HSSP 114b – Racial/Ethnic & Gender Inequalities in Health and Health CareSYLLABUS

Brandeis UniversityHealth: Science, Society and Policy

Olin-Sang American Civilization Center, Room 104Thursdays, 2:00 pm – 4:50 pm

Laurie Nsiah-Jefferson, Ph.D., M.P.H., M.A. GTA: Phomdaen Souvanna, PhD StudentRoom 349, Heller School psouvanna@brandeis.edu (781)-781-3757 (p) Office hours - TBD(781)-736-3773 (f)ljeffers@brandeis.edu Office hours by appointment

Course DescriptionThis course is designed to help students learn about the nature of health disparities among racial and ethnic minorities and other vulnerable populations in the United States, and become familiar with the research literature on health disparities. Through lectures, readings, class discussions, papers and exercises, students will become knowledgeable about the most commonly used indices to measure health disparities and the role of poverty, racism, discrimination, residential segregation community context, stress, genetics, and other factors on health status disparities. We will also explore the role of the intersection of race and gender on health disparities, and the needs and challenges of special populations in regard to health disparities. Upon completion of this course students will be able to identify demographic and epidemiological patterns in health status by race, ethnicity, gender, and socio-economic status. They will also be able to identify and critique the current theories for racial/ethnic disparities in health status, access and quality, as well as become familiar with conceptual models and frameworks for reducing and/or eliminating health status and health care disparities. Class exercises and course readings will also help students to understand and critically analyze the multiple pathways in which racial discrimination impacts on health status, access to, and quality of care. Upon completion of the course students will be familiar with and have the ability to identify and critique several public health and policy initiatives/strategies designed to reduce and ultimately eliminate health disparities among racial/ethnic and other vulnerable populations.

The general objectives of the course are to: Introduce epidemiological concepts and theories Introduce and explain the differences between health status and health care disparities. Provide perspectives on the causes for health status and health care disparities. Highlight proposed strategies to address health and health care disparities. Highlight interventions and initiatives that are effective in addressing health status and health care

disparities. Provide students with the ability to critically evaluate perspectives and strategies to address health

and health care disparities Provide ideas about their role as students and workers in addressing health disparities.

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.

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Academic IntegrityAcademic 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 word or ideas of others provided that the source is properly acknowledged. This means that you must use footnotes and quotation marks to indicate the sources 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 result in suspension from the University. If you are in doubt about the instructions for any assignment in this course, you must ask for clarification.

Required Texts Barr, D. A. (2008). Health Disparities in the United States, Social Class, Race, Ethnicity and

Health, The Johns Hopkins University Press.

LaVeist, T. A., & Isaac, L. A. (2013). Race, ethnicity, and health: A public health reader. San Francisco, CA: Jossey-Bass.

Recommended Texts: Krieger, N. (2011). Epidemiology and the people's health: Theory and context. New York:

Oxford University Press.

Laveist, T.A. (2005). Minority Populations and Health: An Introduction to Health Disparities in the United States, San Francisco, Jossey-Bass.

Schulz, A. J., & Mullings, L. (2006). Gender, race, class, and health: Intersectional approaches. San Francisco, CA: Jossey-Bass.

Materials on LatteAdditional readings materials will be posted on Latte

Grading1. Final Project/Paper 20%2. Short Papers (2) 20%3. Participation in class (include final class project) 20%4. Web-based 10%5. Group Assignment 15% 6. Final Paper Proposal 10 %7. Quiz (on epidemiology, health disparity terms, & federal health agencies) 5% Class Format and EmphasisThis course will utilize a social justice lens that reviews evidence of the social determinants of health and facilitates discussion on how nations, communities and individuals can take action on root and secondary causes of inequities. Students will be provided with a critical health analysis, which will focus on; 1) upstream circumstances that affect health; empowering them to improve the health of populations and sub-populations; 3) strategies to take action to address inequities in health. Specifically we will address what is health; what are health disparities; the causes and strategies to address them. The first half of the class session will include a lecture and/or video to highlight the basic tenets relate to the topic of the day. The remainder of the session students will break into groups to process the topic of the day and/or garner skills in public health engagement, especially advocacy in regard to health and health care disparities

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Course Requirements and Expectations

Class Participation: Students are expected to attend all classes, have completed all the readings, and participate in discussions. Class participation will be graded on attendance and the quality of the participation. Please make sure that readings are completed, as there is the possibility of pop quizzes, which will be calculated as part of your class participation grade.

Current Events: Students will be expected to be familiar with current events related to health disparities issues. Therefore each week students will be required to read the Daily Report Headlines at http://www.kaisernetwork.org/static/spotlight_minorityhealth_index.cfm. This will provide up to date information on health disparities issues. For each class students will be called upon to briefly highlight something in the news of interest to them. Current events will be subsumed under class participation.

Reflection/Review Papers: On occasion students will be required to write a 500 - 1000 word (1- 2 page) reflection paper on their weekly reading in class. This will happen at random and consequently students should be ready to meet this request.

