THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL SCHOOL OF SOCIAL WORK COURSE NUMBER: SOWO 836.001 COURSE TITLE: Examining Health Access and Health Disparities SEMESTER AND YEAR: Spring 2013 MEETING TIME/LOCATION: Tuesday, 9‐10:30am; Room 300 INSTRUCTOR: Lisa de Saxe Zerden, MSW, PhD Email: Lzerden@email.unc.edu Phone: 919.962.6430 OFFICE HOURS: 425 (Students are always welcome to stop by but appointments recommended so I will be in my office when you need me). COURSE DESCRIPTION: Examines disparities in health outcomes as a function of access to and quality of care for persons disadvantaged by income, ethnicity, sexual orientation, and other factors. Critically evaluates health and social policies related to exacerbation and resolution of health inequities. COURSE OBJECTIVES: The student who successfully completes this course should be able to: 1. Identify the principles, foundation and provisions of the primary social welfare programs that constitute the healthcare safety net in the United States. 2. Demonstrate the analytic, theoretical and value assessment skills that enable social workers to evaluate policies and apply change strategies. 3. Apply concepts and principles of human rights, social justice, and social work ethics to policy analysis, development and change strategies. 4. Describe major disparities in diagnosis, prognosis, and health outcomes in the United States for persons of varying gender, race and ethnicity, sexual orientation, and level of economic advantage. 5. Discuss the historical and political context of contemporary health disparities, including their roots in discriminatory systems and policies. 6. Describe the interrelationships among a range of economic and social factors that result in inadequate access to quality care. 7. Describe characteristics of healthcare systems and policies that inhibit the provision of high‐quality, culturally sensitive care. 8. Discuss ethical challenges for the social worker related to practicing in an environment that is structured in a way that promotes unequal access to and quality of care. 9. Evaluate a range of policy and intervention solutions that have been proposed in order to address and resolve health disparities. 10. Articulate strategies for the exercise of leadership and advocacy in successfully addressing health disparities. 1 TEACHING METHODS: This course will stimulate new ideas and insights related to health disparities and policy. During the course, students will agree and disagree with course content. Respectful discussion and debate is strongly encouraged. Students should feel free to relate the readings to broader policy, intervention, prevention, treatment, and systemic factors previously discussed and from experience in the field. Each session will include a combination of lecture, discussions, and classroom exercises. As the semester progresses, there will be allotted time for group and individual consultation to prepare for the final assignment. Depending on the week, guest speakers will be invited for a portion of the class to discuss relevant content. Adult learning methods will be utilized. Therefore, students are expected to complete all assigned readings before each class begins so they can contribute to discussion in meaningful ways. Not every article will be discussed in elaborate detail but should serve as a background for which the class topic is based. All students are expected to attend classes, participate in class discussion and activities, and make connections to class content in field and community contexts. POLICY FOR ACCOMMODATIONS FOR STUDENTS WITH DISABILITIES: Students with disabilities that affect their participation in the course and who wish to have special accommodations should contact the University’s Disabilities Services (http://disabilityservices.unc.edu) and provide documentation of their disability. Students should discuss the specific accommodations they require directly with the instructor. APA FORMATTING: Students are expected to correctly cite all of your material following the 5th ed. of the APA manual. If you are not