BRANDEIS UNIVERSITY

Health: Science, Society and Policy

HSSP 110A - 4: Integrative Seminar on Health

Spring 2014

Monday and Wednesday, 5:00 to 6:20 p.m.

Instructors and Location:

Section A:Neighborhood Effects on HealthSection B: Infant Mortality

Alison Earle, Ph.D.Darren Zinner, Ph.D.

Heller SchoolHeller School

352 Heller-Brown208 Schneider

x6-3918x6-3971

Office Hours: Wednesdays 11am-noonOffice Hours: Monday 4-5pm

Section C: Heart DiseaseSection D: Hunger in America

Elaine Lai, Ph.D.Deborah Garnick, Sc.D.

BiologyHeller School

Bassine 406, Penthouse floor256 Heller Brown

x6–3152x6-3840

Office Hours: Monday 4-5pmOffice Hours: Monday 4-5pm

Classroom Mandel Ctr for HumanitiesG10

Teaching assistant: TBD

COURSE DESCRIPTION:

The format of the course is based on a “problem based learning” (PBL) format. This will require students to be active learners for the course. An initial list of background reading is supplied, after which, the work will be student-directed. Students will decide (with guidance) how to tackle the ‘problem’ and learn about it in all its “science” “society” and “policy” aspects. Students will be responsible (again with guidance) to generate readings and discussion materials for each class. With the PBL approach, students will use all resources available to obtain information about the problem at hand depending on their section. This means exploring the scientific literature, contacting experts, evaluating claims-makers and stakeholders, locating and evaluating advocacy or self-help groups, assessing treatment programs, etc. Students will be asked to develop a group paper (approximately five-six student groups per course) paper and a presentation on some significant aspect of the problem. Based on these presentations, each student will develop abrief position paper, selecting and prioritizing recommended policies to address the problem. These position papers will be debated within the section, a selected set of policies will be presented to the entire HSSP senior class, and students will rate the policies through an on-line ranking and commenting process. Class time will include both within-section and overall cross-section class sessions. In-class time will be made available for some of the groupwork. Grading will be based on participation (both class attendance and active classroom participation) and evaluation of written and presentation material.

SECTION TOPICS – 2014

Section 1: Neighborhood Effects on Health — Professor Sara Shostak

When it comes to health, a recent Robert Wood Johnson Foundation policy brief suggests that “your ZIP code may matter more than your genetic code.” In fact, life expectancy varies – up to 20 years – among people living just a few miles from each other. In addition to diminished life expectancy, a wide variety of health outcomes, including infant mortality, accidental injury, hunger and homicide, cluster in the same communities. Research shows that these spatial patterns are longstanding, and that neither poverty, nor individual behavior, nor racial/ethnic composition is sufficient to explain them.

So, how is it that neighborhoods have such a profound effect on our health? In seeking to answer this question, we will consider research being done in diverse fields, including epidemiology, epigenetics, geography, and sociology. We will also conduct our own case study, focused on Waltham. Students in this section should be ready to explore city archives, analyze public health statistics, learn the basics of GIS mapping, investigate local health and social policies, examine the work of community based organizations, and venture off campus to do participant observation. We will conclude our work together by formulating a set of recommendations for improving population health in Waltham.

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Section 2: Infant Mortality — Professor Darren Zinner

Currently, the United States ranks 34th among countries in keeping babies alive through their first year of life (ahead of Malta but just behind Cuba). Why? This course will examine the management of prenatal and neonatal care across diverse perspectives, ranging from preconception care, to the growth of neonatal intensive care units, to family leave policies. The course will also pay special attention to international differences in the approach to birth, racial/ethnic disparities, and the role of U.S. public policy. Though group research papers, field interviews, and other assignments, the students will aggregate their findings and prioritize their recommendations to reducing national infant death rates.