Short Essay Assignments: Writing short essays will help students to think critically about, and/or synthesize and integrate the readings on a particular topic. The essay assignment may require a response to a specific question, or a critique and/or synthesis of the readings. If students are asked to critique a set of readings they may want to compare and contrast arguments, methodologies, perspectives and implications. The specific assignments for the essays will be handed out in class.

Web-based Assignments: These assignments consist of completing a web-based course on measuring health disparities and responding to case studies. Responses to the case studies must be written up and submitted unless otherwise indicated. Evidence that you have completed the web-based course will also be required.

Group Assignments: One important skill is collaborative work. Students who have varying talents, perspectives and political ideologies will be required to work together to accomplish a task in a short period of time. Group assignments will usually require that students solve a real-life health disparity problem in a creative and effective manner, or synthesize and/or critique health disparity documents. At the beginning of the semester students will be assigned to a group. For both their weekly discussions, as well as group assignments, Group projects might require work in or outside of class.

Question Formulation Technique: This activity is essentially a structured brainstorming technique that will help you to develop your own question formulation skills. I will ask you either in class or for homework to think about the topic and generate your own questions. There will only be a penalty for not responding to the questions.  They will not be graded.

Final Paper or Project: Students can choose to write a research paper or conduct a final project on a topic of interest relating to health or health care disparities. It is expected that students will use a range of references, and show creativity in their work. Final papers must be submitted by the last day of class. By March 1st students will be required to submit a 1-2 page proposal for their final assignment including, topic, objectives, proposed methods, data sources, and time-line for completion.

PART 1: DESCRIBING HEALTH DISPARITIES AND CONCEPTUALIZING RACE AND ETHNICITY

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Session 1 – January 16, 2014Course Overview

Class Objectives:By the end of class, students will be able to:

Describe course goals, objectives and expectations for the course. Articulate why it is important to study health disparities. Have an understanding of the reasons that their classmates are interested in the topic of health

disparities.

View in class Trailer for “Unnatural Causes” View Discovery Health Disparities Video (parts 1-3) http://www.youtube.com/watch?v=wlnqJwyuNfk&feature=player_embedded

Group Work and Exercises Share with group how you define health and a health disparity

Session 2 – January 23, 2014The Historical Aspects of Race/Ethnicity and Health and Conceptualizing Race and Ethnicity

Class ObjectivesBy the end of class students will be able to:

Discuss population demographics in the US and its transition Discuss the definition and meaning of health Discuss historic examples of unequal treatment of different populations in the US Discuss the social roots of health disparities Discuss conceptual issues in defining race and ethnicity Define the OMB Directive 15.

View in Class Video on Conceptualizing Race

Group Work and Exercises Chapter 2 Laveist (2005) Exc. Racial/Ethnic Categories

Required Readings

Historical AspectsBarr, D. A. (2008). Health Disparities in the United States, Social Class, Race, Ethnicity and Health, The Johns Hopkins University Press. “Race/Ethnicity and Health” pp. 105-133 and “Introduction to the Social Roots of Health Disparities” pp. 1-14

Berkman, L. & Kawachi, I. (n.d.). Historical framework for social epidemiology. Chapter 1 (pp. 3-12)

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Kawachi, I. (January 01, 2002). Social epidemiology. Social Science & Medicine (1982), 54, 12, 1739-41.

LaVeist TA (2005). “Historical Aspects of Race/Ethnicity and Health”, pp. 1-7,

Thomas, B. (2013). The Color Line: Race Matters in the Elimination of Health Disparities. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 35-40). San Francisco: Jossey-Bass.

Allen, Richard (2011), pp 7-21, Historical Perspectives of Healthcare Disparities: Is the Past Pro-logue?”Healthcare Disparities at the Crossroads with Healthcare Reform

Conceptualizing Race and Ethnicity

“Conceptual Issues in Race, Ethnicity and Health”, pp. 7 -29 in Laveist ( 2005)

Part 2 Conceptualizing Race and Ethnicity. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 47-73). San Francisco: Jossey-Bass.

Session 3 – January 30, 2014Key Definitions and Terms, Epidemiological Profile of Racial/Ethnic Health Disparities, Organizations that Address Minority Health

Class ObjectivesBy the end of class students will be able to:

Describe demographic trends related to racial/ethnic minorities in the U.S. Be familiar with key terminology and definitions used in describing health disparities Define epidemiology and epidemiological terms such as, life expectancy, prevalence,

incidence, age adjustment, survival curve, infant mortality, maternal mortality, life expectancy, years of potential life lost, disability etc.

Identify the historic trends in mortality rates by race/ethnicity. Identify key mortality, morbidity, and other health status indicators by race, ethnicity and

gender. Describe leading causes of health morbidity and the prevalence of conditions on sub-

populations in the United States. Be familiar with governmental organizations that address minority health

Group Work and/or Exercise Political Autobiography discussion

Required Reading

Epidemiological ProfileLaVeist, T. A., & Isaac, L. A. (2013). Race, ethnicity, and health: A public health reader. San Francisco, CA: Jossey-Bass. Introduction & Chapter 1

LaVeist TA (2005). “The Epidemiological Profile of Racial and Ethnic Minorities”, pp. 53-82HHS Action Plan to Reduce Racial and Ethnic Health Disparities. (2011). Kaiser Family Foundation.