familiar with this style, please refer to the APA manual and/or the School’s Writing Resources Page: (http://ssw.unc.edu/students/writing). This link provides access to an array of resources including the newly updated “APA Quick Reference Guide.” You may also schedule an appointment with the SSW Writing Support Team: Diane Wyant, (dwyant@email.unc.edu) or Susan White, (sewhite@email.unc.edu). POLICY ON ACADEMIC DISHONESTY: Please refer to the APA Style Guide, The SSW Manual, and the SSW Writing Guide for information on attribution of quotes, plagiarism and appropriate use of assistance in preparing assignments. All written assignments should contain a signed pledge stating: "I have not given or received unauthorized aid in preparing this written work". In keeping with the UNC Honor Code, if reason exists to believe that academic dishonesty has occurred, a referral will be made to the Office of the Student Attorney General for investigation and further action as required. TEXTBOOKS AND OTHER READINGS: There is no required text for this course. All readings will be accessible through the UNC library system or posted on Sakai. If a reading has not uploaded or the link is broken please notify the instructor as soon as possible. 2 GRADING SYSTEM: H = 94 and above P = 80 to 93 L = 70 to 79 F = 69 and below ATTENDANCE AND PARTICIPATION: Student attendance at all class sessions is expected. If you will not be able to attend a class, notify the instructor as soon as possible. It is your responsibility to obtain handouts and information about class content from your classmates if you are unable to attend a class. In order to fully participate in and benefit from each session, students must complete required readings and come to class prepared and on time. Student who miss 2 or more classes without permission from the instructor, or who are continually late, will receive an “L”. LATE ASSIGNMENTS: Late assignments are strongly discouraged. To obtain permission to submit an assignment after the deadline, the student must seek approval from the instructor before the due date. If permission for late submission is not granted before breaking a deadline, the grade will automatically be reduced 10% each day, including weekends. In case of an emergency, a late paper may be accepted without penalty at the discretion of the instructor. Avoid having last minute computer failures prevent you from turning papers in on time. Plan ahead! CELL PHONE AND COMPUTER POLICY: Cell phones are a disruption to the learning process. Please turn off cell phones during class. Laptops are allowed for class notes and also to look up information pertinent to class discussion. However, you are to refrain from email or any other off‐topic computer/internet search while class is in session. Your participation grade will reflect non‐compliance. COURSE OVERVIEW: 1/15/13 Class 1: Introduction and course overview; why study health disparities? 1/22/13 Class 2: Patterns and causes of health disparities—past and present 1/29/13 Class 3: Pattern and causes of health disparities (cont.) 2/05/13 Class 4: Frameworks and theories to understand racism and health disparities 2/12/13 Class 5: Overview of Healthcare in the U.S: Financing & Policies ** Auditorium** 2/19/13 Class 6: Healthcare in the U.S. (cont.); ACA 2/26/13 Class 7: Health care disparities in developing countries ** Auditorium** 3/05/13 Class 8: Examples and interventions of community approaches to improve health 3/12/13 SPRING BREAK: NO CLASS 3/19/13 Class 9: How immigration, acculturation and national origin influence health 3/26/13 Class 10: Birth outcomes disparities: A multifaceted approach ** Auditorium** 4/02/13 Class 11: The role of social workers in advocacy and addressing health disparities 4/09/13 Class 12: Interventions to Reduce Disparities in an Age of Scarce Resources 4/16/13 Class 13: Final presentations 4/23/13 Class 14: Final presentations and class wrap up 3 Requirement
COURSE REQUIREMENTS OVERVIEW: Points
Date/Due Date
Class Participation
Reading Memo and Questions
