Public Health Politics and Policy: Global and Domestic Perspectives (PAD 653/453, HHPM 651) Spring 2019 (online) _________________________________________________________________ _____________ Instructor: Ashley M. Fox, PhD, MA Skype id: ashfoxly Office Hours: Online 10am-12pm Thursday and available for Skype Call Course Description and Objectives: From the opioid crisis and Ebola quarantines to texting while driving, public health policy permeates our daily lives and is prominent in the news media. Civil libertarians criticize the overreaching hand of the “nanny state” in enforcing paternalistic public health policies while social progressives bemoan the lack of a safety-net and social protections that contribute to entrenched health disparities. This course examines major political factors that shape health policy decision-making and the effect that policy decisions have on either increasing or decreasing inequalities in health among social groups. Specific questions include: What are the major health challenges facing high-income and low- and middle-income countries today? Why are some health conditions more likely to get on the public agenda than others? What types of policy responses are available to reduce health inequalities and why do some health policies actually exacerbate inequalities? Why is it so hard to incorporate clinical and economic evidence into public health policy decisions? When should public health campaigns employ fear and scare tactics versus positive social messaging? This online course explores how policy is used as a tool to further public health goals and examines how political processes 1
Transcript
Public Health Politics and Policy: Global and Domestic Perspectives (PAD 653/453, HHPM 651)
Spring 2019 (online)______________________________________________________________________________Instructor: Ashley M. Fox, PhD, MASkype id: ashfoxlyOffice Hours: Online 10am-12pm Thursday and available for Skype Call
Course Description and Objectives: From the opioid crisis and Ebola quarantines to texting while driving, public health policy permeates our daily lives and is prominent in the news media. Civil libertarians criticize the overreaching hand of the “nanny state” in enforcing paternalistic public health policies while social progressives bemoan the lack of a safety-net and social protections that contribute to entrenched health disparities. This course examines major political factors that shape health policy decision-making and the effect that policy decisions have on either increasing or decreasing inequalities in health among social groups.
Specific questions include: What are the major health challenges facing high-income and low- and middle-income
countries today? Why are some health conditions more likely to get on the public agenda than others? What types of policy responses are available to reduce health inequalities and why do
some health policies actually exacerbate inequalities? Why is it so hard to incorporate clinical and economic evidence into public health policy
decisions? When should public health campaigns employ fear and scare tactics versus positive social
messaging?
This online course explores how policy is used as a tool to further public health goals and examines how political processes shape health policy and health outcomes both domestically and globally. The course is designed to introduce students of policy and politics to concepts and debates specific to the field of public health. Likewise, the course will introduce public health students to public policy concepts and approaches. The course will draw on readings and examples both from high-income and low- and middle-income countries and will explore similarities as well as differences in theories of the policy process pertaining to each.
Through an introduction to theoretical and applied concepts in public policy analysis and political science, students will learn how to assess the political feasibility of different public health policy options and how to craft persuasive policy briefs targeting decision makers at all levels of government. In addition to theory-based material, the course will draw on insights from a concrete set of case studies across a variety of public health policy topics and current events including: obesity policy, sexual and reproductive health policy, and drug policy. Topics may vary based on current events.
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Learning Objectives Define and distinguish key terms and debates in public health policy Assess how political factors shape health policy decisions and their effects on health
equity Discuss different social constructions of disease and implications for health equity Identify how health issues get on the public policy agenda and why health disparities
issues have gotten less attention than other issues Critically compare political processes across diseases and health issues Refine your communication, discussion, writing, and research skills
CLASS EXPECTATIONS
TEXTBOOKNone required. All readings will be posted on BB for corresponding weeks.
Instructor Expectations Online courses are not self-paced. In the Course Learning Activities section, we have clearly spelled out the timeline by which you are expected to complete each learning activity within the space of a week. In order to keep up with the material and the pace of the class, you will need to follow that timeline closely. In addition to receiving a penalty in your grade for late work, submitting work late may contribute to you falling behind in the class and will hinder my ability to give you timely feedback on your work. Keeping up with the course will also be critical to your ability to complete the final paper.
It is also important to bear in mind that as an online course, experiencing technical difficulties will not be considered an acceptable excuse for late or incomplete work, nor will being “away”. If you plan to travel during the course, you should plan to bring a computer with you or arrange access to one and ensure that you will have internet connectivity. We suggest that you develop a back-up plan in the event that your computer crashes or gets a virus, etc. This may mean identifying a library you can go to access a computer, having on hand an old back-up computer or work computer, etc.
For technical difficulties with Blackboard or questions about how to use Blackboard, you SHOULD contact ITS (ITS Service Desk). You SHOULD NOT contact the instructor about technical questions related to Blackboard except to point out that you are having an issue that might affect the timeliness of assignments and provide documentation of such.
We expect your contributions to the Discussion Board to be respectful, have a professional tone, and be written with appropriate spelling, grammar and punctuation (i.e., no emoticons or internet slang). Discussion boards replace in-class discussions. Do not write anything in an online platform that you would not say to someone's face and write at a level of quality of a written assignment that you would turn into a professor. We strongly suggest you write out your posts in a document first, save them, and then copy and paste into Blackboard.
