<
 
   
  Professor
Victor G. Rodwin

Phone: (212) 998-7459
Fax: (212) 995-3890
E-mail: victor.rodwin@wagner.nyu.edu

   
 
     
Home
Bio
Courses
Publications
Projects & Awards
World Cities Project
RWJ Health & Megacities
French Health Care System
Links
 
 


NEW YORK UNIVERSITY
Robert F. Wagner School of Public Service
COMMUNITY HEALTH AND MEDICAL CARE - P11.1830
Spring 2003

Prof. Victor Rodwin
Tuesdays, 8:10-9:50 PM
Shimkin Hall Rm. 333
Ph. 998-7459
Office: 4 Washington Squre North, Rm. 51
E-mail:victor.rodwin@wagner.nyu.edu

Assistant: Zuzanna Kobrzynski: 212-998-7435, zk3@nyu.edu

COURSE SYLLABUS

    This introductory course in the Health Policy and Management Program is designed to familiarize students with some of the basic concepts and ideas concerning the distribution of health and illness in our nation, the organization of the health care system, and the relationship of one to the other. Definitions of health and illness, and tools for their assessment, as well as the historical context for developments in public health and medicine, are discussed and debated. Concerns about the uneven distribution of illness and health care resources in the United States and other nations are also analyzed in the context of trends in the distribution of disease and in the organization of health services and health personnel.

    Students should come to class ready to discuss and debate the major themes related to urban health and society, the social geography and distribution of disease, as well as the policy environment that influences access to public health and health care services.

BOOKS AND READINGS

      Three textbooks are required. They are available at NYU's Professional bookstore. Specified chapters or articles from these texts are required each week. The articles in the book edited by Conrad and Kern provide a sociological view, and critique, of health and health care delivery. The chapters in the Kovner and Jonas textbook describe the organization of the health care delivery system in the United States. The articles and chapters incorporated in the reader edited by Lee and Estes provide insight into health politics and policy. Together, these three texts will provide students with a strong foundation for their future studies and health care careers.

      In addition to these required texts, students will be assigned readings in a popular book by Nuland, the book by Randy Shilts and the book by Lynn Payer. Nuland will be used to deepen the understanding of the issues raised in Class XI (the role of the patient and relevant ethical issues). The book by Randy Shilts provides case study materials on the evolution of the AIDS epidemic. Lynn Payer's book provides an international perspective on the cultural dimensions of medicine. All of these texts are available on reserve at Bobst Library, most medical libraries, and through the NYU Professional Bookstore.

REQUIRED BOOKS:
Conrad, Peter (ed.), The Sociology of Health and Illness: A Critical Approach, (6th Edition). New York: St. Martin's Press (1997).

Kovner, Anthony (ed.), Health Care Delivery in the United States (7th Edition). New York: Springer Press (2002).

Lee, Philip and Carroll Estes (ed.), The Nation's Health (6th Edition). Boston: Jones and Bartlett (2000).
ADDITIONAL BOOKS:
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).

Payer, Lynn, Medicine and Culture. New York: Henry Holt (1999).

Journal Abbreviations:
AJPH - American Journal of Public Health
JAMA - Journal of the American Medical Association
NEJM - New England Journal of Medicine

CLASS TOPICS AND READINGS

A. INTRODUCTION

I. Health, Disease and Community - January 21
  • 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 do we measure and assess health status?
  • How are health status and health care related?
  • How does individual health relate to community health?

The Sociology of Health and Illness: A Critical Approach
  1. John B. McKinlay and Sonja M. McKinlay. "Medical Measures and the Decline of Mortality," pgs. 7-19.
The Nation's Health
  1. Thomas McKeown. "The Determinants of Health," pgs. 55-77.
  2. William G. Rothstein. "Trends in Mortality in the Twentieth Century, " pgs. 9-29.