Reflection Paper I Midterm: Health Disparity Research Paper Health Disparity Policy Statement Final Health Disparity Presentation 10 points
10 points
20 points 30 points 20 points
10 points
Ongoing
1 week before session Week 6 or Week 9 Week 8 Week 13
Weeks 13 & 14
COURSE READINGS AND COURSE OUTLINE: JAN 15, 2013 Week 1: Introduction and course overview; why study health disparities? 1. Introductions and course overview 2. Introduction to health disparities in diagnosis, prognosis, and health outcomes Readings: Health Affairs Policy Brief (2011, October 6). Achieving health equity. Retrieved from http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_53.pdf Epstein, H. (2003, October 12). Ghetto Miasma; Enough to make you sick? The New York Times. Available: http://www.nytimes.com/2003/10/12/magazine/ghetto‐miasma‐
enough‐to‐make‐you‐sick.html?pagewanted=all&src=pm Braithwaite, K. (2008). Health is a human right, right? American Journal of Public Health, 98, 5‐7. Woolf, S.H., & Braveman, P. (2011). Where health disparities begin: The role of social and economic determinants and why current policies may make matters worse. Health Affairs, 30, 1852‐1859 doi: 10.1377/hlthaff.2011.0685 Recommended: Krieger, N. (2001). A glossary for social epidemiology. Journal of Epidemiology and Community Health, 55, 693‐700. Healthy People 2020. Retrieved http://healthypeople.gov/2020/LHI/default.aspx (Review the 2020 list of Leading Health Indicators [LHIs] on the left side of the website to see stats and figures about identified health areas to improve by 2020, i.e. Access to Health Services, Clinical Preventative Services, Physical Activity, Oral Health, etc.) 4 JAN 22, 2013 Week 2: Patterns and causes of health disparities—past and present 1. Background and history of disparities in healthcare 2. Patterns and causes of health disparities 3. Inequalities in healthcare access and utilization of services Readings: Link, B.G & Phelan, J.C. (2006). Fundamental Sources of Health Inequalities. In Mechanic, D., Rogurt, L.B., Colby, D.C. & Knickman, J.R. (Eds.), Policy Changes in Modern Health Care (71‐84). New Brunswick: Rutgers University Press. Williams, D.R. (2006). Patterns & Causes of Disparities. In Mechanic, D., Rogurt, L.B., Colby, D.C. & Knickman, J.R. (Eds.), Policy Changes in Modern Health Care (115‐134). New Brunswick: Rutgers University Press. Moniz, C. (2010). Social work and the social determinants of health perspective: A good fit. Health & Social Work, 35(4): 310‐313. Recommended: Drexler, M. (March 3, 2005). Spreading the health: Government's role in addressing health disparities. Harvard School of Public Health Symposium Series 2005: Health Disparities & the Body Politic. Available: http://134.174.190.199/disparities/book/HealthDisparities.pdf (Focus on p.11‐24) JAN 29, 2013 Week 3: Pattern and causes of health disparities (cont.): SES, employment and neighborhood 1. Patterns and causes of health disparities (cont.) 2. SES, neighborhood, employment and other factors related to health inequality 3. Video: Is inequality making us sick? Place Matters (view in class) Readings: Williams, D.R., & Jackson, B.P., (2005). Social sources of racial disparities in health. Health Affairs, 24(2): 325‐334, doi: 10.1377/hlthaff.24.2.325. Kwate, N.O. (2008). Fried chicken and fresh apples: Racial segregation as a fundamental cause of fast food density in black neighborhoods. Health & Place,14;32‐44. Policy Link (2011). Why race and place matter (Executive Summary): Impacting health through a focus on race and place. Retrieved: http://www.policylink.org/atf/cf/%7B97c6d565‐
bb43‐406d‐a6d5‐eca3bbf35af0%7D/WPRM%20EXSUM%20(LORES).PDF (Focus on pages 17—37; We will read the remainder in future weeks). Recommended: The John D. and Catherine T. MacArthur Foundation Research Network on 5 Socio‐economic Status and Health (2008). Reaching for a healthier life: Facts on Socio‐
