The following is an audio transcript of the video lesson plan Unfair Race.

Hi, I’m Carol, and I’m going to share with you the lesson Unfair Race. This lesson looks at public health and its economic, social, political, and geographic dimensions. Because there are different conditions in different countries, a person’s health will be influenced by where they live.

By the end of this lesson, students will be able to: explain how a country’s economic and social conditions can impact public health; identify indicators associated with both positive and negative health outcomes for a country’s residents; and discuss the relationship between health spending and universal health coverage.
This is an excellent activity for high school social studies, including AP human geography, geography, health, and economics.

Part One: The Race
To prepare for part 1, you’ll want to secure a large, open space. You can move around the desks in your classroom to make space, but a gym or outdoor space would work well too. To start the lesson, line students up shoulder to shoulder in a straight line to form the “starting line” of your race. Each student should get one of the 24 Country Cards provided in the lesson plan.

Each of these Country Cards has ten quality of life indicators on it. Some of these topics may be new to your students, so it helps to go over definitions before or during the activity.

Using the Race Instructions Teacher Script from the lesson plan, you’ll go through each statistic with students. This script will prompt students to move forward, move backward, or stay still based off of the value of each indicator on their Country Card.

For each indicator, use the following four steps:

First, read the bolded topic from the Race Instructions. For example, the first topic is Gross National Income per capita.

Next, ask students to brainstorm how this topic relates to health. Sticking with GNI, your students might mention that countries with a lower per capita GNI have a greater proportion of the population experiencing poverty, and people are more likely to live in unsafe, unsanitary conditions with greater exposure to environmental or industrial toxins. The country’s residents might not be able to afford fresh produce so rely on fast foods, and they could be less likely to see a doctor when they are ill or be able to afford expensive medical treatments.

After that, you’ll read the full statement and instructions for that indicator from the Teacher Script, and your students move forward or backwards according to their country’s stats. Using our example, I’ll read:
Gross National Income (GNI) per capita: If the per capita GNI in your country is: more than $40,000, take two steps forward. If the GNI is between $10,000 and $39,999, take one step forward. That means if a country’s GNI is less than $10,000, the student will not move.

The second indicator is average annual health care spending, which includes both public and private care. Discuss with students how health care spending can impact overall public health. Then, read the instructions to your students, “If average annual health care spending is more than $3,000 per person, take two steps forward. If it is between $1,000 and $2,999 per person, take one step forward.” Once or twice during the activity, have students take a moment to look around the room and notice where each country is located.

I’m not going to go through all ten indicators, but I will let you know that the remaining indicators are:

    • The percentage of people immunized against measles.
    • Number of physicians per 100,000 people.
    • Average life expectancy.
    • Access to clean drinking water
    • A child’s chance of reaching their 5th birthday.
    • Maternal mortality rate
    • Malaria threat
    • And the adult literacy rate.

One thing I especially like is that while some of the indicators have obvious connections to health (like the number of physicians) others will take a bit more critical thinking to determine cause and effect (like the literacy rate).

Students may have noticed that the Country Cards are different colors. At the beginning of the race, the meaning of the colors will be unclear. But once you’ve gone through all 10 indicators, students will see that certain colors are closer to the front of the race while others are at the back. These colors represent the countries’ World Bank income classifications.

If you’d like, you can now challenge the group to a foot race. Choose a “finish line” a few paces in front of the students who have stepped furthest forward and explain that this finish line represents a high level of public health. Who do you think will win the race? Well it will probably be the students representing countries with higher incomes because they started with an advantage, they were already close to the finish line.

We offer a variety of discussion questions to help debrief this activity with your students. For example, you can ask: “What are some major impediments to good health and good health care?” Students might say low per capita income, or lack of clean water, or malnutrition. You might also ask them, “What kind of changes would improve the quality of health for countries that stayed further behind during the race?” Answers could include improved economic conditions, improved environmental conditions like clean water, or social programs like expanded education.

Throughout it all, students will be considering: Why is there a relationship between wealth and health?

Part Two: Universal Health Coverage
In the second part of this activity, students explore the idea of Universal Health Coverage. The Student Worksheet included in the lesson plan introduces students to this idea and provides some graphs and statistics to help students develop their opinions. It’s a great opportunity for students to authentically practice map and graph interpretation. The worksheet then provides the basis for a short class discussion on healthcare spending and its relationship to health around the world.

And that’s the activity Unfair Race. To get the full lesson plan, and explore many others, visit our website,