What You Can Expect of the Instructor
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As the instructor for the course, I will also be keeping up with the pace of the course. I will return homework assignments to you within a week (by the following Sunday) and login on Thursdays and Fridays to respond to discussion threads in addition to regularly logging into create announcements, and for office hours, etc.
You are free to email me with questions anytime. Skype meetings may also be scheduled but need to occur during regular business hours Eastern Time (i.e., 9am-5pm).
Netiquette Please observe proper "netiquette" -- courteous and appropriate forms of communication and interaction over the Internet (within your online course). This means no personal attacks, obscene language, or intolerant expression. All viewpoints should be respected.
For more information about Netiquette feel free to visit the following site: http://www.albion.com/netiquette/corerules.html
NOTE: The instructor of this course reserves the right to remove any questionable or offensive material from public areas of this course.
Accommodating Disabilities
Reasonable accommodations will be provided for students with documented physical, sensory, systemic, cognitive, learning and psychiatric disabilities. If you believe you have a disability requiring accommodation, please notify the Director of Disabled Student Services (BA-120, 442-5490). That office will provide the course instructor with verification of your disability, and will recommend appropriate accommodations.
How to find out more:
The University provides a great deal of information on the services it offers to disabled students which can be found on the Disability Resource Center page.
Contact information
Carolyn Malloch, Director of Disabled Student Services [email protected]: (518) 442-5490Fax: (518) 442-5589TTY: (518) 442-3366
Academic Dishonesty: University Policies
Any form of academic dishonesty will not be tolerated. Please refer to University at Albany’s Academic Code at: http://www.albany.edu/content_images/AcademicIntegrity.pdf for the definition of academic dishonesty. Ignorance of these policies will not excuse dishonest conduct.
Violations of these standards will result in one of the following penalties or some variant: reduction in the grade for the assignment, failure of the assignment, failure of the course, or expulsion. In all cases, a Violation of Academic Integrity Report will be submitted to the Dean of Graduate Studies to be placed in your university file, with copies provided to you, the department head, and the Dean of Rockefeller College.
Students may appeal a grade on a specific assignment within two weeks of the assignment being returned. To submit an appeal, the student should return the original graded assignment and a letter/memo outlining why you think the grade should be changed. Appeals must be submitted on paper, typed-written. In the appeal, students must identify 1) the specific issue you believe should be reconsidered and 2) evidence from assignment instructions, assigned readings, lectures, or other materials that would indicate your original submission is worthy of a higher grade. Be aware that your grade may go up, down, or remain the same as a result of your appeal.
Seeking problem sets, answers to problem sets, past exams, or past exam answers from any previous student is prohibited without my expressed, written permission. I will treat such behavior as serious academic misconduct by both the current and past student.
Students with needs consistent with the Americans with Disability Act should inform the instructor during the first week of class so that reasonable accommodations can be made.
Policies for making up missed exams and/or penalties for late submission of assignments
Submitting work on time is critical for keeping up with the pace of the class. In this course, there will be different penalties for different types of late work.
Discussion Boards: Every week there will be a Discussion Board, which takes the place of an in-class meeting session. There is no way to “make-up” discussion board posts that you miss because these are meant to be an interactive exercise and it is functionally equivalent to missing an in-person class. You are allowed to miss up to two weeks of Discussion Board without a documented excuse (see more below). If you miss more than 2 and are able to get documentation that the absence should be “Excused”, the missed discussions will not be counted against you and your missed weeks will be assigned the average of your Discussion Board points.
Critical Reading Reflections (CRR): You are required to submit 4 Critical Reading Reflections during the semester. Technically these assignments do not have a specific due date since you are allowed to select the weeks for which you would like to submit these. There will be no late penalty imposed unless you wait until the last three weeks of the semester to submit your first CRR. At that point, if you submit more than one in the same week, a full letter grade will be deducted for each week that it is late. I strongly recommend you pace yourself with these and plan ahead. They comprise a large portion of your grade.
Final Research Paper: There is no midterm for this course, however, you will be asked to turn in a detailed outline laying out your final paper topic at the midpoint of the semester. This is
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intended to get you thinking about and researching your topic well in advance of the paper due date. A half point will be deducted for each day that the outline is late.The final paper is due the Wednesday of finals. It is imperative that you get this in on time to allow me enough time to grade the papers and submit your grades on time. If you anticipate having a problem getting the paper in on time, please reach out to me and let me know your situation. Beware that a failure to turn in assignments in a timely manner without documentation of extenuating circumstances will not qualify you for an incomplete in the course. If you fail to turn in the paper before grades are due, unless you have a documented excuse, I will be forced to give you a zero on the assignment, which will severely affect your grade (See University Incomplete Policy below). More details on specific penalties for lateness on the final paper will be outlined in the assignment itself.
University Incomplete Policy:
The official University policies regarding incompletes can found here: https://www.albany.edu/undergraduateeducation/grading.php https://www.albany.edu/graduatebulletin/requirements_degree.htm#graduate_grades
Please bear in mind that unless you have documentation of extenuating circumstances, a failure to turn in assignments in a timely manner will not qualify you for an incomplete in the course.