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Centers for Disease Control and Prevention (U.S.). (2013). Health disparities and inequalities report--United States, 2013. Atlanta, GA: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention http://www.cdc.gov/disparitiesanalytics/Docs/CHDIR13_factsheet_nov_20_2013_final_508.pdfhttp://www.cdc.gov/DisparitiesAnalytics/topic_table.html

TerminologyMather, M., Pollard, K. M., Jacobsen, L. A., & Population Reference Bureau. (2011). First results from the 2010 census. Washington, DC: Population Reference Bureau. (Reports on America)

Carter-Pokras, O., & Baquet, C. (2002). What is a "health disparity"? Public Health Reports (Washington, DC: 1974), 117, 5.) (pp. 426-434)

Kindig, D. (January 01, 2007). Understanding Population Health Terminology. The Milbank Quarterly, 85, 1, 139-161.

Isaac, L. (2013). Defining Health and Health Care Disparities and Examining Disparities Across the Life Span. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 11-27). San Francisco: Jossey-Bass.

Government Agencies Addressing Health CareSatcher, D. (2006). The Role of Government in Minority Health: A Surgeon General’s Perspective. In D. Satcher and R.J. Pamies, Multicultural Medicine and Health Disparities, New York, McGraw Hill (pp. 547-555).

Report on Activities Related to “Improving Women’s Health” as required by the Adffordable Care Act, HHS, 2013 http://www.womenshealth.gov/publications/federal-report/ACA%20Full%20Report.pdf

Part 2: THEORIES TO EXPLAIN HEALTH DISPARITIES

Session 4 – February 6, 2014General Epidemiological Theories, Socio-economic Position, Social Injustice

Class Objectives:By the end of class students will be able to:

History of human rights in regard to health Describe the sources of inequitable distribution of disease. Understand the role of race, class and gender position in health inequities. Articulate the social justice perspective on health inequities. Describe or highlight the social determinants of health or proximate sources of health

inequities.

View in Class Unnatural Causes: In Sickness and In Wealth Video (56 mins.)

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In Class Work IN CLASS *Quiz (on epidemiology, health disparity terms, and health organizations)

Required Reading

General Epidemiological TheoriesRose, G. (January 01, 2001). Sick individuals and sick populations. International Journal of Epidemiology, 30, 3, 427-32. *

Krieger, N. (January 01, 2001). Theories for social epidemiology in the 21st century: an ecosocial perspective. International Journal of Epidemiology, 30, 4, 668-77.*

Krieger, N. (2011). Epidemiology and the people's health: Theory and context. New York: Oxford University Press. (Chapter 1)

Berkman, L. F. (July 24, 2009). Social epidemiology: Social determinants of health in the United States: Are we losing ground? Annual Review of Public Health, 30, 27-41. *

Mechanic, D. (September 01, 2007). Population Health: Challenges for Science and Society. The Milbank Quarterly, 85, 3, 533-559.

Socio-Economic PositionBarr, D. A. (2008). Health Disparities in the United States, Social Class, Race, Ethnicity and Health, The Johns Hopkins University Press. Chapters 3-4. “The Relationship between SES and Health” and “How Low Social Status Leads to Poor Health” pp. 42-7 *

Adler, N. & Stewart, J. (2007). The MacArthur Scale of Subjective Social Status. John D. and Catherine T. MacArthur Research Network on Socioeconomic Status and Health.

Lynch, J. W., Smith, G. D., Kaplan, G. A., & House, J. S. (2000). Income inequality and mortality: importance to health of individual income, psychosocial environment, or material conditions. British Medical Journal, 320(7243), 1200-1204.

Starfield, B., & Birn, A.-E. (2007). Income redistribution is not enough: income inequality, social welfare programs, and achieving equity in health. Journal of Epidemiology & Community Health, 61(12), 1038-1041. (PRACTICE ARTICLE)

Phelan, J. C., Link, B. G., & Tehranifar, P. (January 01, 2010). Social conditions as fundamental causes of health inequalities: theory, evidence, and policy implications. Journal of Health and Social Behavior, 51, 28-40.*

Social InjusticeBeauchamp, D.E. Public Health and Social Justice, In R. Hofrichter (ed.) Health and Social Justice, Politics, Ideology and Inequity in the Distribution of Disease. (pp. 267-284).

Sen, A. (December 13, 2008). Why and how is health a human right? The Lancet, 372, 9655, 2010. *

Recommended Reading

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Krieger N. Introduction: Embodiment, Inequality, and Epidemiology: What are the Connections? In. N. Krieger (ed.) Embodying Inequality Epidemiological Perspectives, Amityville, New York: Baywood Publishing Company, Inc., 2004. (pp 1-10).

