NEW YORK UNIVERSITY ROBERT F. WAGNER GRADUATE SCHOOL OF PUBLIC SERVICE. HEALTH AND MEDICAL CARE P (001), Spring 2009

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1 NEW YORK UNIVERSITY ROBERT F. WAGNER GRADUATE SCHOOL OF PUBLIC SERVICE HEALTH AND MEDICAL CARE P (001), Spring 2009 Prof. Kieke Okma Mondays, 6: pm First class: January 26, 2009; last class May 4, 2009; Spring Break March Silver Center Office hours: before class, upon request COURSE SYLLABUS Health and Medical Care is a mandatory course in the Health Policy and Management Program of the Wagner School. It is designed to familiarize students with basic concepts and ideas concerning the distribution of health and illness in society and the organization of health care systems. We shall discuss definitions of health and illness, tools for their assessment, and historical developments in public health and medicine. We examine characteristics of health care systems at the local, state and federal levels in the United States as well as in other nations. In addition, we require students to become familiar with the health care system in one other country of their choice so that they may develop a comparative perspective over the semester. Students should come to class prepared to participate in the discussion of major themes related to health and society, social and geographical distribution of disease, as well public policy and other factors that influence access to health care services. BOOKS AND READINGS Students are expected to read the chapters and articles listed in the syllabus each week. Conrad s edited volume provides a (critical) sociological view of health and health care delivery. The textbook edited by Kovner and Knickman, focuses on the organization and financing of health care delivery in the United States. Additional articles on the syllabus are designed to extend the materials in these textbooks and expose students to other views. We have also added books by Nestle, Nuland and Shilts. Nuland s book provides a clinical perspective on death and dying and deepens our understanding of the role of the patient and relevant ethical issues. Shilts provides case study material on the evolution of the AIDS epidemic and the importance of public health infrastructure. Nestle highlights the political nature of a pressing public health issue, namely obesity and nutrition policy. All of these books are available, on reserve, at Bobst Library, most medical libraries, and the NYU Professional Bookstore. For all readings below that are not in these books, students can download PDF versions from the blackboard site associated with this course. They must also be prepared to find additional background materials, on their own, about the country they choose as a standard of comparison to the US. 1

2 REQUIRED TEXTBOOKS: Conrad, Peter (ed.), The Sociology of Health and Illness: Critical Perspectives, (7th Edition). New York: St. Martin's Press (2008). Kovner, Anthony and Knickman, James (ed.), Health Care Delivery in the United States (9th Edition). New York: Springer Press (2008). ADDITIONAL BOOKS AND JOURNALS We encourage students to browse recent issues of well-respected journals, e.g., American Journal of Public Health; Journal of the American Medical Association; New England Journal of Medicine; The Journal of Health Politics, Policy and Law, and Health Affairs. The recent book by former senator Tom Dashell (nominated to be the Secretary for Health and Human Services in 2009) provides an excellent overview of the history of health politics in the US in the 20 th century and current problems (as well as his suggestions for solutions). Kovner and Knickman s book also contains be helpful website and references. Those sources also provide important background material for student papers. Two of the following three books: Nestle, Marion. Food Politics. Berkeley: UC Press (2002). Nuland, Sherwin B. How We Die: Reflections on Life s Final Chapter. New York: Alfred A. Knopf (1994). Shilts, Randy. And the Band Played On. New York: St Martin s Press (1988). 2

3 CLASS TOPICS AND READINGS Introduction Class I Jan 26, 2009 Health, Disease and Community Discussion of course readings and class requirements. Definitions of health and illness. What does it mean to speak of the social production of disease? How are health status and health care related? 1. John B. McKinlay, Sonja M. McKinlay. Medical Measures and the Decline of Mortality, in Conrad, P. The Sociology of Health and Illness: A Critical Approach, (Ch. 1). 2. Evans, Barer and Marmor: Why Are Some People Healthy and Others Not? (ch 1) Distribution of health, disease and public health problems Class II Febr 2, 2009 Introduction to Epidemiological Measures and Methods Descriptive vs. analytic methods. Social factors and disease How do we assess and measure health status? 1. Mary Ann Chiasson, Steven Jonas. Measuring Health Status, Ch. 2. Conrad, P. The Sociology of Health and Illness: A Critical Approach: 2. Phil Brown. Popular Epidemiology: Community Response to Toxic Waste- Induced Disease, Ch Victor Rodwin, Melanie Croce-Galis. Population Health in Utah and Nevada: An Update on Victor Fuchs Tale of Two States (on blackboard) 4. Michael Marmot, Zoe Oldfield, James Smith, Disease and Disadvantage in the United States and England, Ch. 5. 3