YOUR NEXT STEPS
The Bulletin Board is a discussion area for our class outside the context of a particular course module. Just as you have the opportunity to talk or chat with each other or with the instructor when taking a conventional classroom course, you should also have the opportunity to do the same in a web course. The Bulletin Board is available only to students enrolled in this class to post and/or read messages and respond. These can include questions or comments to other students and me about course material, assignments, readings, etc. It is also a place where you can go to socialize and have open discussion on subjects of your interests.
Meet Your Classmates is where you will introduce yourself to the class. You will find my profile and the profiles of the other students in this course. Your profile will help us get to know each other and begin to build a sense of class community, so please feel free to personalize your profile by attaching a digital image of yourself. Since profiles will be posted as people join the course, you may have to return to Meet Your Classmates several times during the first few weeks of class to read the latest entries.
As your next steps, click on the Discussions link (on tool bar on the left) and complete the following tasks:
Click on Bulletin Board. Post an item to start a discussion or read other students' responses, if there are any, and respond.
Click on Meet Your Classmates. Select the Create Message button and be sure to enter your name in the subject field. Write something about yourself, attach a photo and select the Post button to submit.
When you have completed these two tasks, you are ready to begin the first module of the course under the Course Content link (tool bar on the left).
Course Learning Activities and Grading
Course gradingWeekly Reading Comprehension Checks 120 points (10 points each); 27% of gradeWeekly Discussion Posts and Replies 120 points (10 points each); 27% of grade4 “Reflection Papers” on the Readings 100 points (25 points each); 22% of gradeFinal Paper Detailed Outline 10 points; 2% of gradeFinal paper 100 points; 22% of gradeTotal points 450 points
Bonus PointsCourse Feedback Survey (Midpoint and End of Class, last week) 20 points (to be added to final grade)
NOTE: There is no midterm in this class. Small cumulative assignments count for far more of your grade than large assignments. Therefore, it is critical to stay focused and engaged every week.
Course Learning Activities
Class Readings. This is a reading intensive course that relies heavily on the assigned readings for all assignments including discussions posts. As we have no in person meetings, the readings may be a bit more extensive than you are used to but bear in mind that you have an additional 4 hours of free time each week than you would if this were a face-to-face course. The readings have been carefully selected to be provocative and to introduce core concepts in the field. Some of the readings are older and may be considered “classics,” while others are more recent and may be assigned to highlight the empirical evidence on a topic or represent more recent developments in the field. Some readings will be from the popular press and investigative reports on a topic. Each week I provide an annotated bibliography of the assigned readings that explains why I have selected them and what concepts they are intended to illustrate and what I want you to take away from that week. The slides each week further reinforce key points from the readings. These are not a substitute for actually doing the readings, but are a helpful guide to highlighting salient points. The readings elaborate much more extensively and contain far more information, which you will need to draw upon in your weekly discussion posts and other course assignments to succeed in this course.
Assignment expectations will vary depending on the level of student enrolled in the course (i.e., undergraduate, masters, doctoral). For undergraduate and masters students taking this course, if a research article is assigned that contains an empirical component (i.e., methods, results, etc), you may skip those sections and focus on the Background and Discussion sections. The goal of the readings is not for you to evaluate the sufficiency of the methodological
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approach but rather the theoretical and ethical arguments that the articles are putting forward. For doctoral students, you will be expected to be capable of understanding the Methods portion of empirical papers or additional assigned reading and to be capable of commenting on empirical debates within the field.
In addition to the weekly readings, there will be Video Resources that you are asked to watch certain weeks. These are will not necessarily be lecture recordings, but rather are outside videos that are helpful in elucidating key concepts discussed in the weekly readings. You will be required to watch these and can incorporate them into your Discussion Posts or Critical Reading Reflections in the same way as you would a reading assignment.
Weekly Reading Comprehension Checks (12 assessments at 10 points each). Every Tuesday you will be required to complete a weekly reading comprehension assessment (due by 11:59pm ET). These will consist of 5-10 multiple choice questions that draw on concepts from the readings. These are graded, but you will granted unlimited time to complete them and you will have the opportunity to retake the assessment and update your answers. The scores of your first and second attempts will be averaged. As a consequence, it does matter that you attempt to get the right answers the first time, but you will have the chance to improve your score on the second attempt. I fully anticipate everyone being able do well on these as long as you take the time necessary to complete them. The goal of the reading assessments is not to “quiz” you per se so much as to help you to focus in on key concepts and core ideas from the readings. The reading load for this course is heavy and represents the majority of work for the course. The assessments aim to keep you on track and progressing at a pace that will enable you to post your Discussion Post on Wednesday. At the end of this document is a course schedule that summarizes key due dates each week. While there are 14 weeks of content for this course, I will only count 12 of your reading comprehension checks.
Given that I will only count 12 of the Reading Comprehension checks, this allows you to be able to miss up to 2 without penalty. However, because I am allowing this, I will be very strict about enforcing the deadline that these need to be completed by 11:59 pm on Tuesday. Please use this lifeline sparingly and do not abuse it early in the semester.
