Mel and Enid Zuckerman College of Public Health University of Arizona

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1 Mel and Enid Zuckerman College of Public Health University of Arizona Syllabus Changing Health Policy through Cultural Understanding and Epidemiological Analysis CPH 606/Fall 2012 Course Time: Wednesdays 9:30 to 11:30am Fridays 8:30 to 10:30am Class Room: Drachman Hall, Room A123/125 Course Instructors: Kacey Ernst, PhD Duke Duncan, MD Office Hours: Kacey Ernst: Call, or drop by Duke Duncan: Call, or drop by Catalog Description: Students will develop the skills to work in another culture by discovering how culture influences health, finding existing data, analyzing and interpreting it in appropriate cultural contexts to form policy. Course Objectives: To make a genuine contribution to improve health in another culture one must first acquire an intimate understanding and respect for local communities, a variety of cultures and belief systems, and their people. Such knowledge will facilitate the gathering of pertinent data, allow for the development and assessment of community needs and assets, and subsequently the prioritization of those needs. The purpose of this course is to assist the student in understanding a community s political and functioning structure and the influence culture has on matters of health, and to direct the student to where important health data can be gathered. This course will emphasize maternal and child health (MCH) issues in developing countries. Using data available from existing datasets, the students will prioritize the health needs and assets of a country. The ultimate goal is to formulate a change in national policy that would improve the health of the people living in that nation ( developing nation ). The course culminates in the students presenting their proposal to a panel of experts, focusing on the importance of the policy and how it can improve health of the community. This course will be a pragmatic preparation for what the College anticipates its graduates will be able to do: i.e., champion and advocate for a cause that will improve the health of the public. Course Prerequisite: CPH 573A Basic Principles of Epidemiology CPH 576A Biostatistics in Public Health Course Prerequisites or current enrollment: CPH 574 Public Health Policy & Management CPH 577 Socio-cultural & Behavioral Aspects of Public Health 1

2 Learning Objectives: 1. Develop an understanding and respect for cultural differences with emphasis on their relationship to MCH 2. Gain an understanding of the international agreements on improving the health of children (Convention on the Rights of the Child and Millennium Development Goals) 3. Learn how to conduct literature reviews to discover how culture may influence health in a given population 4. Gain a working knowledge of the existing international health datasets particularly relative to MCH 5. Learn how culture can impact data collection and analysis in epidemiological studies 6. Understand the limitation and the utility of international health datasets 7. Introduce ArcView GIS as a tool for mapping and descriptive analysis 8. Use maps as a way to convey concepts and health problems 9. Prioritize health issues based upon statistical analyses and what is culturally feasible 10. Learn to develop and defend a culturally appropriate policy for health action Competencies: Biostatistics A. 5. Apply descriptive techniques commonly used to summarize public health data. Epidemiology C. 1. Identify key sources of data for epidemiologic purposes. C. 3. Describe a public health problem in terms of magnitude, person, time and place. C. 4. Explain the importance of epidemiology for informing scientific, ethical, economic and political discussion of health issues. C. 6. Apply the basic terminology and definitions of epidemiology. C. 7. Calculate basic epidemiology measures. C. 8. Communicate epidemiologic information to lay and professional audiences. C. 9. Draw appropriate inferences from epidemiologic data. Health Policy 2