Section 3: Heart Disease —Professor Elaine Lai

Heart disease or cardiovascular disease refers to a wide variety of different conditions that affect the heart and circulatory system. Heart disease is the number one killer of both men and women in the US and the world. In the US, heart disease is responsible for 40% of all deaths, which is more than all types of cancer deaths combined, as well as being responsible for strokes and many other debilitating diseases. Many types of cardiovascular disease can be both prevented and treated. This section will explore a range of issues, beginning with a scientific understanding of the pathophysiology of coronary heart disease (heart attack), cerebrovascular disease (strokes), and circulatory diseases (including atherosclerosis), and including heredity factors, risk factors such as stress, hypertension, tobacco smoking, lipids, physical activity, obesity and diabetes. We will discuss heart-healthy diets, and whether a glass of red wine a day may help to keep the cardiologist away. We will also consider why exercise is so important. We will explore the latest development in treatments including heart medicines, stents, surgery, and even the possibility of stem-cell therapies. We also will examine this global epidemic, the impact of socio-economic status and education level on disease development and mortality, its rising health care costs and health care policy. We will consider the following challenging question: How can our society be educated and inspired to a lifestyle that will reduce the impact of heart disease on our lives. We will conclude our semester’s work by providing guideline recommendations suitable for strategic planning by the American Heart Association.

Section 4: Hunger in America — Professor Deborah Garnick

In 2012, 14.5% of U.S. households (49 million people) were food insecure - lacked consistent access throughout the year to adequate food. In short, one out of every seven Americans sometimes went hungry. In Congress, the debate continues on cuts to the $800 billion a year Supplemental Nutrition Assistance Program (SNAP), commonly known as food stamps. In this section, we will explore causes of hunger and food insecurity, as well as its long-term physical, social, and psychological impacts. Students will work together to examine multiple approaches to alleviating hunger, including public nutritional support programs, economic and agricultural policies, community efforts, advocacy, and corporate coalitions. At the end of the semester, students will make recommendations for solutions to ending hunger in America.

COURSE OBJECTIVES:

  1. To examine an important health problem in terms of “Science, Society and Policy.”
  2. To bring together information and perspectives students learned in other HSSP courses.
  3. To learn to work together as teams to research and present information, as evidence based as possible.
  4. To identify key issues, major debates and leading figures about the problem.
  5. To learn to independently use a range of resources to interrogate the issues around the problem.
  6. To present verbal and written findings to instructor and class in a coherent and professional style.
  7. Based on the collective research, develop a class derived “white paper” on the most important aspects of the problem and policies that can be created to deal with it.

ASSIGNMENTS, COURSE GRADING:

The final grade will be determined as follows:

25% Classroom participation/preparation: The success of this class depends on full preparation by all students for each class, demonstrated by participation and contribution to class discussions. It is understood that there are different styles for accomplishing this, and no one style is preferred by the instructors over the other. We look for engagement and investment in the class and evidence of interest in the material under study. Please, restrict noise-emitting devices to outside-of-class, including those in the ear only; laptops will be allowed after a class discussion regarding rules for their use, and ONLY for class-related work.

Attendance is required and recorded at every class. Absences will be excused only for very exceptional circumstances. If an absence is anticipated, please request it in writing by submitting an e-memo to the professor. If an unanticipated need to be absent arises, please submit a written memo or email explaining the circumstances as soon as possible before the next class.

10% Project Preparation Document:Before splitting into subgroups, each student will be asked to think about ways to study the section's health topic overall. Drawing from the HSSP program's key learning objectives, the student will write a 2 page planning document, suggesting areas of research to examine the nature of disease, illness, or problem: 1) from a basic scientific perspective; 2) the social and cultural contributions; 3) the impact of the formal health care system; and 4) how public policies to ameliorate these issues can be developed, implemented, and evaluated.

25% Group paper/presentations on major sub-topics: Much of the class will be designed and led by the students themselves. In small groups (3-5 students), students will organize and lead a class session on a sub-topic germane to the course theme. The groups will be responsible for researching the topic, assigning background reading to their peers, presenting their findings, and leading class discussion on how this topic fits with the overall course theme. Background reading should be forwarded to the professor at least two class sessions prior to presentation in order for it to be posted on LATTE and available to students in time to prepare. Based on feedback from the presentation, the groups will complete a 10-12 page paper on their topic, due within one week after their presentation. Grade will be based on combination of preparation, presentation and paper.