YOU WILL NOT BE ABLE TO ACCESS OTHER MODULE MATERIAL (I.E. PPT SLIDES OR DISCUSSION PROMPT) UNTIL YOU HAVE COMPLETED THE READING ASSESSMENT.
Weekly Discussion Posts and Replies (12 Discussion Posts and Responses at 10 points each 250-500 words): Each week the instructor will pose a critical, policy relevant question and ask you to react using the week’s readings. You will be required to respond to at least one of your classmates discussion posts as well on both Thursday and Friday adhering to the following schedule:
Wed by 11:59pm, your original Discussion Post is due
Thursday by 11:59pm, you must respond to at least one of your classmates Discussion Posts [you may respond to more than 1 if you are so inclined].
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Friday by 11:59pm, you must respond to at least one of your classmates Discussion Posts
[Note: I will be providing a summary of Discussion Posts and directing commentary each Thursday morning before noon. If no one replies to your post, you may also respond to my post instead on Friday]
YOU MAY POST YOUR ORIGINAL DISCUSSION PROMPT BEFORE WEDNESDAY, BUT YOUR RESPONSES MUST COME ON THURS AND FRI RESPECTIVELY. There are two reasons for this. First, in order to have a “Discussion” that is asynchronous, we have to stagger our posts. We do not know when exactly people will post in a day and we need to give them time to get their replies in. More practically, the other reason is to compel you to login and read people’s responses. If we did not do this, there would be no way to enforce you reading and responding to people’s replies to you and the conversation would fizzle.
Your Discussion Post is worth 8 points and each Reply is worth a point, so to get the full 10 points each week you must post an original Post (by Wed) and a Reply on Thurs and another Reply on Fri. The posts and replies MUST engage with the readings on some level to get full points.
Discussion posts should be no more than 500 words (approx. 2/3 of a page single-spaced, 12 pt font) and no less than 200 words (about 1/3 of a page single-spaced, 12 pt font). PLEASE INCLUDE THE WORD COUNT OF YOUR POST AND FULL CITATIONS OF CITED TEXTS AT THE END OF YOUR POST.
A grading rubric and detailed example for the Discussion Posts is appended to the Syllabus.
NOTE: To make the discussion board manageable with 20-25 students in the class, you will be divided into groups of 4-5. You will only be responsible for reading/replying to other students’ discussion posts that are in your group. The Discussion Groups will be randomly assigned at the beginning of the semester. Undergraduates will be in Discussion groups with other undergraduate students and masters and doctoral students in separate discussion groups.
In addition to posting a Discussion Post on Wednesday, you will need to post a reply to at least one of your classmates posts by Thursday evening and then a reply to a reply by Friday. You may also post a reply that addresses issues raised in more than one of your classmates’ posts and raise questions. I will be weighing in on the Discussion Posts on Thursday to help guide the Discussion and then checking in again on Friday.
Like the Weekly Reading Comprehension Checks, I will only count 12 weeks’ worth of your Discussion posts. This means you are allowed to miss or drop up to two weeks of discussion posts without penalty and without …. However, once again, because I am allowing this, I will be very strict about enforcing the deadlines that these need to be completed by. Please use this lifeline sparingly and do not abuse it early in the semester.
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Critical Reading Reflections (CRRs) (4 at 25 points each): DUE SATURDAY BY 11:59pm. In addition to your weekly discussion posts, you will be asked to prepare 4 critical reading reflection papers throughout the semester. These are slightly longer than discussion posts and should be between 1,000 to no more than 2,500 words. You may select which 4 weeks to prepare the CRRs, but I strongly advise against waiting until the end of the semester to complete these. I would recommend taking a look at the course topics on the syllabus and identifying weeks where you find the material to be particularly interesting and plan ahead to prepare reflection papers for that week. I ALSO STRONGLY RECOMMEND COMPLETING AT LEAST 2 IN THE FIRST HALF OF THE SEMESTER (BEFORE SPRING BREAK/ MIDTERM BREAK).
Much like your Discussion Prompts, I will pose a question to help focus your commentary in the Reading Reflections, but the question will be a bit looser and less directed than the Discussion Prompt. The rubric for grading these is similar to the Discussion Post in that you must draw on at least two of the assigned readings and cite them explicitly, avoid opinion, etc. APPENDED TO THE SYLLABUS IS A DETAILED OUTLINE AND EXAMPLE THAT GIVES YOU AN IDEA OF HOW TO STRUCTURE THESE TO MAXIMIZE YOUR SUCCESS.
Readings for each week are chosen to reflect different theoretical orientations within the field and differences of opinion on certain issues. A good reflection paper will be able to identify these differences of opinions/orientations and comment on them. Avoid simply critiquing an article you did not agree with- instead show how the authors come to different conclusions or identify different causes of an issue. You may reflect on which position you agree with more and why, but avoid too much editorializing. You may apply the material to a recent health policy topic in the news to illustrate your point and link concepts to current events.