B. DISTRIBUTION OF HEALTH, DISEASE AND PUBLIC HEALTH PROBLEMS

II. Introduction to Epidemiological Measures and Methods - January 28
  • Concepts in epidemiology.
  • Descriptive vs. analytic methods.
  • Social factors and disease

The Sociology of Health and Illness: A Critical Approach
  1. Barbara Ellen Smith. "Black Lung: The Social Production of Disease," pgs. 55-67.
  2. Phil Brown. "Popular Epidemiology: Community Response to Toxic Waste-Induced Disease," pgs. 68-75.
  3. Victor Fuchs. "A Tale of Two States," pgs. 50-51.
Health Care Delivery in the United States
  1. Steven Jonas and Mary Ann Chiasson "Measurement," pgs. 10-43.
The Nation's Health
  1. 5. Office of Public Health and Science, DHHS. "Healthy People 2010 Objectives," pgs. 30- 47.
III. The Uneven Distribution of Disease - February 4
PAPER 1 -DUE

  • How do such factors as age, gender, race, poverty, occupation and lifestyle relate to morbidity and mortality?

The Sociology of Health and Illness: A Critical Approach
  1. S. Leonard Syme and Lisa F. Berkman. "Social Class, Susceptibility and Sickness," pgs. 24-29.
  2. Colin McCord and Harold P. Freeman. "Excess Mortality in Harlem," pgs. 30-36.
  3. Ingrid Waldron. "What Do We Know about Causes of Sex Difference in Mortality?" pgs.37-49.
  4. James S. House et al. "Social Relationships and Health," pgs. 76-84.
The Nation's Health
  1. Nancy E. Moss et al. "Socioeconomic Disparities in Health in the U.S.A.: An Agenda for Action," pgs. 65-78.
  2. Vicente Navarro. "Race or Class Versus Race and Class: Mortality Differentials in the United States," pgs. 79-83.
  3. Karen Scott Collins et al. "Health Consensus Across a Woman's Lifespan," pgs. 503-513.
Additional Reading
  1. R.G. Evans. "Introduction." In Why Are Some People Healthy and Others Not? NY: Aldine de Gruyter, 1994; pgs. 3-26. (Available on Blackboard)
  2. WHO. "Social Determinants of Health," 1998. (Available on Blackboard).
IV. Public Health, Medicine and Resource Allocation - February 11
  • Achievements in public health
  • Public health versus medicine
  • Ethics of resource allocation
The Nation's Health
  1. The Centers for Disease Control and Prevention. "Ten Great Public Health Achievement-United States, 1900-1999," pgs. 225-227.
  2. The Centers for Disease Control and Prevention. "Achievements in Public Health, 1900-1999: Control of Infectious Diseases, " pgs 233-239.
  3. The Centers for Disease Control and Prevention. "Achievements in Public Health, 1900-1999: Decline in Deaths from Hearth Disease and Stroke," pgs. 240-246.
  4. Roz. D. Lasker and the Committee on Medicine and Public Health. "Medicine and Public Health: The Power of Collaboration." pgs. 262-302.
The Sociology of Health and Illness: A Critical Approach
  1. Daniel Callahan. "Rationing Medical Progress: The Way of Affordable Health Care," pgs. 421-424
  2. Arnold S. Relman. "The Trouble with Rationing," pgs. 425-428.
Additional Readings
  1. H. Aaron and W.B. Schwartz. "Rationing Health Care: The Choice Before Us," Science 247 (4941): 418-22, January 26, 1990. (Available on Blackboard).
  2. Boufford, Jo. "Health Future: The Managerial Agenda," Andrew Patullo Lecture, AUPHA, June 26, 1999. (Available on Blackboard)
V. Public Health Case Studies - February 18
  • The use of the public health model to address the problem of motor vehicle safety.
  • The impact of violence on the health care system.
  • The evolution of the AIDS epidemic.
  • Medicine and culture.
  1. Shilts, Randy, And the Band Played On.
The Nation's Health
  1. The Centers for Disease Control and Prevention, "Motor-Vehicle Safety: A 20th Century Public Health Achievement," pgs. 228-232.