Session 5 – February 13, 2014Theories to Explain Health Disparities; Stress and Discrimination/Racism as Variables

Class Objectives:By the end of class students will be able to:

Describe the three categories that make up the determinants of health model. Describe 2 theories to explain health disparities from each of three categories that constitute

the health disparities model. Articulate the role of stress in health disparities and name and explain two models. Articulate the concepts of racism and discrimination and their impact on health care and

health status among ethnic and racial minorities. Describe the relationship between perceived racism and discrimination and health outcomes.

View in Class Excerpts from The Angry Heart: The Impact of Racism on Heart Disease Among African

Americans Or Episode 4 of Unnatural Causes “Bad Sugar” How Racism Affects Health: http://www.youtube.com/watch?v=opukACz_Qx8

Group Work Mapping the Causes of the Cause Exercise; each group to debrief the class on their findings

and their process How Racism is Embodied Exercise

Required Readings Thorpe Jr, R. J. & Kelley-Moore, J. A. (2013). Life course theories of race disparities: A comparison of the cumulative dis/advantage theory, perspective, and the weathering hypothesis. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 355-376). San Francisco: Jossey-Bass.

LaVeist, T.A. (2005). Minority Health: An Introduction to Health Disparities in the United States. San Francisco: Jossey Bass (Chapters 7, 8, 9. pp. 133-201).*

Stress ( group 1)James, S. A. John Henryism and the Health of African- Americans. In T.A. LaVeist (ed). (pp.350-368).

Bennet et al. (2013). Stress, coping, and health outcomes among African-Americans: A review of the John Henryism hyposthesis. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 139-155). San Francisco: Jossey-Bass.

Geronimus, A.T. (2002). Black-White Differences in the Relationship of Maternal Age to Birthweight: A Population-based Test of the Weathering Hypothesis. In T.A. LaVeist (ed.) (pp.213-230).

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Geronimus, A.T., Hicken, M., Keene, D., & Bound, J. Age-patterns of allostatic load scores among Blacks and Whites in the United States: Might allostatic load algorithms measure weathering? American Journal of Public Health

Myers, H. (January 01, 2009). Ethnicity- and socio-economic status-related stresses in context: an integrative review and conceptual model. Journal of Behavioral Medicine, 32, 1, 9-19.

Racism and Discrimination ( group 2)Clark et al. (2013). Racism as a stressor for African Americans: A Biopsychosocial Model. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 79-104). San Francisco: Jossey-Bass.

Jones, C. (2013). Levels of Racism: A Theoretical Framework and a Gardner’s Tale. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 323-330). San Francisco: Jossey-Bass. *

Williams, D., & Mohammed, S. (January 01, 2009). Discrimination and racial disparities in health: evidence and needed research. Journal of Behavioral Medicine, 32, 1, 20-47. *

Nuru-Jeter, A., Dominguez, T., Hammond, W., Leu, J., Skaff, M., Egerter, S., Jones, C., Braveman, P. (January 01, 2009). "It's The Skin You're In": African-American Women Talk About Their Experiences of Racism. An Exploratory Study to Develop Measures of Racism for Birth Outcome Studies. Maternal and Child Health Journal, 13, 1, 29-39. *

Balsam, K. F., Rothblum, E. D., & Beauchaine, T. P. (June 01, 2005). Victimization Over the Life Span: A Comparison of Lesbian, Gay, Bisexual, and Heterosexual Siblings. Journal of Consulting and Clinical Psychology, 73, 3, 477-487. (skim abstract, intro, tables, discussion) *

Recommended Readings and other media

Wise, T. (2012). Racism, Public Health and the High Cost of White Denial. http://www.timwise.org/2012/10/racism-public-health-and-the-high-cost-of-white-denial/

Group Work: on racism and stress (group facilitation)

ASSIGNMENT DUE: (Due 2/13/24 at midnight) MEASURING HEALTH DISPARITIES – 10% of your grade

Lynch, J., Harper, S. (2007). Measuring Health Disparities (Module 1-4 of the University of Michigan web-based course– PLEASE PROVIDE PROOF OF COMPLETION BY UPLOADING TO

LATTE A SINGLE WORD DOCUMENT WITH THE FINAL PAGE OF EACH MODULE WITH YOUR SCORE.

Measuring Health Status Disparities

Class Objectives

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By the end of class students will be able to: Describe current measurement and methodological issues in the study of racial and ethnic

disparities in health. Discuss measures of health disparities when groups of similar income and wealth are

compared. Discuss current problems with the use of racial data to describe racial and ethnic disparities. Measure health disparities utilizing specific techniques and methods.

Required ReadingsCommonly Used Health Disparities Measures (2 page hand-out)

Braveman, P. (2006). Health Disparities and Health Equity: Concepts and Measurement, Annual Review of Public Health, 27, 167-194.

Wagstaff, A., Van Doorslaer, E. (2004). Overall Versus Socioeconomic Health Inequality: A Measurement Framework and Two Empirical Illustrations. Health Economics, 13, 297-301.

Asada, Y. (January 01, 2005). A framework for measuring health inequity. Journal of Epidemiology and Community Health, 59, 8, 700-5.