Final Paper- Critical Commentary or Investigative Report (100 points). Select a health topic and write a critical reflection paper that addresses the extent of the problem and at least one policy alternative that has been considered to address the problem. For instance, you might choose to explore maternal mortality in the US and the question of why it is higher than in other countries, if and why it is on the rise, or what accounts for race-ethnic disparities in maternal mortality. See these recent reports as examples: US News and World Report; ProPublica. Final papers should be a maximum of 8,000 words but can range from 3,000 to 8,000 words. The length is not nearly as important as the substance.
For PhD students, this paper can be written as a Commentary or Critical Review paper that could be submitted to a peer reviewed journal (see AJPH, SSM or Health Affairs blog for examples). I will also post some examples to draw from.
Masters-degree and Undergraduate students could write this as an Op-Ed or Blog style investigative report targeted at the Huffington post, Vox or other outlets. Real world examples will be posted in the Final Assignment. While I will not hold you to “real world” standards in my grading per se, you are expected to aspire to this level.
Course Outline Course Sessions and Assignments Summary Table [this schedule is tentative and may be updated. Rely on BB modules for most accurate reading assignments]
Session #
Topic Assignments Due
Part I: Overview, and Definitions of Key Terms/Objectives
Module 0: [Jan 23-25]
Warm Up Session: Why Health Inequalities?No readings due this week, but see assignments. [note: since no readings are due this week, you could get a head start on the readings for the following week.]
Intro Survey [Wed 11:59pm]
Discussion post [Wed 11:59pm]
Reply to Disc Post [Thurs 11:59pm]
Reply to Reply to Disc Post [Fri 11:59pm]
Module 1: [Jan 28-Feb 1]
Introduction: Health inequalities within and between countries Readings:
Angus Deaton (2013). Chapter 1: The Wellbeing of the World in The Great Escape: Health, Wealth and the Origins of Inequality, Princeton University Press.
Marmot, M. “Social determinants of health inequalities,” Lancet 2005; 365: 1099–104.
Watkins, K. (2016). “Longer lives and unfinished agendas on child survival,” The Lancet, 388(10053): 1450-1452.
Murray C.J.L., Lopez A.D. “Measuring global health: motivation and evolution of the Global Burden of Disease Study,” Lancet 2017; 390: 1460–64
The Lancet Editorial. (2017). “Life, death, and disability in 2016,” The Lancet, Vol. 390, No. 10100
Video Materials:
Global Health Inequalities: https://www.youtube.com/watch?v=elug11ocG3A
Part II: Health Inequalities and Public Policy in High Income Countries Module 3: [Feb 11-15]
Inequality and Health
Readings:
Wilkinson & Pickett. The Spirit Level: Why Greater Equality Makes Societies Stronger. Chapters 1 & 2.
• Marmot, M. The Status Syndrome. Chapter 3. “Poverty Enriched”• Coburn D. (2004). “Beyond the income inequality hypothesis: class, neo-
liberalism, and health inequalities,” Social Science and Medicine;58:41-56.• Kawachi I, Kennedy BP. (1999). “Income Inequality and Health: Pathways and
Mechanisms,” Health Services Research, 31(4): 215-227.• Katz, M. Income Inequality: It's also bad for your health, New York Times.
Video Resources:
Dysfunctional Societies: How Equality Makes Societies Stronger; Health inequalities and the Glasgow effect
Health Inequalities: Socio-Economic and Race-Ethnic Health Disparities in High Income Countries and Proximal Causes
Readings
Marmot, The Status Syndrome ch. 1-2. Lynch JW, Smith GD, Kaplan GA, House, JSD. Income inequity and mortality:
importance to health of individual income, psychological environment, or material conditions. BMJ 2000;320:1200-1204
Williams, D. R. (1999). Race, Socioeconomic Status, and Health: The Added Effects of Racism and Discrimination. Annals of the New York Academy of Sciences , 896, 173-188.
Diez-Roux AV, Mair C. (2010). “Neighborhoods and health,” Annals of the New York Academy of Sciences, 1186: 125–145.
Hebert PL, Sisk, JE, Howell, EA. When Does A Difference Become A Disparity? Conceptualizing Racial and Ethnic Disparities in Health,” Health Affairs, 27(2): https://doi.org/10.1377/hlthaff.27.2.374
Daniels N., Kennedy B.P., Kawachi I . (1999). “Why Justice Is Good for Our Health: The Social Determinants of Health Inequalities,” Daedalus, 128(4): 215-251.
Roberts MJ, Reich MR. (2002). Ethical analysis in public health. The Lancet, 359(March): 1055-1059.
Deaton, A. (2011). What does the empirical evidence tell us about the injustice of health inequalities? Working Paper.