C. HEALTH CARE ORGANIZATION, FINANCING AND WORKFORCE ISSUES

VI. Organization of the U.S. Health Care System - February 25
  • History, trends, and characteristics.
  • What are the social, medical, and technological factors that have led to the health care system as we know it today?
  • Medicare and Medicaid
  • The future
Health Care Delivery in the United States
  1. James Knickman. "Futures," pgs. 455-475.
  2. Anthony Kovner and Steven Jonas. "Introduction: The State of Health Care Delivery in the United States," pgs. 3-9
  3. Michael Sparer. "Government," pgs. 315-338
The Nation's Health
  1. Jennifer Campell. "Health Insurance Coverage: Consumer Income," pgs. 313-320.
  2. Robert Kuttner. "The American Health Care System: Health Insurance Coverage," pgs. 321-330.
  3. Robert Kuttner. "The American Health Care System: Employer Sponsored Health Coverage," pgs. 331-340.
  4. John Iglehart. "The American Health Care System: Medicare," pgs. 349-362.
The Sociology of Health and Illness: A Critical Approach
  1. Howard Waitzkin. "A Marxian Interpretation of the Growth and Development of Coronary Care Technology," pgs. 248-261.
  2. Arnold S. Relman. "The Health Care Industry: Where Is It Taking Us?" pgs. 242-247.
VII. Hospitals - March 4
  • How are hospitals financed?
  • How are hospitals organized and governed?
  • How has role of the hospitals changed over time?
Health Care Delivery in the United States
  1. Anthony R. Kovner. "Hospitals," pgs. 145-172.
  2. Ibid. "Governance and Management," pgs. 339-361.
VIII. Ambulatory Care - March 11
  • Comparisons of solo practice, group practice, and pre-paid groups/HMOs.
  • Hospital-based ambulatory care and saftey-net providers
  • Mental health services.
The Sociology of Health and Illness: A Critical Approach
  1. John McKnight. "Politicizing Health Care," pgs. 446-449.
  2. Ann Withorn. "Helping Ourselves, " pgs. 450-459.
Health Care Delivery in the United States
  1. Andrew P. Mezey. "Ambulatory Care," pgs. 173-198
SPRING BREAK

IX. The Rise, Fall and Significance of Managed Care - March 25
  • Organizational structures of managed care
  • Reimbursement mechanisms of managed care
  • Strengths and weaknesses of managed care
Health Care Delivery in the United States
  1. Helen Smits. "Managed Care," pgs. 289-314
The Nation's Health
  1. John Rother. "Consumer Protection in Managed Care: A Third-Generation Approach," pgs. 417-425.
  2. The Kaiser Commission on Medicaid and the Uninsured. "Medicaid and Managed Care," pgs. 426-429.
  3. Eli Ginzberg. "The Uncertain Future of Managed Care," pgs. 430-434.
X. Health Care Personnel: Physicians, Nurses, and Allied Professionals - April 1
  • Demographic and socio-economic characteristics of doctors.
  • Physicians as a dominant profession.
  • Licensure and medical monopoly.
  • Role of medical education.
  • Historical and emerging roles.
Health Care Delivery in the United States
  1. Christine R. Kovner and Edward S. Salsberg. "The Health Care Workforce," pgs. 68-106.
The Sociology of Health and Illness: A Critical Approach
  1. Peter Conrad and Joseph W. Schneider. "Professionalization, Monopoly and the Structure of Medical Practice," pgs. 156-161.
  2. Richard W. Wertz and Dorothy C. Wertz. "Notes on the Decline of Midwives and the Rise of Medical Obstetricians," pgs.162-174.
  3. John B. McKinlay and John D. Stoeckle. "Corporatization and the Social Transformation of Doctoring," pgs. 175-185.
  4. Donald W. Light. "Countervailing Power: The Changing Character of the Medical Profession in the United States," pgs. 189-197.
  5. Susan Reverby. "A Caring Dilemma: Womanhood and Nursing in Historical Perspective," pgs. 217-227.
  6. Barbara Katz Rothman. "Midwives in Transition: The Structure of a Clinical Revolution," pgs. 340-348.
Additional Reading
  1. Vanessa Northington Gamble. "Subcutaneous Scars," Health Affairs 19 (1), Jan/Feb 2000, pp. 164-169. (Personal Essay on Racial Prejudice in Medicine)