economic status and health in the U.S. Available on Sakai. Moore, L.V., Diez Roux, A. (2006). Associations of neighborhood characteristics with the location and type of food stores. American Journal of Public Health, 96(2): 325‐ 331. FEB 5, 2013 Week 4: Frameworks and theories to understand racism and health disparities 1. Individual risk factors vs. social conditions 2. Lifecourse health development theory (LCHD) 3. Historical trauma and population health Readings: Krieger, N. (2001). Theories for social epidemiology in the 21st century: An eco‐social perspective. International Journal of Epidemiology, 30,(4) 668‐677. Jones, C.P. (2000). Levels of Racism: A Theoretic Framework and a Gardener’s Tale. American Journal of Public Health, 90(8), 1212‐1215. Halfon, N. (2009). Life Course Health Development: A New Approach for Addressing Upstream Determinants of Health and Spending. Policy Brief (Available on Sakai). FEB 12, 2013 **MEET IN AUDITORIUM** WEEK 5: Overview of Healthcare in the U.S.—How the system is financed and related policies Guest lecture from NC Institute of Medicine (http://www.nciom.org/) 1. Federal health agencies 2. Federal financing of health care in the US 3. Private sector health care and reform 4. Role of social workers in health care settings Readings: Barusch, A.S. (2012). Health: Chapter 6. In A.S., Foundations of social welfare policy: Social justice in human perspective (164‐203). Belmont, CA: Brooks/Cole, Cengage Learning. Andrulis, D.P., & Siddiqui, N.J. (2011). Health reform holds both risks and rewards for safety‐net providers and racially and ethnically diverse patients. Health Affairs, 30, 1830‐1836. Horton, S. (2006). The double burden on safety net providers: Placing health disparities in the context of the privatization of health care in the US. Social Science & Medicine, 63(10), 2702‐2714. 6 Recommended: Holahan, J., & Garrett, B. (2009). Rising Unemployment, Medicaid and the Uninsured: January 2009. Available at: http://www.kff.org/uninsured/upload/7850.pdf Kaiser Family Foundation (2005). Medicare and Medicaid at 40: Key Medicare and Medicaid statistics. Retrieved: http://www.kff.org/medicaid/40years.cfm FEB 19, 2012 WEEK 6: Overview of Healthcare in the U.S (cont.); ACA, Improving access and quality  Reflection paper due today or week 9 1. Ideological and cultural issues to tackle 2. Brief history of health Insurance in the U.S. 3. Health reform and role of social work Readings: Golden, R.L. (2011). Coordination, integration, and collaboration: A clear path for social work in health care reform. Health & Social Work, 36(3): 227‐228. Zabora, J.R. (2011). How can social work affect health care reform? Health & Social Work, 36(3): 231‐232. Ofosu, A. (2011). Implications of health care reform. Health & Social Work, 36(3): 229‐ 230. Kaiser Family Foundation. (2009). National health insurance—a brief history of reform efforts in the U.S. Available: http://www.kff.org/healthreform/upload/7871.pdf Institute of Medicine. (2002). Unequal treatment: What healthcare system administrators need to know about racial and ethnic disparities in healthcare. Retrieved: http://www.iom.edu/~/media/Files/Report%20Files/2003/Unequal‐Treatment‐
Confronting‐Racial‐and‐Ethnic‐Disparities‐in‐Health‐Care/DisparitiesAdmin8pg.pdf Recommended: Mackey, J. (August 11, 2009). Op‐Ed: The Whole Foods Alternative to Obamacare. Wall Street Journal: http://online.wsj.com/article/SB10001424052970204251404574342170072865070.html Kaiser Family Foundation (2009). Massachusetts Health Care Reform: Three Years Later. Available: http://www.kff.org/uninsured/upload/7777‐02.pdf FEB 26, 2013 ** MEET IN AUDITORIUM** WEEK 7: Health Care Disparities in Developing Countries Guest lecturers on health in Honduras and Africa 1. Global health inequality 7 2. Structural approaches to reducing health disparities 3. Guest Lecturers (Please note these readings may change slightly, TBD) Rennie, S., & Behets, F. (2006). Desperately Seeking Targets: The Ethics of Routine HIV Testing in Low‐Income Countries. WHO Bulletin, 84(1): 52‐57. Garrett, L. (2007). The Challenge of Global Health. Foreign Affairs, 2007. 