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CRITICAL HEALTH ISSUES
On-Line Winter Session 2011
(HPS-20500-01; CRN#30066)
Stewart Auyash, MPH PhD 24 Hill Center
607-274-1312
All elements for this course will be on the Ithaca College BLACKBOARD system. Student can access the syllabus, assignments, discussions, and grades at the site. All assignments will also be delivered on the Blackboard site. If you need assistance with Blackboard, start by reviewing the “Blackboard for Students Quick Guide at: http://www.ithaca.edu/computing/quickguides/pdfs/blackboard_students.pdf
If there are any problems using the site, email will be our backup.
Read this syllabus very carefully. Online courses (especially those lasting only 2 weeks) require students to pay careful attention to all aspects of the course from the beginning. Look at the readings, assignments, and other requirements NOW. Students should email any questions you have about the course to the professor as soon as possible.
Introduction and Subjects Covered
Critical Health Issues is about the evolution and analysis of U.S. health policy. Health services in the U.S. are a vast enterprise that includes all sectors of government and industry. In a country where health services accounts for about 1 out of every 10 workers and about 15 cents out of every dollar spent, there are also about 45 million people without access to these services. But, health is also more than financial access. The air, water, and food must be safe to consume for everyone. If it is not, whose responsibility is it to make it so? Using epidemiological evidence and contrasting alternatives, this course employs a multidisciplinary approach to analyze the most recent issues in U.S. health services and public health. Current news items may alter the topics we cover, but the following list summarizes the major subjects reviewed and analyzed in this course.
· The evolution of the way we provide health services and public health in the U.S.
· The financing and organization of a vast system including the largest single government program anywhere at anytime: Medicare.
· Epidemiology as a cornerstone for understanding health problems and health status.
· Growing challenges offered by groups interested in profiting from illness and disease.
· Individual and community responsibility for health improvements.
· The most recent issues: HIV/AIDS, avian flu, HPV vaccine, prescription drug costs, among others.
· The challenges for professional education in health and medicine.
· Envisioning a better health policy in the U.S.
In addition, the US is currently engaged is a national debate regarding the health insurance reform that was passed on 2010. The professor will post news items, websites, and blogs to which student can respond to engage this major current issue. (This will be an extra credit opportunity for students.)
Required Readings
Nancy Adler, et.al., Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the U.S. The John D. and Catherine T. MacArthur Foundation Research Network on Socioeconomic Status and Health.
Can be downloaded online at:
http://www.macses.ucsf.edu/downloads/Reaching_for_a_Healthier_Life.pdf
This short and important treatise makes the argument that if we care about health status as well as medical care costs then we have to look at social policy and not merely health policy. They also argue than many health problems are not simply the result of “lifestyle” or individual behavior. You will be asked to write a brief essay on these arguments.
Robert H. LeBow, Health Care Meltdown: Confronting the Myths and Fixing Our Failing System (Chambersburg, Pa.: Allan C. Hood & Co., 2007). This book is authored by a physician who uses his experiences to offer an analysis of the problems and solutions to what he calls a “failing system.” NOTE: This is a new edition. Used copies of the 2003 edition are acceptable though the pages may be different.)
Anthony R. Kovner and James R. Knickman, eds., Health Care Delivery in the
United States, 9th Edition (New York: Springer Publishing, 2008). The Kovner and Knickman book is a recent textbook. It provides an overview of the U.S. health system and presents about one chapter on each of the major sectors of how health services are delivered, paid for, planned, and controlled.
The New York Times or other media sources. See assignment #5 below.
ONE of the following:
Michael Pollan, In Defense of Food: An Eater’s Manifesto (N.Y.: Penguin Press, 2008). Pollan is a journalist who makes a case for changing the way we grow, prepare, and select our food. He argues against the approach to eating processed foods dominated by the food industry and the U.S. Department of Agriculture. Warning: this book could change the way you eat.
Abraham Verghese, My Own Country: A Doctor’s Story (NY: Vintage, 1995).
Dr. Verghese was a new infectious disease resident during the beginning of the
HIV/AIDS epidemic and tells his story in this award winning account. The book is more than about disease, family, medical education, health communication, and alienation. It is the story of the issues faced early in the epidemic and the personal observations of an outstanding writer as he navigates between his careers, his dedication to his patients, his family, his new country, and his own stereotypes and biases.
Assignments
Online Notice: Remember that you are taking a 3-credit course in about 2 weeks, which normally involves 35 hours of in-class time and about 63 hours of out of class time for a total of 98 hours. Not every student has the learning style or the self-motivating strategies to complete a course on this intense basis. You will see guidelines and due dates for assignments on Blackboard. Please keep to these deadlines as closely as possible. Though I am willing to be flexible, regular late assignments will affect your grade. Incompletes are not unusual but they should be avoided if possible.
Most of the assignments for the class emanate from the readings. Students will also respond and comment on postings of the other students and the professor.
INTRODUCTIONS: Before posting any assignments, each student will introduce her/himself to our online class community. Using the Discussion Board Blackboard (or from the email list the professor sends you) send a message that includes at least the following:
a. name, major, year, hometown, and your January location during the course.
b. why are you taking this course?
c. what are your career aspirations at the present time?
d. what is your favorite restaurant in Ithaca?
Each of the assignments below should be submitted on Blackboard in the appropriate section under Assignments. It is not necessary to submit your assignments as WORD documents since they should fit in the box provided.