D. HEALTH CARE DEMANDS, NEEDS AND SYSTEM PERFORMANCE

XI. The Role of the Patient - April 8
  • The sick role.
  • Issues of patient compliance.
  • The relationship of patients, physicians, and the health care system.
  • Information and consumer issues.
The Sociology of Health and Illness: A Critical Approach
  1. Elliot G. Mishler. "The Struggle between the Voice of Medicine and the Voice of the Lifeworld," pgs. 293-304.
  2. Renee R. Anspach. "The Language of Case Presentation," pgs. 321-339.
  3. Peter Conrad. "The Meaning of Medications: Another Look at Compliance," pgs. 137-148.
  4. David Mechanic. "Changing Medical Organization and the Erosion of Trust," pgs. 198-204.
  5. Deborah Lupton. "Risk as Moral Danger: The Social and Political Functions of Risk Discourse in Public Health," pgs. 394-401.
  6. Irving Kenneth Zola. "Medicine as an Institution of Social Control," pgs. 404-413.
The Nation's Health
  1. George J. Annas. "A National Bill of Patients' Rights," pgs. 157-165.
  2. David Oppenheimer and Marjorie Shultz. "Gender and Race Bias in Medical Treatment," pgs. 483-489.
How We Die: Reflections on Life's Final Chapter
  1. Chapter 1, plus at least one other chapter.
XII. Access, Insurance, Comparative International Experience - April 15
  • Issues of access and inequity.
  • Barriers to care.
  • The crisis in health insurance and the problem of the uninsured.
The Sociology of Health and Illness: A Critical Approach
  1. David J. Rothman. "A Century of Failure: Health Care Reform in America," pgs. 266-274.
  2. Thomas Bodenheimer and Kevin Grumbach. "Paying for Health Care," pgs. 275-282.
  3. Donald Light. "Comparative Models of 'Health Care' Systems," pgs. 464-478.
  4. Theodore R. Marmor and Jerry L. Mashaw. "Canada's Health Insurance and Ours: The Real Lessons, the Big Choices," pgs. 479-488.
  5. Jonathan Gabe. "Continuity and Change in the British National Health Service," pgs. 489-501.
  6. Deborah A. Stone. "Doctoring as a Business: Money, Markets, and Managed Care," pgs. 283-290.
Health Care Delivery in the United States
  1. Victor G. Rodwin. "Comparative Analysis of Health Systems: An International Perspective," pgs. 107-144.
  2. John Billings. "Access to Health Care Services," pgs. 395-426.
XIII. Impact of Changing Health Care Needs on the Health Care System - April 22
  • The need for long-term care and alternative modes of delivery.
  • Chronic illness, aging and HIV and AIDS.
The Sociology of Health and Illness: A Critical Approach
  1. Renee C. Fox. "The Medicalization and Demedicalization of American Society," pgs. 414-418.
Health Care Delivery in the United States
  1. Penny Hollander Feldman, Pamela Nadash, and Michael D. Gursen. "Long-Term Care," pgs. 199-237.
The Nation's Health
  1. Carroll L. Estes et al. "The Politics of Long-Term Care Reform Under the Clinton Health Plan: Lessons for the Future," pgs. 206-214.
  2. Carroll L. Estes and Tracy A. Weitz. "Aging and Gender: A New Voice on the Women's Health Agenda," pgs. 523-546.
  3. Dorothea Rice. "Medicare: A Woman's Issue," pgs. 514-522.
XIV. Quality Assessment and Quality Assurance - April 29
  • How do we measure and monitor the qulity 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?
Health Care Delivery in the United States
  1. Susan D. Horn. "Improving Quality Care," pgs. 362-394.
The Nation's Health
  1. Introduction to Chapter 10, pgs. 435-439.
  2. Thomas Bodenheimer. "The American Health Care System: The Movement for Improved Quality in Health Care," pgs. 441-451
  3. Brook, Kamberg and McGlynn. "Health System Reform and Quality," pgs. 452-465.
Additional Reading
  1. Donabedian, A. "The Quality of Care. How can it be Assessed?" JAMA 260(12), 1988 Sept. 23-30, pgs. 1743-1748
May 6 PAPER 2 - DUE