86(1):14‐38. Foreign Affairs Roundtable Discussion. Available at: http://www.foreignaffairs.com/discussions/roundtables/how‐to‐promote‐global‐health MAR 5, 2013 WEEK 8: Examples and interventions of community based approaches to improve health  Midterm health disparity research paper due today 1. Impact of social injustice on the health of marginalized populations 2. Addressing racial inequality in healthcare through civil rights 3. Group work on health disparities presentation Readings: Gehlert, S., Coleman, R. (2010). Using community‐based participatory research to ameliorate cancer disparities. Health & Social Work, 35(4): 302‐309. Isaac, E., Rowland, M., & Blackwell, L. (2007). Fighting health disparities: The Educational role of the African American church. Cross Currents, 57(2), 261‐265. Wiechelt, S.A., Gryczynski, J., Jeannette, L., (2009). Designing HIV prevention interventions for urban American Indians: Evolutions of the ‘Don’t Forget Us’ program. Health & Social Work, 34(4): 301‐304. Sequist, T.D., Cullen, T., & Acton, K. (2011). Indian Health Service innovations have helped reduce health disparities affecting American Indian and Alaska Native people. Health Affairs, 30, 1965‐1973. doi: 10.1377/hlthaff.2011.0630 Recommended: Gamble, V. N. (1997). Under the shadow of Tuskegee: African Americans and health care. American Journal of Public Health, 87, 1773‐8. MAR12, 2013 : NO CLASS, ENJOY YOUR SPRING BREAK 8 MAR 19, 2012 WEEK 9: How immigration, acculturation and national origin influence health  Reflection paper due today if you did not turn in week 6 1. Effects of immigration and acculturation on health 2. The Latino Health Paradox 3. Case example: Latino injection drug users 4. Video: Unnatural Causes‐‐ Becoming American (view in class) Readings: DeRose, K. P., Escarce, J. J., & Lurie, N. (2007). Immigrants & health care: Sources of vulnerability. Health Affairs, 26(5), 1258‐1268. Zambrana, R.E., Carter‐Pokras, O. (2010) Role of acculturation research in advancing science and practice in reducing health care disparities among Latinos. American Journal of Public Health, 100(1), 18‐23. Galarneau, C. (2011). Still Missing: Undocumented immigrants in health care reform. Journal of Health Care for the Poor and Underserved, 22: 422–428. Recommended: Vega, W.A., & Amaro, H. Latino outlook: Good health, uncertain Prognosis. (2002). In T.A. LaVeist (Ed.), Race, Ethnicity, and Health—A public health reader (47‐75). San Francisco: Jossey‐Bass. Sherrill, W., Crew, L., Mayo, R., Mayo, W., Rogers, B., & Haynes, D. (2005). Educational and health services innovation to improve care for rural Hispanic communities in the US. Education for Health: Change in Learning & Practice, 18(3), 356‐367. MAR 26, 2013 **MEET IN AUDITORIUM** WEEK 10: Birth outcome disparities: A multifaceted approach 1. Effects of birth outcomes on health equity 2. Case example: Current initiative in NC to address health inequities in birth outcomes Lu, M., Kotelchuck, M., Hogan, V., Jones, L., Wright, K., and Halfon, N (2010). Closing the black‐white gap in birth outcomes: A Life‐Course Approach. Ethnicity & Disease. 20 (1 Suppl 2):S2‐62‐76. (you may have read this for SoWo500 so go back to notes on this week from your first year, first semester) Hogan, V., Rowley, D., Bennett T., and Taylor, K.D. (2012). Life course, social determinants, and health inequities: Toward a national plan for achieving health equity for African American infants – a Concept Paper. Maternal Child Health Journal. 16(6): 1143‐50.
9 APR 2, 2013 WEEK 11: The role of social workers in advocacy and addressing health disparities 1. Role of social work profession in addressing health disparities and improving access 2. Policy practice and legislative action 3. Advocacy Readings: Poindexter, C.C. (1999). Promises in the Plague: The Ryan White CARE Act as a Case Study for Legislative Action. Health and Social Work, 24, 35‐41. Altpeter, M., Mitchell, J.F. & Pennell, J. (2005). Advancing Social Workers' Responsiveness to Health Disparities: The Case of Breast Cancer Screening. Health and Social Work, 30(3), 221‐232. Policy Link (2011). Why race and place matter (Executive Summary): Impacting health through a focus on race and place. Retrieved: http://www.policylink.org/atf/cf/%7B97c6d565‐
