allowed me to explain the connections I made between the text of Between Shades of Gray and the Conflict-Born Superbug article.”  Students who worked with a partner found that they developed closer relationships and a sense of community, whether it was because they could teach and learn design skills from their partner or because they had to record multiple takes of a video after catching the giggles mid-video. When I asked students to “like” and comment on their choice for the top three most effective advocacy projects, I was pleased to see that students made comments that were respectful and truthful.  I also enjoyed reading a few young men’s comments on their own muted presentations; they accidentally left their microphone off during their recording and commented on how much they enjoyed the audio portion.  There’s nothing like a project with bloopers, outtakes, and a bit of humor.  Needless to say, they did indeed re-record their presentation, and the third take was a charm (with a few bloopers mid-video).  

Developing and implementing this lesson emphasized that students are eager to learn about real-world, contemporary issues, and are absolutely open to taking a leap from one century to another if the content and task address an important, relevant, and globally significant topic. I was also gratified to watch my students choose to extend their learning after this global health advocacy lesson. Just two weeks later,  I introduced a more involved research project during which students identify and research a person who is making a difference in the world.  As I walked around the class, several students shared that they planned to choose a person who is making a difference by advocating for global health in their home country. 

As I walk away from this global health unit, I hold onto the idea that students can and will embrace what may seem like unrelated readings with just a small nudge.  And perhaps more importantly, they welcome opportunities to use their literacy skills to advocate for issues that may first seem shocking and scary, but then feel a sense of satisfaction and comfort when they can get involved and raise awareness about issues that may at first seem out of their control.  As one student most astutely recorded both in his reflection and advocacy piece, “One concept that I take away from reading Between Shades of Gray and ‘Could a Conflict-Borne Superbug Bring On Our Next Pandemic?’  is that we should open our eyes to underreported stories that may affect us in the future.”  

Finally, in a serendipitous moment, it turns out the students read about and created advocacy projects about AMR during the World Health Organization's World AMR Awareness Week. Needless to say, more than 150 World Literature students were surprised and delighted to learn that their work was unexpectedly part of a larger campaign fighting against a global health threat that they had never heard of before. Next November, I hope to introduce 150 new World Literature students to the ways that they can raise awareness about AMR and other global health threats.  For, as this unit title points out, “objects in the mirror are closer than they appear.”  We hope to make those objects in the mirror disappear entirely.

About Amy Frontier

Amy is an English teacher at Pioneer High School in Ann Arbor, Michigan. This lesson reached 146 12th grade World Literature students. 

Michigan K-12 Standards, English Language Arts

Reading Informational Text, Grades 11-12 

1- Cite strong and thorough textual evidence to support analysis of what the text says explicitly as well as inferences drawn from the text, including determining where the text leaves matters uncertain

7-  Integrate and evaluate multiple sources of information presented in different media or formats (e.g., visually, quantitatively) as well as in words to address a question or solve a problem.

Writing, Grades 11-12

1- Write arguments to support claims in an analysis of substantive topics or texts, using valid reasoning and relevant and sufficient evidence.

2- Write informative/explanatory texts to examine and convey complex ideas, concepts, and information clearly and accurately through the effective selection, organization, and analysis of content.

4- Produce clear and coherent writing in which the development, organization, and style are appropriate to task, purpose, and audience. 

7-Conduct short as well as more sustained research projects to answer a question (including a self-generated question) or solve a problem; narrow or broaden the inquiry when appropriate; synthesize multiple sources on the subject, demonstrating understanding of the subject under investigation.

Advocacy Projects Take Many Forms in Frontier's World Literature Class

 “I realize that I still have a lot to learn about the world of medicine and how war affects it.  Just because a country “won” a war doesn’t mean that the country doesn’t bear the effects of the war.  I learned that disease can escape war and lead to widespread infection if not addressed immediately.” 

12th grade student, Pioneer High School in Ann Arbor, Michigan

Objects in the Mirror are Closer Than They Appear: The Global Health Threat of International Conflict reached 146 12th grade World Literature students. Through close text analysis, discussion, and the advocacy performance task, Frontier's students created over 69 advocacy artifacts including letters to decisions makers, infographics on antimicrobial resistance testing, and informative videos. All artifacts can be reviewed on Frontier's public Padlet. By housing these artifacts on a group Padlet, Frontier also encouraged further discussion amongst peers. Students were able to comment on the impact of each artifact.

On the Padlet homepage, you can:

• View the images as a slide deck by clicking the play button on the right-hand corner
• Open individual artifacts
• Download artifacts individually

Review the full padlet below and expand the view of artifacts at your own convenience.

Option A: Letters Advocating for Change

20 Students drafted letters to decision-makers to advocate for more attention to the global threat of AMR, especially cases that originate in conflict zones. All letters can be found on the class Padlet including this letter address to Representative Dingell by Jayden Song.

Option 2: Raising Awareness of AMR and its Impacts Through Flyers

40 Students or student pairs developed flyers with an infographic, quotes, and images to raise awareness about the ways that wartime conflict is contributing to the spread of AMR and how their peers can take action to alert appropriate people in power. All flyers can be found on the class Padlet including this infographic by Brian Lin and Rio Maglione.

Option 3: Raising Awareness Through Video

6 Students or student pairs developed a short video story to inform others about AMR, the fact that it is an increasing global threat, and what their audience can do to raise awareness and combat this problem before it becomes a crisis

“One concern I have is that people or officials won’t take this issue seriously until it is too late.  AMR is a threat, and I believe that people who suffer from it or have loved ones who suffered should speak out.”

12th grade student, Pioneer High School in Ann Arbor, Michigan