3 D. 4. Discuss the policy process for improving the health status of populations. Social and Behavioral Science E. 2. Identify the causes of social and behavioral factors that affect health of individuals and populations. E. 3. Identify individual, organizational and community concerns, assets, resources and deficits for social and behavioral science interventions. E. 4. Identify critical stakeholders for the planning, implementation and evaluation of public health programs, policies and interventions. E. 8. Apply evidence-based approaches in the development and evaluation of social and behavioral science interventions. E. 9. Apply ethical principles to public health program planning, implementation and evaluation. E. 10. Specify multiple targets and levels of intervention for social and behavioral science programs and/or policies. Diversity and Culture G. 3. Explain why cultural competence alone cannot address health disparity. G. 5. Use the basic concepts and skills involved in culturally appropriate community engagement and empowerment with diverse communities. G. 10. Develop public health programs and strategies responsive to the diverse cultural values and traditions of the communities being served. Leadership H. 7. Use collaborative methods for achieving organizational and community health goals. H. 8. Apply social justice and human rights principles when addressing community needs. H. 4. Engage in dialogue and learning from others to advance public health goals. H. 5. Demonstrate team building, negotiation, and conflict management skills. Professionalism J. 2. Apply basic principles of ethical analysis (e.g. the Public Health Code of Ethics, human rights framework, other moral theories) to issues of public health practice and policy. J. 3. Apply evidence-based principles and the scientific knowledge base to critical evaluation and decision-making in public health. J. 4. Apply the core functions of assessment, policy development, and assurance in the analysis of public health problems and their solutions. 3

4 J. 5. Promote high standards of personal and organizational integrity, compassion, honesty and respect for all people. Systems Thinking L. 6. Explain how the contexts of gender, race, poverty, history, migration, and culture are important in the design of interventions within public health systems. L. 10. Analyze the impact of global trends and interdependencies on public health related problems and systems. Course format: The course will use a seminar format with student-faculty interaction simulated by a mixture of presentations by both students and instructors. The students must read the material and be prepared and willing to enter into class discussions. The students will be divided into three teams and assigned to one of three different countries: Ethiopia, Pakistan and Cambodia. The teams will be responsible for understanding the way local or regional culture influences health in that country, researching health data from their assigned country, reviewing existing policies pertinent to the health data, and then developing a health policy that addresses a health issue of particularly interested to them. Wednesday sessions will consist of a 15-minute presentation by one of the three teams of health data pertinent to their particular country including reference to health policies and other information that brings the data to life. The short presentation will be followed by a discussion lead by one of the other teams based on questions submitted by the students and instructors relevant to the assigned readings and in concert with the students presentation. Friday sessions will consist of a presentation by one of the instructors that will introduce the topic(s) for the following week. The Friday sessions will include a 1-hour lab to allow the students to gain in-depth experience with DHS and with Epi-Info programs. These labs will assist the students in developing the materials to be presented the following Wednesday. Wherever possible, health data should be linked with policies that may or may not have influenced changes in the health data. To enliven the data and to assist in selection of a policy, several people who have experience in each of the three counties and who have agreed to act as consultants will be provided to the students. Course Requirements: Class Attendance/ Participation: This course is designed to be highly interactive. All students must attend and engage in discussion each class period. All holidays or special events observed by organized religions will be honored for those students who show affiliation with that particular religion. Absences pre-approved by the UA Dean of Students (or Dean s designee will be honored.) Homework: 4

5 o During the first week of this semester list your top 5 learning goals for this course and turn the list in to the instructors o At mid-term, assess yourself to see how far you are to meeting your goals and turn your evaluation in to the instructors o At the end of the semester, assess yourself again and turn your evaluation in to the instructors o One of the teams will make a formal 15-minute presentation at most of the Wednesday sessions. o Each team will submit a page report each week for nine of the weeks. Feedback on the presentations from the instructors and from your peers will be given to the students. Instructors will give feedback on the weekly reports to each of the teams. o Each team is expected to have selected the topic area for their policy by week 9 and the teams should spend the next 2-3 weeks developing their policy statement incorporating the DHS data and pertinent existing policies. o In addition, two individual analysis reports will be required to evaluate progress on individual analytical skills. o A scholarly 20-page report is to be submitted on the final day of class outlining why and how the policy was selected including justification of its enactment. The weekly page reports should be included as an appendix to the final 20-page report. Readings: Readings will be comprised of literature from peer-reviewed journals, established public health organizations such as WHO and CDC and book chapters. See attached references and course website. Project: Each team will develop a health policy that, if enacted would improve the general health and well being of the people of that country. During the final next three weeks each team will present their case to a panel of legislators with the intent of presenting informed and convincing augments to the legislators that the policy should be enacted. In the selection of the policy, there should be an attempt to develop a policy that has culturally relevance and is feasible within the barriers of the culture and the situation of the country. Detailed project instructions will be provided. Evaluation: Individual Participation: 10 points Group weekly Presentations 5 points): 10 points Group reports points): 30 points Individual reports 10 points Peer Evaluation: 10 points Final Report: 15 points Final Presentation: 15 points Total points: 100 points Standard grading will be used to assign letter grades (90% and above) A, ( %) B, ( %) C, ( %) D, (below 60%) F. 5