bb43‐406d‐a6d5‐eca3bbf35af0%7D/WPRM%20EXSUM%20(LORES).PDF (Focus on pages 37‐42). Praxis Project (2005). Advocating for Better Policies. Available: http://www.unnaturalcauses.org/assets/uploads/file/UC_PolicyAdvocacy.pdf (*This will be a helpful tool to consider as you plan your final presentation). Recommended: Shaw‐Ridley, M., & Ridley, C.R. (2010). The health disparities industry: Is it an ethical conundrum? Health Promotion & Practice,11: 454‐464. Wallack, L. (2002). Public health, social change, and media advovacy. Social Marketing Quarterly, 8(2): 25‐31. McDonough‐Figueira, J. (1993). Policy Practice: The Neglected Side of Social Work Intervention. Social Work, 38(2), 179‐188. (HIGHLY RECOMMEND) Gamble, V., & Stone, D. (2006). U.S. policy on health inequities: the interplay of politics and research. Journal of Health Politics, Policy & Law, 31(1), 93‐126. APR 9, 2013 WEEK 12: Interventions to Reduce Disparities in an Age of Scarce Resources 1. Policy intervention efforts to address health disparities 2. Case examples: tobacco policy, obesity epidemic, and HIV/AIDS in the U.S. Readings: Warner, K.E. (2006). Tabacco Policy in the U.S.: Lessons for the Obesity Epidemic. In Mechanic, D., Rogurt, L.B., Colby, D.C. & Knickman, J.R. (Eds.), Policy Changes in Modern Health Care (99‐114). New Brunswick: Rutgers University Press. 10 MacMaster, S.A., Vail, K.A., & Neff, J.A. (2002). The Xchange point: A drop‐in center for African American active injection drug users. Health & Social Work, 27(3):227‐231. Marlatt, A.G., & Witkiewitz, K. (2010). Update on harm‐reduction policy and intervention research. Available at: http://dionysus.psych.wisc.edu/lit/Articles/Marlatt2010a.pdf APR 16, 2013 WEEK 13: Final presentations  Health disparity policy statement due today for all groups/individuals regardless of presentation date APR 23, 2013 WEEK 14: Final presentations and class wrap up SOW0 836, HEALTH ACCESS & DISPARITIES CLASS ASSIGNMENTS: CLASS PARTICIPATION: (10 POINTS) Due: Ongoing All students are expected to complete the readings and to actively participate in class discussions. If you do not feel comfortable speaking in class, you may also email me a three one‐page reflection papers by week 13. Active and constructive participation matters; be on time and be prepared to be called on. READING SUMMARY MEMO & QUESTIONS: (10 POINTS) Due: One week before the reading was assigned. For example, if you are creating a memo for week 6, your summary memo and question will be due by the end of the day on week 5. Each student is responsible for submitting a 1‐page page memo outlining the main points of the article. Do not get lost in details or statistics; Instead, ask yourself what are the main points to take away from this reading? Why does this reading matter? Please include the title and authors on your memo and submit this to your instructor a week before it is due so it can be uploaded to Sakai for your classmates. In addition, please provide 1‐2 critical thinking questions about the reading to help guide students when doing the reading (questions can be on page 2). REFLECTION PAPER (20 POINTS) Due: Week 6 or Week 9 (February 19, 2013 or March 19, 2013) Students will complete 1 writing reflection assignments due either at the beginning of week 6 or class 9. Students can explore any topic of interest that relates to course content from any of the class sessions. Reflection papers should be 3‐5 pages (not including references) and needs to demonstrate student’s ability to think critically about health policy information in a variety of contexts. Students may want to consider the following kinds of issues: • What are the main disparities and related policies under discussion?
• Do you agree or disagree with a perspective or theory as discussed in class? Explain.
11 •
•
•
•
•
Are you aware of health disparities in your own community, professional setting? What additional questions or issues did a reading or film from class bring up for you? What are the cultural and/or ethical considerations for the policy under discussion? What are the implications for social work practice given class content?
