The Last Straw!: A Tool for Participatory Education About the Social Determinants of Health

Background: In response to a scarcity of teaching tools regarding the social determinants of health (SDOH), Kate Reeve and Kate Rossiter created The Last Straw! board game, an innovative participatory education tool to facilitate and engage critical thinking about the SDOH.

Objectives: The Last Straw! is designed to encourage discussion about the SDOH, promote critical thinking, and build empathy with marginalized people.

Methods: The game begins as each player rolls the dice to create a character profile, including socioeconomic status (SES), race, and gender. Based on this profile, players then receive a certain number of “vitality chips.” Moving across the board, players encounter scenarios that cause them to gain and lose chips based on their profile. The player who finishes the game with the most chips wins the game. The game can be facilitated for a variety of audiences, including both players with no prior knowledge of the SDOH and those experienced in the field.

Conclusions: The game has been played with students, policymakers, and community workers, among others, and has been met with immense enthusiasm. Here, we detail the game’s reception within the community, including benefits, limitations, and next steps.