6 Course Schedule Week Presenters Topic/Item Readings* Due 1 8/22 Ernst & Duncan 2 8/24 8/29 Duncan Ernst Introduction to the course What do you expect from this course? Bringing it together: Culture, Epidemiology, and Policy Global child health Millennium Goals and the Rights of the Child Computer lab all morning Brownson RC. Marks JS. Matanoski GM. Panisset, U MDG 2011 Promises made, yet to be kept Convention on the rights of the child Progress for children September 2012: ad/progress_for_children_no9.pdf Pronyk PM Background Report 8/31 3 9/5 9/7 All for discussion (in Rwanda) All for Discussion (in Nepal) All for Discussion (in Guyana) Cultural Forum - Rwanda Cultural Forum - Nepal Cultural forum Guyana Individual Analysis Report 1 4 Ernst and Duncan Poverty Conditional Cash Transfer Analysis Report 1

7 9/12 Development Bank (ADB) ERD Policy Brief Series # Chen S. Ravallion M. Bollen KA. Yunus, M, Banker for the Poor Chapters 1-4 9/14 Mark Nichter, PhD Team Rwanda presents (P) Cultural impact on health Formative Research Buruli ulcer Poverty and Health in Cambodia Planet of Slums Chapters 2-5 Dying for Growth: Global inequality and the health of the poor. Chapter 3 and Chapter 5 Health) 5 Wed 9/19 9/21 6 9/26 Team Nepal Discussion lead (DL) Duncan and Ernst Team Guyana (P) Team Rwanda (DL) Discussion of Readings on Poverty Female Education and Power in Guyana Discussion of Readings on Female Education and Empowerment Half the Sky Chapters 1-6 Population Reference Bureau 2003, policy brief Duncan and Ernst Food Security Policy Brief: food security Barret et al. Lobell et al. Muller et al. Kerr et al. Fanzo JC Analysis Report 2 (Female Education and Power and Health) Analysis Report 3 (Food and Health) 7

8 Ivers LC 9/ /3 10/5 8 10/10 10/12 Team Nepal (P) Team Guyana (DL) Food and Health in Nepal Discussion of Readings on Food Security and GOBI Duncan and Ernst Water and Sanitation Montgomery MA. Unwater: Gender, Water and Sanitation: A Policy Brief. Water for Life, The GLAAS report Team Guyana (P) Team Nepal (DL) Water and Sanitation in Guyana Discussion of Previous Week s Readings on Water and Sanitation Planet of Slums Ch Duncan and Ernst Maternal Mortality Beyond Maternal Mortality: PB Burchett HE Cross S Gil-Gonzalez D WHO: Trends in maternal mortality Team Rwanda (P) Team Guyana (DL) Pregnancy in Rwanda Discussion of Previous Week s Readings on Maternal Mortality Analysis Report 4 (Water and Sanitation and Health) Half the Sky Ch Analysis Report 5 (Pregnancy and Health Indicators) 9 10/17 Dan Derksen, MD Policy development Development with a human face Chapter 3: Health and education policies in high-achieving countries: some lessons Individual Analysis Report 2 8