4 Class III Febr 9, 2009 The Uneven Distribution of Disease How do such factors as age, gender, race, poverty, occupation and lifestyle relate to morbidity and mortality? Are these relationships consistent across nations? (Reminder: First blackboard assignment due) 1. C. Tracy Orleans, Elaine F. Cassidy. Health-Related Behaviors. Ch. 10 Conrad, P. The Sociology of Health and Illness: A Critical Approach: 2. S. Leonard Syme and Lisa F. Berkman. Social Class, Susceptibility and Sickness. Ch Colin McCord and Harold P. Freeman. Excess Mortality in Harlem. Ch Ingrid Waldron. Gender Differences in Mortality - Causes and Variations in Different Societies. Ch James S. House et al. Social Relationships and Health. Ch Richard Wilkinson, Health Inequalities: Relative or Absolute Material Standards. Ch. 9 Class IV Febr 16, 2009 Public Health, Medicine and Resource Allocation Public health versus medicine Ethics of resource allocation Public Health Infrastructure 1. Laura C. Leviton, Scott D. Rhodes and Carol Chang. Public Health: Policy, Practice, and Perceptions. Ch McKinlay, John. A Case for Refocusing Upstream: The Political Economy of Illness. Ch. 48. Class V Febr 23, 2009 Public Health Case Studies Public health and nutrition. The evolution of the AIDS epidemic. Terrorism as a public health issue (Reminder: First Paper Assignment Due) Read either book: 1. Shilts, Randy. And the Band Played On; or Nestle, Marion. Food Politics. 2. Herek, Gregory M., AIDS and Stigma. Ch. 11 (optional). 4

5 Health care organization, financing and workforce Class VI March 2, 2009 A Comparative Overview of U.S. Health Care History, trends, and characteristics What social, medical, and technological factors have shaped the current health care arrangements? What is the role of government in U.S. health care? How does this differ from other countries? How does U.S. health care compare to that of other (developed) nations? (Reminder: 2 nd blackboard assignment due) 1. Knickman, James and Kovner, Anthony, Introduction: The State of Health Care Delivery in the United States. Ch Sparer, Michael S. The Role of Government In U.S. Health Care. Ch Rodwin, Victor G. A Comparative Analysis of Health Systems Among Wealthy Nations. Ch Light, Donald W., Comparative Models of Health Care Systems. Ch Jill Quadragno. Why the United States Has No National Health Insurance: Stakeholder Mobilization Against the Welfare State, Ch Marmor, Freeman and Okma, J of Comp Policy Analysis. Class VII March 9, 2009 Health Care Delivery: Hospitals and Ambulatory care How are hospitals organized and governed? How has role of the hospitals changed over time? How are ambulatory services organized and provided? How and why has the delivery of ambulatory care changed in recent years? 1. Gourevitch, Marc N., et al., Acute Care. Ch Anderson, Gerard and James R. Knickman, Chronic Care. Ch Jonathan Gabe, The British Health Service: Continuity and Change. Ch

6 Class VIII March 23, 2009 Commercialization of Medicine: Focus on Pharmaceuticals What factors have spurred the growth in the pharmaceutical industry? How has public policy responded to the growth in pharmaceuticals and new technologies? What conflicts of interest have emerged with the commercialization of U.S. Medicine? 1. Strongin, Robin J. and Ron Geigle, Pharmaceuticals and Medical Devices. Ch John McKnight. Politicizing Health Care. Ch Arnold Relman, The Healthcare Industry: Where Is It Taking Us? Ch Heather Hartley, The Pinking of Viagra Culture: Drug Industry Efforts to Create and Repackage Sex Drugs for Women. Ch. 23. Articles posted on blackboard 5. Relman, A. What Market Values are Doing to Medicine. Atlantic Monthly, March 1992: Berenson, Alex, Incentives Limit Any Savings in Treating Cancer, NY Times, June 12, 2007, C1. 7. Berenson, Alex, Cancer Drug Representatives Spelled Out the Way to Profit, NY Times, June 12, 2007, C1. 8. Carlat, Daniel, Diagnosis: Conflict of Interest. NY Times, June 13, 2007, Op-ed. Class IX March 30, 2009 Financing, Cost Containment and Managed Care Efforts at cost containment Strengths and weaknesses of managed care Alternative mechanisms for financing healthcare. 1. Hunt, Kelly A. and James R. Knickman, Financing for Health Care. Ch Finkler, Steven A. and Thomas Getzen, Costs and Value. Ch. 17. Conrad, P. The Sociology of Health and Illness: Critical Perspectives 3. T. Bodenheimer & K. Grumbach. Paying for Health Care. Ch Deborah A. Stone. Doctoring as a Business: Money, Markets, and Managed Care. Ch