Midterm Recess—2/17/13-2/21/13

PART 3. SPECIAL POPULATIONS AND HEALTH AND HEALTH CARE DISPARITIES

ASSIGNMENT DUE: Everyone will choose one topic (see below) of focus for reading and groups will provide presentation Guidelines for assignment to follow. This assignment is worth 10% of your grade. PREPARATION IS EXPECTED TO TAKE PLACE OUTSIDE OF CLASS.

Session 6 – February 27, 2014Intersectionality, Gender Sub-populations and LGBT groups

Class Objectives:By the end of class students will be able to:

Explain the gender paradox. Articulate how health inequalities differ by sex and gender. Discuss the concept of intersectionality. Discuss the importance of considering how social identities co-exist and shape one

another and also interact with social processes and institutions to impact health outcomes. Describe research methods and measures utilized to investigate interactions between

social identities. Describe the leading causes of health morbidity and the prevalence of conditions for

different subpopulations by gender and race. Describe some of the causes for disparities in these subpopulations, and their

differences by gender. Describe LBGT and non-LGBT population.

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Discuss health differences by sexual orientation and transgender status and the causes of these observed differences.

Describe the specific and unique stressors for African-American women. Describe the health and health care disparities for minority children. Address barriers to maternal and child and other health services for minority women. Describe a qualitative research project which explored the causes for disparities in prenatal

care utilization and birth outcomes.

View in Class “When the Bough Breaks”

Group Work Group Presentations

Required Readings

NOTE: Everyone will choose one topic of focus for reading. The instructor will poll students re: topic in class.

Gender Krieger, N. (August 01, 2003). Genders, sexes, and health: what are the connections-and why does it matter?. International Journal of Epidemiology, 32, 4, 652-657.

Bates, L. M., Hankivsky, O., & Springer, K. W. (October 01, 2009). Gender and health inequities: A comment on the Final Report of the WHO Commission on the Social Determinants of Health. Social Science & Medicine, 69, 7, 1002-1004.

Courtenay, W. H. (2000). Constructions of masculinity and their influence on men's well-being: A theory of gender and health. Social Science & Medicine, 50, 1385-1401.

Bird, C. E., & Rieker, P. P. (1999). Gender matters: An integrated model for understanding men's and women's health. Social Science & Medicine, 48(6), 745-755.

Wisdom, J.P., Berlin, M, Lapidus JA (2005). Relating health policy to women's health outcomes. Social Science & Medicine, 61(8), 1776-1784. (PRACTICE ARTICLE)

Satcher, D. (2003). Overlooked and Underserved: Improving the Health of Men of Color, American Journal of Public Health, 93(5), 707-709 and W.K. Kellogg Foundation, Community Voices (2003). Saving Men’s Lives. (pp 1-4).

Summary of Discussion and Recommendations A Summit for Action: The Health of Women and Girls Beyond 2010 Prepared For HHS Coordinating Committee on Women’s Health http://www.-womenshealth.gov/publications/federal-report/womens-summit-summary-060810.pdf

Sexual OrientationMeyer, I. H. (January 01, 2003). Prejudice, social stress, and mental health in lesbian, gay, and bi-sexual populations: conceptual issues and research evidence. Psychological Bulletin, 129, 5, 674-97.

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The National Academies Press, The Health of Lesbian, Gay, Bi-sexual and Transgender People: Building A Foundation for Better Understanding, 2011 Executive Summary

Clements-Nolle, K., Marx, R., Guzman, R., & Katz, M. (January 01, 2001). HIV prevalence, risk behaviors, health care use, and mental health status of transgender persons: implications for public health intervention. American Journal of Public Health, 91, 6, 915-21. PRACTICE ARTICLE

U.S. Department of Health and Human Services. Recommended Actions to Improve the Health and Well-Being of Lesbian, Gay, Bisexual, and Transgender Communities Last Updated: Janu-ary 2012 http://www.hhs.gov/lgbt/health.html

U.S. Department of Health and Human Services. Lesbian, Gay, Bisexual, and Transgender Health. Last Updated: November 2013. http://www.healthypeople.gov/2020/topicsobjec-tives2020/overview.aspx?topicid=25

IntersectionalityWeber, L. (2006). Intersectionality and Health: An Introduction (pp. 3-17) andReconstructing the Landscape of Health Disparities Research: Promoting Dialogue and Collaboration Between Feminists: Intersectional and Biomedical Paradigms (pp 21-59). In A. Schulz and L. Mullings (Eds.).Gender, Race, Class and Health: Intersectional Approaches

*Dhammoon, R. and Hankivsky, O. (2011). Why the theory of and practice of intersectionality matters in health research and policy. In R. O. Hankivsky (Eds). Health inequities in Canada: Intersectional frameworks and practices (pp. 16-35). Vancouver and Toronto, UBC Press.

Morgen, S. (2006). Movement-Grounded Theory: Intersectional Analysis of Health Inequities in the United States, pp. 394-423

Diaz, R. M., Ayala, G., Bein, E., Henne, J., & Marin, B. V. (January 01, 2001). The impact of ho-mophobia, poverty, and racism on the mental health of gay and bisexual Latino men: findings from 3 US cities. American Journal of Public Health, 91, 6, 927-32.