Scheper-Hughs, N. (1993). AIDS, public health, and human rights in Cuba. The Lancet, 342: 965-967
Abraido-Lanza A, Chao M, Florez K. Do healthy behaviors decline with greater acculturation? Implications for the latino mortality paradox. Social Science & Medicine. 2005;61:1243–1255. Doi:S0277-9536(05)00052-3
Video Resources:Unnatural Causes: Becoming American [Discusses the “Latino Health Paradox” and shows that not all inequalities produce disadvantage.]Unnatural Causes: Bad Blood [Discusses the reasons for higher diabetes rates among Pima Indians including genetics versus social causes]Justice, Equality and Global Health [summarizes Rawl’s theory of justice as applied to health inequalities]
Policy Solutions to Health Inequalities and Ethical Considerations
Readings:
IOM Report. (2014). “Ch. 8: Policies and Social Values,” in Woolf et al, U.S. Health in International Perspective: Shorter Lives, Poorer Health. The National Academies Press: file:///Users/af475569/Downloads/207-238%20(1).pdf
Frieden, TR. A Framework for Public Health Action: The Health Impact Pyramid, Am J Public Health. 2010 April; 100(4): 590–595. doi: 10.2105/AJPH.2009.185652
A L Fairchild and G M Oppenheimer. Public health nihilism vs pragmatism: history, politics, and the control of tuberculosis. Am J Public Health. 1998 July; 88(7): 1105-1117.
Menard, J-F. A 'nudge' for public health ethics: Libertarian paternalism as
Losing Ground: The Opioid Crisis, Diseases of Despair and Declining Life Expectancy in the USReadings:
Case A, Deaton A. Rising morbidity and mortality in midlife among White non-Hispanic Americans in the 21st century. Proc Natl Acad Sci U S A. 2015;112(49):15078–15083.
Stein EM, Gennuso KP, Ugboaja DC, Remington PL. The Epidemic of Despair Among White Americans: Trends in the Leading Causes of Premature Death, 1999–2013
Monnat SM. (2016). Deaths of Despair and Support for Trump in the 2016 Presidential Election
Lauren Brown, Reginald Tucker-Seeley. “Will ‘Deaths of Despair’ among Whites Change How We Talk about Racial/Ethnic Health Disparities?,” Ethn Dis. 2018 Spring; 28(2): 123–128. Published online 2018 Apr 26. doi: 10.18865/ed.28.2.123
Guo, J. “How dare you work on whites’: Professors under fire for research on white mortality,” April 6, 2017.
Scott E. Hadland, Maxwell S. Krieger, Brandon D. L. Marshall, “Industry Payments to Physicians for Opioid Products, 2013–2015”, American Journal of Public Health 107, no. 9 (September 1, 2017): pp. 1493-1495
DuPont S, Bezaitis A, Ross M. (2015) “Stemming The Tide Of Prescription Opioid Overuse, Misuse, And Abuse,” Health Affairs Blog.
Video Resources:
Vox, How the opioid epidemic became America’s worst drug crisis ever Vox, How fentanyl is making the opioid epidemic even worse Vice, The Opioid Effect: Inside Pennsylvania's Heroin Epidemic Vice, The best opioid addiction treatment is more opioids Vice, Back from the Brink: Heroin's Antidote Vice, Chronic Pain are Suffering from Maine's Strict Opioid Laws
reflection from the first half of the semester. Post [Thurs 11:59pm]
Detailed Paper Topic and Outline [Fri 11:59pm]
PART III: Health Inequalities and Public Policy in Low- and Middle-Income CountriesModule 9: [April 1-5]
Causes of Health Inequalities btw Low and High-Income Countries: Globalization, Structural Adjustment, Colonialism/Neocolonialism
Readings:
Bloom DE, Canning D. (2007) Commentary: The Preston Curve 30 years on: still sparking fires. Int. J. Epidemiol. 36 (3): 498-499.
Millen JV, Irwin A, Kim JY. Chapter 5, "Theoretical Therapies, Remote Remedies: SAPs and the Political Ecology of Poverty and Health in Africa" by Brooke G. Schoepf, Claude Schoepf, and Joyce V. Millen in Kim JY, Millen JV, Irwin A, Gershman J. In Dying for Growth: Global Inequality and the Health of the Poor. Common Courage Press, Monroe, ME, 2000, pp. 3-10.
Pogge, Thomas. “World Poverty and Human Rights” in Ethics and International Affairs 19/1, 1-8;
Fukuyama, F. (2004). Ch1: “The missing dimensions of stateness,” in State-Building: Governance and the World Order in the 21st Century, Cornell University Press: Ithaca, NY.
Dollar, D. Is globalization good for your health? Bulletin of the World Health Organization, 2001, 79: 827–833.
Hoen, E. (2002). “TRIPS, Pharmaceutical Patents, and Access to Essential Medicines: A Long Way From Seattle to Doha,” Chicago Journal of International Law, 3(1), article 6.
Sud SR, Brenner, JE, Ellen R. Shaffer ER. (2015). “Trading Away Health: The Influence of Trade Policy on Youth Tobacco Control,” Journal of Pediatrics; 166(5): 1303–1307. http://dx.doi.org/10.1016/j.jpeds.2015.01.016
Video Resources: Unnatural Causes: Collateral Damage [Video about US relationship with the
Historical Remedies to Health Inequalities- Social Medicine, Alma Ata and Health for AllReadings:
Porter D (2006) How did social medicine evolve, and where is it heading? PLoS Med 3(10): e399.
Farmer, P. et al. (2006). “Structural Violence and Clinical Medicine,” Plos One, 3(10): e449.
Waitzkin H. “Commentary: Salvador Allende and the birth of Latin American social medicine,” International Journal of Epidemiology 2005;34:739–741
Myer L, Ehrlich RI, Susser ES. Social epidemiology in South Africa. Epidemiol Rev. 2004;26:112-23.