1. Kovner and Knickman Text:
For each chapter students will write a list of questions (at least 5). The questions may ask about definitions, issues, data, or any concerns the student may have. It is not expected that you will either know or provide answers to these questions. However, the questions are likely to be of two types: some that you are posing as if you were a professor asking detailed essay exam questions; and some that you are asking because you really do want to engage the professor to answer the question. These second type of questions should be marked with an asterisk (*), so that the professor can take the time to respond to you directly. There are 18 chapters. Students should submit their assignments in groups of 3 chapters (as designated in the course outline). Therefore there should be 6 sets of questions, 3 chapters in each set. The questions should be separated by chapters. (30% of final grade)
2. LeBow Book: Consider this book the “anti-text.” LeBow has a provocative point of view. So, instead of asking questions about each chapter (which you may still do), you will answer the questions below in about 1-2 paragraphs total. There are 18 chapters. Students should submit their assignments in groups of 3-4 chapters. These will total 5 sets of responses, 2-4 chapters in each set as indicated on the syllabus (combine the introduction with Ch. 1). (20% of final grade):
a. What is/are the point(s) LeBow is trying to make?
b. What, if anything, surprised, interested, or made you angry or frustrated about the chapter?
Yes, you may combine the chapters when you answer the questions above, but make sure you refer to the chapter you are writing about when you make your responses.
3. Pollan or Verghese: You need only read ONE of these books though the assignment is the same for both. You will be expected to make at least 3 one-page postings during the of reading of the book. These can be done at about equal intervals with the final post coming at the end of the book. Each posting should provide a) a very brief summary of events covered, and b) comments and/or questions about the reading to that point. The final posting will also answer: What did you learn about health from reading this book? The professor will also pose questions to each student based on their individual postings. There will be a total of 3 postings. (15% of final grade)
4. Short Essay on Reaching For a Healthier Life: Write an essay of about 250-300 words (about 1.5 typed pages) reacting to this report. First, provide a brief comment on all/some of the findings in the report including any criticisms you may have. Second, comment on whether the report’s findings offer any new information that might help you understand the plight of the poor and/or minorities. (10% of final grade)
5. News Items and Responses: During the next 2 weeks, students are expected to make
6 postings of news stories and 4 responses to news items sent to the students by the professor or other students (these will be provided irregularly a few times during the class). All postings for news items will be sent via Blackboard. NO DUPLICATE news stories are allowed. Also, each student must respond to at least 4 of the postings made by other students or the professor. The news items can come from any source but the sources must be cited in the posting. (Internet sources are fine and should include the exact URL.) Each posting should provide a brief summary of the news item and also comments about why you think it’s an important or interesting health issue and/or how it is related to something in the readings. There are a total of 10 postings. (10% of total grade).
6. Final Exam: There will be final exam based on the readings and news items. Obviously, it is open book. You must complete at least 75% of all assignments before I will send you the final exam. Those of you who do so will receive the final exam no later than January 14. The exam should be posted on Blackboard no later than Friday, January 22 at Midnight. (15% of final grade)
Assignments Summary:
1. Kovner and Knickman (K & K)– 6 postings, 3-4 chapters each (5 points X 6 postings = 30 points)
2. LeBow – 5 postings, 2-4 chapters each (4 points X 4 postings = 20 points)
3. Pollan or Verghese – 3 postings (5 points X 3 postings = 15 points)
4. Short Essay – 1 posting (10 points X 1 posting = 10 points)
5. News Items – 6 postings + 4 responses (1 point X 10 postings = 10 points)
6. Final Exam – 15 points
TOTAL = 100 points
One final note about grading: I will provide you with comments on your early chapter postings for Kovner/Knickman and LeBow so you have a good idea about their quality and how they are graded. I grade them using criteria that are listed on the website. Late assignments (especially the final exam) are subject to a lower grade depending on the degree of lateness.
Schedule and Contact
Students may begin the course at any time. However news postings should be made during the 2 week course schedule. Below is a schedule to help you along. Most of the readings in Kovner/Knickman and LeBow are in the first week. For the assignments for each book, see the list above. You may get ahead of the schedule, but please do not get behind. The professor may be contacted at any time via email only.
You will notice that the weekend is excluded from the schedule below. That can be a time for you to catch up if necessary.
Readings Key: K/K= Kovner & Knickmnan; L=LeBow; Pollan and/or Verghese should be started and read at your own pace and your assignment should be posted accordingly.
NOTE: The dates below correspond to the calendar on Blackboard. However, News Postings and Responses on Blackboard are grouped together to allow flexibility.
Date Topic Readings
1/10 (Mon.) K/K: Overview of Health Care K/K, Ch. 1-3
Access to Health Care for All?
1/11 (Tues.) LeBow: Myths, Profits, and Monsters L, Intro-Ch.3
1/12 (Wed.) K/K: Public Health: The Neglected Area? K/K, Ch.4-6
The Role of Government and International Comparisons
1/13 (Thurs.) LeBow: Rationing, the Uninsured, and Squeezing Patients L, Ch.4-7
(BEGIN reading Pollan or Verghese if you have not already done so. Also: Remember the news postings)
1/14 (Fri.) KK: Acute, Chronic, and Long Term Care: K/K, Ch.7-9
History, Hospitals, Costs, and Issues
DUE: At least the FIRST posting for Pollan or Verghese
(Start reading “Reaching for a Healthier Life” by Adler if you have not already done so.)