Maternal and Child Health Issues*Seith, D., Isakson, E., & Columbia University. (2011). Who are America's poor children?: Examining health disparities among children in the United States. New York, N.Y: National Center for Children in Poverty.

Goldhagen, J., Remo, R., Bryant, T. Wludyka, P., Dailey, A., Wood, D., Watts, G., Livingood, W. (January 01, 2005). The health status of southern children: a neglected regional disparity. Pediatrics, 116, 6, 746-53.

Jackson, F. (2007). Race, Stress and Social Support: Addressing the Crisis of Black Infant Mortality, Joint Center for Political and Economic Studies, Health Policy Institute (pp. 1-17).

*Best and Promising Practices for Improving Research, Policy and Practice Involvement in Pregnancy Outcomes, Joint Center for Political and Economic Studies, Health Policy Institute PRACTICE ARTICLE

Is 16 and Pregnant and Effective Birth Control Method? (LISTEN NPR)

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http://www.npr.org/2014/01/13/262175399/is-16-and-pregnant-an-effective-form-of-birth-control

* Final paper/Project proposal due on 3/1/2014 at midnight (if required revisions will be due the week of 3/17/2014

Session 7 – March 6, 2014Neighborhoods and Place/Residential Segregation and Health Disparities

Class ObjectivesBy the end of class students will be able to:

Describe the difference between a compositional and contextual effect. Discuss some of the major methodological issues related to studying the effects of context on

health. Explain why racial residential segregation is associated with health. Discuss the association between racial residential segregation and racism and prejudice and

how racial segregation complicates the study of neighborhood effects on health. Describe the role of neighborhood-level social/structural processes that have influenced the

spread of STD’s in the U.S.

View in Class Episode Five: Place Matters of Unnatural Causes Series (28 minutes)

Group Work Find your Passion What are your social change intentions? Writing A Mission Statement for advocacy intention

Required Readings

Neighborhoods, Place and HealthLovasi, G. S. et al. (2013) Built Environments and Obesity in Disadvantaged Communities. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp.455-484). San Francisco: Jossey-Bass.

*Acevedo-Garcia, D., & Osypuk, T. L. (2008a). Impacts of Housing and Neighborhoods on Health: Pathways, Racial/Ethnic Disparities, and Policy Directions. In J. H. Carr & N. K. Kutty (Eds.), Segregation: The Rising Costs for America pp. 197-235. New York: Routledge.

Why Place and Race Matter, Policy Link, 2011http://www.policylink.org/atf/cf/{97c6d565-bb43-406d-a6d5-eca3bbf35af0}/WPRM%20FULL%20REPORT%20(LORES).PDF

OR

Wegner, M. (2012). Place matters: Ensuring Opportunities for Good Health for All. Prepared by the Joint center for Political and Economic Studies.http://www.jointcenter.org/sites/default/files/upload/research/files/Place%20Matters%20Community%20Reports%20Summary.pdf

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Webinar on Promise Zoneshttp://www.dialogue4health.org/php/jointcenter/hpi/11_13_13.html

Residential SegregationAcevedo-Garcia, D., Osypuk, T. L., McArdle, N., & Williams, D. (2008). Toward a Policy-Relevant Analysis of Geographic and Racial/Ethnic Disparities in Child Health. Health Affairs, 27(2), 321-333.

Williams, D. R., & Collins, C. (2001). Racial residential segregation: A fundamental cause of racial disparities in health. Public Health Reports, 116, 404-416

Osypuk, T. L., & Acevedo-Garcia, D. (2010). Beyond Individual Neighborhoods: A Geography of Opportunity Perspective for Understanding Racial/Ethnic Health Disparities. Health & Place, 16(6), 1113-1123.

Osypuk, T. L., & Acevedo-Garcia, D. (2008). Are Racial Disparities in Preterm Birth Larger in Hypersegregated Areas? American Journal of Epidemiology, 167(11), 1295-1304.

*3 - 5 page paper reflecting understanding of theories based on sessions ( 4 & 5) . Due on 3/6/2014

Session 8 – March 13, 2014Immigration and Health Disparities

Class ObjectivesBy the end of class students will be able to:

Explain the immigrant paradox. Discuss several potential explanations for this paradox. Discuss the general pattern of the trajectory of health over time for immigrants in the US. Explain the effect of immigrant status (both duration and nativity) on the health of Asians and

Pacific Islanders. Articulate the five myths of immigrants and the U.S health care system.

View in Class Becoming American: Episode 2 of Unnatural Causes Series – 28 minutes.