7 Class X April 6, 2009 Physicians, Nurses, and Allied Professionals Demographic and socio-economic characteristics of health care workforce Physicians as a dominant profession Licensure and medical monopoly Role of medical education Historical and emerging roles for doctors, nurses, and other providers (Reminder: third Blackboard assignment due) 1. Carol Brewer and Thomas Rosenthal, The Health Care Workforce. Ch Peter Conrad and Joseph W. Schneider. Professionalization, Monopoly and the Structure of Medical Practice. Ch Richard W. Wertz and Dorothy C. Wertz. Notes on the Decline of Midwives and the Rise of Medical Obstetricians. Ch John B. McKinlay and Lisa D. Marceau. The End of the Golden Age of Doctoring. Ch Donald W. Light. Countervailing Power: The Changing Character of the Medical Profession in the United States. Ch Susan Reverby, A Caring Dilemma: Womanhood and Nursing in Historical 7. Perspective, Ch. 20. Health care demands, needs and system performance Class XI April 13, 2009 The Role of the Patient Issues of patient compliance The relationship of patients, physicians, and the health care system Information and consumer issues 1. Peter Conrad, Shifting Engines of Medicalization. Ch Elliot G. Mishler. The Struggle between the Voice of Medicine and the Voice of the Lifeworld. Ch Renee R. Anspach. The Language of Case Presentation. Ch Irving Kenneth Zola. Medicine as an Institution of Social Control. Ch Victoria Pitts. Illness and the Internet: Writing and Reading Breast Cancer in Cyberspace. Ch. 44 Nuland: How We Die: Reflections on Life s Final Chapter: 6. Chapter 1, plus at least one other chapter. 7

8 Class XII April 20, 2009 Access, Equity and Rationing Barriers to care The crisis in health insurance and the problem of the uninsured Comparisons with other nations in regard to access and insurance coverage 1. John Billings and Joel C. Cantor. Access to Care. Ch. 16. Conrad, P. The Sociology of Health and Illness: A Critical Approach: 2. Raisa Berlin Deber. Health Care Reform: Lessons from Canada. Ch Gregory Weiss, Uninsured in America. Ch Susan Starr Sered and Rushika Fernandopulle, Young, Sick, and Part-Time: The Vulnerability of Yourth and the nenew American Job Market. Ch Daniel Callahan, Rationing Medical Progress: The Way to Affordable Health Care. Ch Arnold Relman, The Trouble with Rationing, Ch 41. Class XIII April 27, 2009 Changing Health Care Needs The need for long-term care and alternative modes of delivery Chronic illness, aging and HIV and AIDS (Reminder: Final blackboard assignment due) 1. Penny Hollander Feldman, et al. Long-Term Care, Ch Eric Klinenberg, Dying Alone, Ch.8. Class XIV May 4, 2009 Quality Assessment and Quality Assurance Last class; PAPER 2 Due How do we measure and monitor the quality of health care services? How do we assess the effectiveness and appropriateness of care? What are the ethical issues in the quality of health care delivery? 1. Roger Kropf, Information Management. Ch Douglas Wakefield and Bonnie Wakefield, The Complexity of Health Care Quality, Ch. 15 8

9 COURSE REQUIREMENTS In addition to attending and participating in classes, students must submit two papers and three short essays in response to specific questions (see below). These requirements are described below and the actual assignments are attached. The assignments assume that students have become knowledgeable about the health care system of the U.S. and one other country selected by the student. Course grades: % of Final Grade Date Due Paper I 20% Febr 23 Paper II 40% May 4 Essays 30% Febr 9, Mar 2, April 27 Class Participation 10% Paper I (see under assignments in blackboard). Students must prepare a paper of no more than 3 pages concerning trends in diabetes or contraceptive use (or another disease) provided by the National Center for Health Statistics (see CDC statistics on its website). The assignment will allow students to demonstrate their ability to understand, interpret, and discuss quantitative data. Class readings will be essential in preparing this memo. Paper II (see under assignments in Blackboard). This paper (5-7 pages) will require a thoughtful, critical, and well-organized discussion of a core concept in health and health care. This provides students the opportunity to reflect upon the course materials. Students should present a carefully organized discussion of a topic of their own choice, with wellsubstantiated claims and ideas. Material should be footnoted to reflect synthesis of key course readings. References to course materials are required. Essays Each student must answer three of the four questions (posted under assignments on Blackboard). The response should be in the form of a brief, one-page essay based on class readings, relevant data and ideas from popular media, journals or websites, and/or your own experiences. You should take the time to create a thoughtful and well-written response. You are also asked each time to respond to at least one other student s essay. Class Participation Classroom discussion and debate are essential to this course. Students are expected to come to class ready to discuss the assigned readings. Administrative Procedure If you have trouble posting the required essays and responses on Blackboard, please contact Blackboard Helpline. 9