Mackenbach, JP. (2009). “Politics is nothing but medicine at a larger scale: reflections on public health's biggest idea,” Journal of Epidemiology and Community Health (1979-), Vol. 63, No. 3: 181-184.
Morabia, A. (2009). “Is epidemiology nothing but politics at a different
level?,” Journal of Epidemiology and Community Health (1979-), 63, No. 3 (March2009), pp. 188-190
Cueto M. The Origins of Primary Health Care and Selective Primary Health Care. Am J
Public Health 2004; 94(11): 1864-1874. Hall JJ, R Taylor. Health for All Beyond 2000: The Demise of Alma Ata
Declaration and Primary Health Care in Developing Countries. MJA 2003; 178: 17-20.
Burström, B Macassa M, Öberg L, Eva Bernhardt E, Smedman L. (2005). “The Impact of Improved Water and Sanitation on Inequalities in Child Mortality in Stockholm, 1878 to 1925,” American Journal of Public Health, 95(2): 208-217.
Video Resources:
Global Health Ethics - A Framework for Thinking Global Health Ethics (understudying right and wrong)
11:59pm]
Module 12: [April 15-19]
Priority-Setting and Public Health Policies Readings:
Shiffman, J. Generating Political Priority for Maternal Mortality Reduction in 5 Developing Countries. American Journal of Public Health; May 2007; 97, 5; pg. 796
Murray C, Lopez A. Progress and directions in refining the global burden of disease approach: a response to Williams. Health Economics; 2000;9:69 – 82.
Mooney G, Wiseman V. “Burden of disease and priority setting,” Health Econ. 2000 Jul;9(5):369-72.
Kaplan, W. (2013). Approaches to Priority Setting Chapter 3. Priority Medicines for Europe and the World 2013 Update. WHO.
Reich, M. Politics of Agenda Setting in International Health: Child Health versus Adult Health, Journal of International Development 1995, 7(3): 489-502.
Leo, B. 2013. “Is Anyone Listening? Does US Foreign Assistances Target People’s Top Priorities?.” CGD Working Paper 348. Washington, DC: Center for Global Development.
Shiffman, J. (2006). “HIV/AIDS and the rest of the global health agenda,” Bulletin of the World Health Organization, 84 (12): 923.
Hotez PJ, Alvarado M, Basáñez M-G, Bolliger I, Bourne R, Boussinesq M, et al. (2014) The Global Burden of Disease Study 2010: Interpretation and Implications for the Neglected Tropical Diseases. PLoS Negl Trop Dis 8(7): e2865. https://doi.org/10.1371/journal.pntd.0002865
Anderson G. (2015). “Non-Communicable Chronic Diseases: Winning on Facts but Losing on Passion,” Health Systems & Reform, 1:2, 119-127, DOI: 10.4161/23288604.2014.989753
Reread from Week 1: Marmot, M. “Social determinants of health inequalities,” Lancet 2005; 365: 1099–104.
Global Health Governance of Emerging Infectious Diseases: Ebola and ZikaReadings: • Kapiriri L & Ross A. (2018) “The Politics of Disease Epidemics: a Comparative
Analysis of the SARS, Zika, and Ebola Outbreaks,” Global Social Welfare.
• Youde, Jeremy. 2015. The World Health Organization And Responses To Global Health Emergencies. PS. 11- 12.
• Busby, Josh and Karen Grepin. 2015. What Accounts For The World Health Organization’s Failure On Ebola? PS. 12-13.
• Moon, Suerie et al. 2015. Will Ebola change the game? Ten essential reforms before the next pandemic. The report of the Harvard- LSHTM Independent Panel on the Global Response to Ebola. The Lancet. 1- 6.
• Price-Smith A and Porreca J. (2016). “Fear, Apathy, and the Ebola Crisis (2014-15): Psychology and Problems of Global Health Governance” Global Health Governance, special issue on Ebola.
• Gostin LO, Mundaca-Shah CC, Kelley PW. (2016). “Neglected Dimensions of Global Security: The Global Health Risk Framework Commission,” JAMA, 315 : 1451-1452
• Dionne Kim Yi and Seay Laura. (2015) Perceptions about Ebola in America: Othering and the Role of Knowledge about Africa,” PS, special issue on Ebola, 6.
• Wilkinson, Annie & Fairhead James. (2017). "Comparison of social resistance to Ebola response in Sierra Leone and Guinea suggests explanations lie in political configurations not culture," Critical Public Health, 27:1, 14-27, DOI: 10.1080/09581596.2016.1252034
• Abramowitz, S. A., McLean, K. E., McKune, S. L., Bardosh, K. L., Fallah, M., Monger, J., Tehoungue, K., & Omidian, P. A. (2015). "Community-centered responses to Ebola in urban Liberia: the view from below," PLoS Neglected Tropical Diseases, 9(4), e0003706.