Group Work Discussion of Video via learning facilitation skills for Health Equity utilizing the ORID

discussion

Required ReadingsSalant, T & Lauderdale, D. (2013). A critical review of acculturation and health in Asian immigrant populations. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 253-289). San Francisco: Jossey-Bass. *

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Acevedo-Garcia, D., & Bates, L. M. (2007). Latino health paradoxes: Empirical evidence, explanations, future research, and implications. In H. Rodriguez, R. Saenz & C. Menjivar (Eds.), Latino/as in the United States: Changing the face of America (pp. 101-113). New York: Springer

Lara, M., Gamboa, C., Kahramanian, M. I., Morales, L. S., & Bautista, D. E. H. (2005). Acculturation and Latino Health in the United States: A Review of the Literature and its Sociopolitical Context. Annual Review of Public Health, 26(1),*

Jones, C. R. (2006). Commentary: ’Culture’, cultural explanations and causality. International Journal of Epidemiology, 35(2), 261-263.

Acevedo-Garcia, D., Soobader, M.-J., & Berkman, L. F. (2005). The Differential Effect of Foreign-Born Status on Low Birth Weight by Race/Ethnicity and Education. Pediatrics, 115(1), e20-30. *

King, M. (2007). Immigrants in the U.S. Health Care System: Five Myths that Misinform the American Public. Center for American Progress (pp. 1-14).

BEGIN TO CONSIDER CLASS PROJECT

PART 3: DISPARTIES IN ACCESS AND HEALTH CARE

Session 9 – March 20, 2014Disparities in Health Care Access and Quality

Class Objectives:By the End of Class, students will be able to:

Describe disparities in access to care for African- Americans, Hispanics, and Asian and Native American populations.

Articulate the Anderson and Aday Behavioral Model of the use of health care services and the factors that determine whether or not people are able to access care.

Articulate the model for sources of health care disparities. Identify patient, provider, and system level influences disparities for health care.

In Class Activity View in Class Video on Health Care Disparities and/or develop an educational program to

address health care or access disparities based on readings and the media.

Required Reading General Readings Williams, R.A. (2007). Historical Perspectives of Healthcare. Is the Past Prologue? In Eliminating Health Care Disparities in America: Beyond the IOM Report, Totowa, New Jersey, Humana Press (pp. 3-20).

Access to Care

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LaVeist, T.A. (2005). Addressing Disparities in Health and Health Care. In T.A. LaVeist, Minority Populations and Health: An Introduction to Health Disparities in the United States, San Francisco, Jossey Boss (pp. 283-297).

National Health Care Disparities Report (2013) http://www.ahrq.gov/research/findings/nhqrdr/nhqr12/nhqr12_prov.pdf

Cao, V. (2013). Health And Human Services Collect Data To Address AAPI Health Disparities. http://www.asianfortunenews.com/2013/10/health-and-human-services-collect-data-to-address-aapi-health-disparities/

Health Care Quality/TreatmentSmedley, B., Stith, A.Y., & Nelson, A.R. (2003) The Health Care Environment and Its Relation to Disparities. In B. Smedley, A.Y. Stith, and A. Nelson (Eds), Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, National Academy of Sciences (pp. 80- 124).

Smedley, B., Stith, A.Y., & Nelson, A.R. (2003). Assessing Potential Sources of Racial and Ethnic Disparities in Care: Patient and System-Level Factors. In B. Smedley, A.Y. Stith, and A. Nelson (Eds), Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care, National Academy of Sciences (pp. 125-159).

Chin et a. (2013) Interventions to reduce racial and ethnic disparities in health care. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 761-786). San Francisco: Jossey-Bass.

Read one of the three below:

Blair, I. V., Steiner, J. F., Fairclough, D. L., Hanratty, R., Price, D. W., Hirsh, H. K., & ... Havranek, E. P. (2013). Clinicians' Implicit Ethnic/Racial Bias and Perceptions of Care Among Black and Latino Patients. Annals Of Family Medicine, 11(1), 43-52. 

Blair, I. V., Havranek, E. P., Price, D. W., Hanratty, R., Fairclough, D. L., Farley, T., & ... Steiner, J. F. (2013). Assessment of Biases Against Latinos and African Americans Among Primary Care Providers and Community Members. American Journal Of Public Health, 103(1), pp. 92-98. (link)*

Hasnain, M., Schwartz, A., Girotti, J., Bixby, A., & Rivera, L. (2013). Differences in Patient-Reported Experiences of Care by Race and Acculturation Status. Journal of Immigrant and Minority Health, 15(3), pp. 517-524. (link)

Read one of the following:

Van Ryn, M & Burke, J. (2013) The effect of patient race and socio-economic status on physicians’ perceptions of patients. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 607-636). San Francisco: Jossey-Bass.

OR

Schulman et al. (2013). The effect of race and sex status on physicians’ recommendation for cardiac catheterization. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 646-664). San Francisco: Jossey-Bass.

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Recommended

American Association of Medical Colleges(2009).Addressing Racial Disparities in Health Care:A Targeted Action Plan for Academic Medical Centers https://members.aamc.org/eweb/upload/Ad-dressing%20Racial%20Disparaties.pdf

PART 4: HEALTHCARE DISPARITIES: INTERVENTIONS AND POLICIES

Session 10 – March 27, 2014Community Health Services and Promising Interventions

Class Objectives: By the end of the class students will be able to:

Highlight and Discuss key components of the HHS Plan to Eliminate Health Disparities Discuss the meaning of the term “community. Provide examples of effective community-based strategies and initiatives to address health

and health care disparities. Define a Federally- Qualified Health Center. Delineate the populations served and services provided by community health centers. Delineate the impact that CHC’s have on health disparities. Explore ways that students can address health disparities.