COURSE REQUIREMENTS

In addition to attending and participating in classes, students must submit two papers and a bi-weekly exercise. These requirements are described below and the actual assignments are attached. Course grades will be calculated as follows:
 %Final GradeDate Due
Paper I20%February 4 (Class III)
Paper II35%May 6 (Exam Week)
Bi-Weekly Exercises30%
Class Participation15%


Paper I - Students must prepare a memo (3-4 pages in length) focusing on the interpretation of morbidity or service use data. The assignment will allow students to demonstrate their ability to understand and interpret quantitative data. Class readings will also be useful in preparing this memo.

Paper II - This paper will require a thoughtful, critical, and well-organized discussion of a provocative concept in Community Health and Medical Care. Rather than a research paper, this paper will provide students the opportunity to reflect upon the course materials. The paper should be 5 to 9 pages in length and students should present a carefully organized discussion, with well backed opinions and ideas. Material should be footnoted where appropriate.

Bi-Weekly Exercises - Students are required to browse recent issues of well-respected journals, such as APHA, JAMA, NEJM, and Health Affairs. The attached list of relevant web sites may also be helpful. The Instructor will pass out a list of questions that should be answered in bi-weekly, two page essays. These essays should be based on class readings and/or relevant data and ideas from the journals or websites.

Class Participation - Classroom discussion and debate are essential to this course. Students are expected to come to class ready to discuss both the assigned and self-selected readings. Students are encouraged to approach the material in a thoughtful and critical manner.

Administrative Procedure - If you have trouble posting your bi-weekly exercises, please contact Zuzanna Kobryzynski at zk3@nyu.edu or 212-998-7535
BI-WEEKLY EXERCISES

Please write a 2 page essay with appropriate citations to the assigned readings for the following topics. These essays must be posted on Blackboard before 5 pm on the due date. Students must complete 4 of the 5 assignments. Late assignments will not be graded.

  1. DUE FEBRUARY 4, 2003 COVERING SESSIONS I & II Topic: Discuss the ways in which health and disease may be considered a "community affair." What implications would you draw for "Healthy People 2010 Objectives?"
  2. DUE FEBRUARY 20, 2001 COVERING SESSIONS III, IV, & V Topic: Given that health and disease are unevenly distributed, what should be the role of public health authorities? On the basis of what criteria should resources be allocated for medical services? For public health services?
  3. DUE MARCH 27, 2001 COVERING SESSIONS VI, VII, VIII & IX (NO JOKE!) Topic: Describe the U.S. health care system to a foreign visitor taking account of its strengths as well as weaknesses. Also, discuss how ambulatory surgery centers and health centers have affected hospitals and speculate on how hospitals will evolve in the future.
  4. DUE APRIL 3, 2001 COVERING SESSION X Topic: What do you think are the three most important functions of each of the following: physicians, nurses, and allied health professionals. Do you think any one group will dominate in the future?
  5. DUE APRIL 24, 2001 COVERING SESSIONS XI, XII & XIII Topic: Do changing health care needs make quality assessment even more important than it used to be? Do the foreign models of health care organizations in Canada, Great Britain, France, and Germany provide lessons for improving the quality of the U.S. health system?
WEBSITES

 



Home     Bio    Courses     Publications     Projects & Awards     World Cities Project     RWJ Health & Megacities     French Health Care System     Links

Copyright 2001