• Gyawali, N., Bradbury, R. S., & Taylor-Robinson, A. W. (2016). The global spread of Zika virus: is public and media concern justified in regions
COURSE CALENDAR AND ASSIGNMENT SCHEDULETopics/Activities Start End Notes/Due Dates
Ice-Breaker Module Wed Jan 23 Fri Jan 25 Compressed Week. Complete the Intro Survey by Wed 11:59Standard timeline applies for Discussion. In lieu of CRR, post an introduction in Meet Your Classmates.
Module 1: Introduction: Health inequalities within and between countries
Mon Jan 28 Fri Feb 1 Standard
Module 2: Why Public Health Policy? Mon Feb 4 Fri Feb 8 StandardModule 3: Inequality and Health Mon Feb 11 Sat Feb 15 StandardModule 4: Health Inequalities: Socio-Economic and Race-Ethnic Health Disparities in HICs
Mon Feb 18 Fri Feb 22 Standard
Module 5: What makes health inequalities unjust?
Mon Feb 25 Fri Mar 1 Standard
Module 6: Policy Solutions to Health Inequalities and Ethical Considerations
Mon Mar 4 Fri Mar 8 Standard
Module 7: Losing Ground: The Opioid Crisis, Diseases of Despair and Declining Life Expectancy in the US
Mon Mar 11 Fri Mar 15
Standard [Note: This is midterm week technically. We do not have a midterm in this class. Instead we will have a normal module this week, but the week after Spring Break, instead of a normal module, you will be asked to turn in an Outline for your final paper.
SPRING BREAK!!!!!!!!! Mon Mar 18 Fri Mar 22Module 8: Midterm Week Mon Mar 25 Fri Mar 29Module 9: Causes of Health Inequalities btw Low and High-Income Countries
Mon April 1 Fri April 5 Standard
Module 9: Historical Remedies to Health Inequalities-Social Medicine, Alma Ata and Health for All
Mon April 8 Fri April 12 Standard
Module 10: Agenda-Setting and Public Health Policies
Mon April 15 Fri April 19 Standard
Module 11: Policy Solutions: Development
Mon April 22
Fri April 26 Standard
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Assistance for HealthModule 13: Global Health Governance
Mon April 29 Fri May 3 Standard
Final Paper Mon May 6 Wed May 8 Compressed week. No module. Just work on your final paper and complete course survey/course eval.
Finals Week Mon May 13 Fri May 17 Final Papers due on Wed May 15th
Grading Rubric: Discussion Posts/Responses
Main Post= 8 pointsEach Response=1 point
Points ExplanationSolid Work (9-10 points)
Assignment is complete (original discussion post and 2 responses) within the appropriate time frame.
Includes word counts and full citations at the end of each post
Draws on 2+ readings from the week and cites them EXPLICITLY in the text of post.
Addresses all aspects of the Discussion Prompt and follows instructions.
Evidence of critical thinking/reflection
Proper grammar, proofreading, etc.
Acceptable but Just Scratching the Surface (8-9 points)
Missing response or not submitted within appropriate time frame.
Is missing word counts or citations or both
Inadequately draws on weekly readings (i.e., draws on <2 readings)
Uses opinion more than argument supported by weekly materials
Follows some but not all of the Discussion Prompt(Reflection Paper) questions/instructions.
Low or insufficient evidence of critical processing of the arguments presented in the week’s resources (e.g., misses major points/debates)
Writing too poor to form a judgement/assign a grade.Assignment Incomplete (0)
Discussion post was not posted at all or within acceptable time frame.
How to Write a Good Discussion Post [adapted from Stephen Weinberg’s Tips for Writing a Good Discussion Post and Response]
What Makes for a Good Initial Discussion Post Is about 250-500 words long, with a word count at the end Uses paragraphs Engages with the prompt using evidence from course readings and clearly cites the
readings in the text. May engage with outside information to support point, but MUST draw on at least two of the weekly readings.
May include personal opinion/experience, but MUST tie this directly to concepts from the readings in a clearly identified manner
Ends with a question to your classmates that offers a clear hook for replying to you Includes in text citations and full citations of assigned readings and any outside sources
What Makes for a Good Follow-Up Discussion Post Is about 50-200 words long, with a word count at the end Addresses one of your colleagues by name (even if you’re the only follow-up post on her
thread, so it is obvious whom you’re talking to) Clearly relates to the post you are replying to
o Does NOT have to use their question, but can Extends that post in some way (goes well beyond just saying “good point!” or “I
disagree”)o Adding an additional insighto Adding additional information from the course or from clearly identified AND
CITED outside informationo Suggesting a counterpoint
Is respectful to your colleagues Is still clearly related to the course readings in some way and is not pure
opinion/anecdote/off-topic Includes in text citations and full citations of assigned readings
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How to Structure your Critical Reading Reflections
I. Include a Title that describes what you are going to argueII. Introduction In the first sentence or two, restate the question as posed from the Critical Reading
Reflection Prompt. State a position or make clear what you are going to argue, but avoid directly saying “I
think,” “I believe,” “It is my opinion that…”.
III. Discussion Para 1: Review/discuss main points from the selected readings in relation to the CRR
prompt Para 2: Present your argument/perspective, supported by evidence from the readings Para 3: Acknowledge and discuss the counterarguments to your argument, supported by
the readings
IV. Conclusion Summarize your main points and conclusions