Required Readings

Brennan Ramirez, L. K., Baker, E. A., & Metzler, M. (2008). Promoting health equity: A resource to help communities address social determinants of health. Atlanta: U.S. Department of Health and Human Services, Centers for Disease Control and Prevention. http://www.cdc.gov/nccdphp/dch/programs/healthycommunitiesprogram/tools/pdf/SDOH-workbook.pdf

Treadwell, Henrie M & Ro, Marguerite J. (2010). Introduction: The Power of Communities: Breaking a Legacy of Inequity and Disparity in Community voices: health matters (1st ed). Jossey-Bass, San Francisco

Perez, L. M., & Martinez, J. (January 01, 2008). Community Health Workers: Social Justice and Policy Advocates for Community Health and Well-Being. American Journal of Public Health, 98, 1, 11.

Perez, Leda M & Linder, Elise M. (2010). Miami : building spaces and relationships that promote promising practices and access to health care in Community voices: health matters (1st ed). Jossey-Bass, San Francisco

Bigby, J. (2007). The Role of Communities in Eliminating Health Disparities. In R.A. Williams (ed.) In Eliminating Healthcare Disparities in America: Beyond the IOM Report, Totowa, New Jersey: Humana Press (pp. 221-236).

Aluko, Y. (2007). Carolinas Association for Community Health Equity-CACHE: A Community Coalition to Address Health Disparities in Racial and Ethnic Minorities in Mecklenburg County

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North Carolina. In R.A. Williams (ed.) In Eliminating Healthcare Disparities in America: Beyond the IOM Report, Totowa, New Jersey: Humana Press (pp. 365-376).

Sessions 11 and 12 – April 3, 2014 and April 10, 2014Culturally Competent Health Care and Workforce Diversity

Class ObjectivesBy the end of class students will be able to:

Delineate the role of cultural competency interventions, health care financing, quality improvement, workforce diversity, intersectional approaches and legal interventions in reducing and eliminating health and health care disparities.

Identify key interventions to address health care disparities. Critically evaluate 2 frameworks that have recently emerged as strategies to reduce disparities

in access to and quality of care. Describe the key components of cultural competence. Identify 3 models of culturally competent care. Describe the effect of culturally competent systems and providers on health disparities. Distinguish between cultural competency, cultural humility, and cultural safety.

View in class Community Voices: Exploring Cross-Cultural Care Through Cancer

Group Work Case Studies for Chapter 12 and Chapter 13. In T. A. Lavist, Minority Populations and

Health, San Francisco, Jossey Bass (Work in groups and prepare your responses to the case studies. (BE PREPARED TO PRESENT IN CLASS.)

Required Readings

Betancourt, J.R., et. al (2003). Defining Cultural Competence; A Practical Framework for Addressing Racial/Ethnic Disparities in Health and Health Care Public Health Reports July – August, 118(4), 293-302.

Office of Minority HealthU.S. Department of Health and Human Services (2013). National Stan-dards for Culturally and Linguistically Appropriate Services in Health and Health Care:A Blue-print for Advancing and Sustaining CLAS Policy and Practice https://www.thinkcultural-health.hhs.gov/pdfs/EnhancedCLASStandardsBlueprint.pdf

Betancourt, J. R. & Green, A. R. (2013). Linking cultural competence training to improved health outcomes. In LaVeist, T. A., & Isaac, L. A. (Eds.), Race, ethnicity, and health: A public health reader (pp. 689-695). San Francisco: Jossey-Bass.

Jackson, C. & Gracia, N (2014). Addressing Health and Health-Care Disparities: The Role of a Diverse Workforce and the Social Determinants of Health, Public Health Reports Supplement. http://www.publichealthreports.org/issueopen.cfm?articleID=3083

Recommended Readings

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Addressing inequities in health, legal, diversity, and cultural competency approachesTervalon, M., Murray-Garcia, M. (1998). Cultural Humility versus Cultural Competence :A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education, Journal of Health Care for The Poor and Underserved, 9(2), 117-125.

Polaschek B.A. (1998). Cultural Safety: A New Concept in Nursing People of Different Ethnicities, Journal of Advanced Nursing 27 (3), 452–457.

Goode, T.D., Dunne, M.C. Bronheim, S.M. (2006). The Evidence-Base for Cultural and Linguistic Competence, The Commonwealth Fund (read executive summary).

Fisher, T.L., Burnett, D.L., Huang, E.S., Chin, M.H., Cagney, K.A. (2007). Cultural Leverage: Interventions Using Culture to Narrow Racial Disparities in Health Care, Medical Care Research and Review, Supplement 64(5) 243s-282S (please skim).

Sessions 13– April 24, 2014

Presentation of Group Projects Final Paper Due in Class

*Final Paper Due the Last Day of Class- April 24, 2014

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