9 10/ /24 10/ /31 11/2 12 Wed 11/7 Duncan and Ernst Perinatal and Infant Mortality Macassa G Omariba DWA Bhutta ZA Team Nepal (P) Team Rwanda (DL) Group meetings on policy All teams (P) Ernst and Duncan All to discuss Perinatal and Infant Mortality in Nepal Discussion of Previous Week s Readings on Infant Mortality Roundtable Discussion of Policy Development Childhood nutrition and micronutrients Micro-nutrients discussion of papers from previous week Spirit Level Ch. 4-7 Hoddinott J et al. Investing in the future: a united call to action on vitamin and mineral deficiencies Global Report 2009 Technical Brief Cambodia. Health Equity Funds: Robert E Black Zulfi qar A Bhutta Analysis Report 6 (Infant and Perinatal Mortality) AND Policy Topic Choice Literature Review of Topic in Country and current policies 11/9 13 Duncan Social determinants of health Status Syndrome: How social In depth Topic 9

10 11/14 11/ /21 11/ /28 11/ /5 Exam Week 12/7 All to discuss No Class Thanksgiving Last day of class *See attached reading list Social Determinants of Health discussion of papers from that week All three teams Presentation to legislators Team Rwanda Presentation to legislators Team Nepal Presentation to legislators Team Guyana Critique of the course by all through D2L standing affects our health and Longevity Ch. 5-7 Unnatural Causes video Bad Sugar (NA in AZ) 29 mins Spirit Level 8-11 Unnatural Causes video In Sickness and in Wealth 56 min Practice for Rwanda team Practice for Nepal team Practice for Guyana team Analysis Draft Policy Statement Final papers due 10

11 Communications: You are responsible for reading s sent to your UA account from your professors and the announcements that are placed on the course web site. Information about readings, news events, your grades, assignments and other course related topics will be communicated to you with these electronic methods. The official policy can be found at: Disability Accommodation: If you anticipate issues related to the format or requirements of this course, please meet with me. I would like us to discuss ways to ensure your full participation in the course. If you determine that formal, disability-related accommodations are necessary, it is very important that you be registered with Disability Resources ( ; drc.arizona.edu) and notify me of your eligibility for reasonable accommodations. We can then plan how best to coordinate your accommodations. The official policy can be found at: Academic Integrity: All UA students are responsible for upholding the University of Arizona Code of Academic Integrity, available through the office of the Dean of Students and online: The official policy found at: and Classroom Behavior: (Statement of expected behavior and respectful exchange of ideas) Students are expected to be familiar with the UA Policy on Disruptive Behavior in an Instructional Setting found at and the Policy on Threatening Behavior by Students found at Grievance Policy: Should a student feel he or she has been treated unfairly, there are a number of resources available. With few exceptions, students should first attempt to resolve difficulties informally by bringing those concerns directly to the person responsible for the action, or with the student's graduate advisor, Assistant Dean for Student and Alumni Affairs, department head, or the immediate supervisor of the person responsible for the action. If the problem cannot be resolved informally, the student may file a formal grievance using the Graduate College Grievance Policy found at Grade Appeal Policy: Syllabus Changes: Information contained in the course syllabus, other than the grade and absence policies, may be subject to change with reasonable advance notice, as deemed appropriate. Telephone and Computer Use: You are not allowed to have your computer on during class. Turn your cell phones to silent or vibrate in order to not disrupt the class and disturb your fellow students and professor. Plagiarism: What counts as plagiarism? 11

12 Copying and pasting information from a web site or another source, and then revising it so that it sounds like your original idea. Doing an assignment/essay/take home test with a friend and then handing in separate assignments that contain the same ideas, language, phrases, etc. Quoting a passage without quotation marks or citations, so that it looks like your own. Paraphrasing a passage without citing it, so that it looks like your own. Hiring another person to do your work for you, or purchasing a paper through any of the on- or off-line sources. Readings: The following is a short list of required readings for the course: Books Required Reading of Selected Chapters (chapters will be posted on D2L: Journal articles (see D2L postings): 12

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