15% Field Interviewand Reflection: The context and nuance of these topics often cannot be found in the published, peer-reviewed literature. It is important to extend beyond the classroom and absorb the experiences of central figures in the field. Students will be required to select and interview a person with substantive knowledge in their course topic. These interviewees can range from an afflicted patient, a caregiver, a physician, a thought-leader, or other relevant practitioner. For example, a student studying obesity may wish to interview a public-school cafeteria dietitian to better understand the day-to-day nutrition struggles between school menus and student choices. Before interviewing, each student is expected to hand in a profile of interviewee, including their bio, their organization, how the individual connects to the topic at hand, and an interview guide/questionnaire. Once approved by the professor, the student may conduct an interview and ultimately present their findings to the class. Students are also expected to write a 2-3 page “reflection” of their interview, outlining important findings, key quotes (paraphrased is acceptable), and a discussion of how the interview fits within the larger themes of the course; the interview guide should be included as an addendum. Please obtain all appropriate permissions before conducting the interview.

NOTE: Students in Section 1 will gather and analyze a variety of kinds of data, including but not limited to interviews. A separate handout will be provided to students in Section 1 regarding this component of their grades.

25%: Policy Position Paper: Once all groups have presented, students will individually prepare a 2-3 page position paper that outlines policies they believe will best ameliorate the issues presented in class. Papers should prioritize policies, ranking and outlining 3-4 initiatives and recommend a strategy for the future. These options should not be limited to only their personal sub-group topic. All papers will be graded on the clarity of problem statement, ability to logically articulate the argument, quality of evidence, appropriateness of conclusion, and the clarity of writing. These papers will form the basis of internal debate in the section and the final recommendations to the entire HSSP senior class.

LIBRARY RESEARCH and CITATION PROTCOL

All students must know how to research library and web resources and proper citation protocol. When in doubt, please consult a reference librarian or the Instructor and Teaching Assistant.

DISABILITY STATUS:

If you are a student with a documented disability on record at Brandeis University and wish to have a reasonable accommodation made for you in this class, please see me immediately.

ACADEMIC INTEGRITY:

Academic integrity is central to the mission of educational excellence at Brandeis University. Each student is expected to turn in work completed independently, except when assignments specifically authorize collaborative effort. It is acceptable to use the words or ideas of another person provided the source is properly acknowledged. This means that you must use footnotes and quotation marks to indicate the source of any phrases, sentences, paragraphs or ideas found in published volumes, on the internet, or created by another student. Violations of University policy on academic integrity, described in Section 3 of Rights and Responsibilities, may result in failure in the course or on the assignment, and could end in suspension from the University. If you are in doubt about the instructions for any assignment, you must ask for clarification.

CLASSROOM ETIQUETTE:

Classes will start promptly. Please refrain from parallel conversations, using any kind of noise-emitting devices, and using your laptop for anything other than class-related activity.

CLASS BY CLASS COURSE OUTLINE:

The syllabus is subject to changes during the semester. Updates will be announced to class and listed on LATTE; the schedule as listed on LATTE supersedes the one listed here.

  1. Jan. 13, 2014 (M) JOINT event - Course Introduction, Section Introductions
  2. Jan. 15, 2014 (W) JOINT event: Qualitative Interviewing, Sara Shostak, PhD

[Jan 20, 2014 (M): MLK day – No Class]

  1. Jan. 22, 2014 (W) Scope and Causes of Hunger, readings available on LATTE
  2. Jan. 27, 2014 (M)Impacts of Hunger, readings available on LATTE
  3. Jan 29, 2014 (W)Solutions to Hunger, readings available on LATTE
  4. Feb. 3, 2014 (M) Section team meeting: Brainstorm topics, Organize groups
  5. Feb. 5, 2014 (W) Surprise event
  6. Feb. 10, 2014 (M)JOINT event: Synergies between health care providers & communities to improve public health, Provost Steven Goldstein, MD PhD & Neil Maniar, PhD, MPH, Director of Health Equity Programs, Brigham and Women’s Hospital Center for Community Health
  7. Feb. 12, 2014 (W)Section Team Meetings : Plan Subgroup Presentations

[Feb 18-21: Midterm Recess – No Classes]

  1. Feb. 24, 2014 (M) Presentation and discussion of field work – Group D
  2. Feb. 26, 2014 (W) Team/group presentations in sections – Group A
  3. Mar. 3, 2014 (M) Presentation and discussion of field work – Group E
  4. Mar. 5, 2014 (W)Team/group presentations in sections – Group B
  5. Mar. 10, 2014 (M)Presentation and discussion of field work – Group F
  6. Mar. 12, 2014 (W)Team/group presentations in sections – Group C
  7. Mar. 17, 2014 (M) Presentation and discussion of field work – Group A
  8. Mar. 19, 2014 (W)Team/group presentations in sections – Group D
  9. Mar. 24, 2014 (M) Presentation and discussion of field work – Group B
  10. Mar. 26, 2014 (W)Team/group presentations in sections – Group E
  11. Mar 31, 2014 (M) Presentation and discussion of field work – Group C
  12. Apr. 2, 2014 (W)Team/group presentations in sections – Group F
  13. Apr. 7, 2014 (M) Section Team Meeting: Working session
  14. Apr. 9, 2014 (W)Section Team Meeting: Discussion and debate
  15. Apr. 14, 2014 (M) Section Team Meeting: Prepare policy points

[Apr 15-22: Spring Recess – No Classes]

  1. Apr 23, 2014 (W) JOINT event: Policy Points Presentation
  2. Apr 28, 2014 (M) JOINT event: Wrap-Up, Evaluation, and Celebration.

Wednesday, January 22 - Scope and Causes

Readings

United States Department of Agriculture, Coleman-Jensen, A., Nord, M., Singh, A. September 2013. Household Food Security in the United States in 2012. 33 pgs.

Ziliak, J.P., and Gundersen, C. August 2013. The State of Senior Hunger in America 2011: An Annual Report. Prepared for the National Foundation to End Senior Hunger. pgs. 1-17.

Bruening, M., MacLehose, R., Loth, K., Story, M., & Neumark-Sztainer, D. (2012). Feeding a family in a recession: Food insecurity among Minnesota parents. Am J Public Health, 102(3), 520-526.

Monday, January 27 - Impacts

Readings

Stolberg, Sheryl Gay. On the Edge of Poverty at the Center of a Debate. The New York Times. September 4, 2013.

Severson, Kim and Hu, Winnie. Cut in Food Stamps Forces Hard Choices on Poor. The New York Times. November 7, 2013.

Seligman, H. K., & Schillinger, D. (2010). Hunger and socioeconomic disparities in chronic disease. N Engl J Med, 363(1), 6-9.

Laraia, B. A. (2013). Food insecurity and chronic disease. Adv Nutr, 4(2), 203-212.

Wednesday, January 29th - Solutions

Readings

Krugman, Paul. Free to be Hungry. The New York Times. September 22, 2013.

Reeves H. “In the good old days, you’d smell the milk” Former Trader Joe’s executive Doug Rauch on why outdated food isn’t so bad. New York Times, November 10, 2013.

Glickman, D., & Veneman, A. M. (2013). The essential role of food and farm policy in improving health. Health Aff (Millwood), 32(9), 1519-1521.

Ludwig, D. S., Blumenthal, S. J., & Willett, W. C. (2012). Opportunities to reduce childhood hunger and obesity: restructuring the Supplemental Nutrition Assistance Program (the Food Stamp Program). JAMA, 308(24), 2567-2568.

Mabli, James, Jim Ohls, Lisa Dragoset, Laura Castner, and Betsy Santos. Measuring the Effect of Supplemental Nutrition Assistance Program (SNAP) Participation on Food Security. Prepared by Mathematica Policy Research for the U.S. Department of Agriculture, Food and Nutrition Service, August 2013. (Note, the report is 300+ pages – review the summary.)

Van Wye, G., Seoh, H., Adjoian, T., & Dowell, D. (2013). Evaluation of the New York City breakfast in the classroom program. Am J Public Health, 103(10), e59-64.

Elliott, P., and Raziano, A. June 2012. American Public Health Association - Issue Brief. The Farm Bill and Public Health: A Primer for Public Health Professionals. pgs.1-21.

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