Discuss biases/flaws or a model to be emulated to reduce health disparities that you are aware of from previous work experiences. Let these points serve as ideas to get your reflection started; not every point needs to be addressed. Reflections do not require extensive outside literature or research. Think of this as a critical reflection that synthesizes material in your own thoughts. Do not summarize an article as your professor is familiar with the content; Instead, analyze and explain how it is informed by your understanding of these issues. You can use first person language and no outside research is necessary. The following policy analysis assignments (Parts I, II, III) can be done individually or in small groups: MIDTERM HEALTH DISPARITY PAPER: PART I (30 POINTS) Due: Week 8 (March 5, 2013) The written component of this assignment will include a 7‐10 page paper (not including references) that addresses: a. Topic and prevalence of issue: who is affected and what comparison data can you offer to highlight the health disparity? (1‐2 paragraphs) b. What are the main health issues and related policies under discussion? (i.e., Ryan White Care Act on HIV/AIDS on the treatment of HIV in communities of color; Rates of obesity and food stamp utilization; asthma and housing policy). (1‐2 pages) c. Causes and Explanations: What are some theories or explanations as to why this disparity exists? Describe underlying causes of the problem (i.e., institutionalized racism, lack of insurance, environmental and/or structural barriers). In other words, who is affected most and why does this happen? (1 pages) d. Related Polic(ies): Describe how an existing or proposed policy addresses/exacerbates the disparity. What are the underlying assumptions of the policy? Review empirical research (peer‐reviewed articles) about the effectiveness of the policy. What are the strengths and limitations of the policy in addressing the health disparity? (2‐3 pages). e. Social Work Role: What if any, has been the role of social work? Why this topic is relevant to social work and social justice. (concluding paragraphs). The midterm assignment will serve as a starting point to get your final health disparity final organized. Papers will provide a context for your topic, you should provide a through and critical literature review with a synthesis of data highlighting the issues. The assignment should explore possible pathways by which race, ethnicity, class, gender or any other variable discussed in class, have resulted in disparate health outcomes among the population of the given disease. All references need to be included in APA format and do not count toward the 7‐10 page limit. Your instructor is available for group consultation before the due date. 12 Note: the final assignment will focus more closely on specific actions (e.g. advocacy activities, research, legislative change, organizational modification, etc.) that can be taken to improve the quality of care provided to underserved or poorly served populations. Your midterm assignment is the groundwork which will lead to more action/change oriented steps. FINAL HEALTH DISPARITY POLICY STATEMENT: PART II (20 POINTS) Due: Week 13 (April 16, 2013) Given the background context research and described from the midterm paper, individually or in groups students are responsible for thinking through the impact of local, state and/or federal policy on mitigating or exacerbating health equity. For this assignment, you will develop a 600‐ 1,000 word (1‐2 pages, single spaced) advocacy statement addressing a program or policy issue relevant to the health disparity you chose for your midterm research paper. You can format your statement as a letter to a legislator or policy maker, or as an editorial submission to a newspaper (if you do this, the word requirements can change based on the submission criteria of the publication). In either case, your letter or statement should clearly describe the issue of concern, cite relevant data (i.e. demographic, economic), identify the disparities and issues of social injustice, and propose a viable and ethical solution. You can focus on the local, state, or national level, as desired. FINAL HEALTH DISPARITY POLICY PRESENTATION: PART III (10 POINTS) Due: Week 13 or 14 (April 16, 2013 or April 23, 2013) In a brief (7‐10minute**) presentation, students will offer a brief overview summarizing the main points of their research and policy recommendations. While this cannot be an exhaustive review of the health disparity and related policy analyzed, students are responsible for informing their classmates on the following presentation points: a. Topic and prevalence of issue: who is affected and what is the disparity? b. What are the main health issues and related policies under discussion? c. What policy interventions or programmatic changes do your recommend taking to address the disparity or problems identified above? d. What might be some unintended or indirect costs and benefits of your policy recommendations? e. Based on your research, what was the most surprising or startling aspect of what you learned? The timing of this presentation will depend on how many solo versus group projects the class ends up with; details will be worked out as the semester gets underway. SUPPLEMENTAL READING LIST: Health Equity and Framing: National Association of City and County Health Officials.The Roots of Health Inequity access at: www.rootsofhealthinequity.org 13 National Partnership to End Health Disparities. National Stakeholder Strategy for Achieving Health Equity access at http://minorityhealth.hhs.gov/npa/templates/content.aspx?lvl=1&lvlid=33&ID=286 Izlar, A.C. (2011). The corporate role in reducing disparities: Initiatives under way at Verizon. Health Affairs, 30(10): 1992‐1996. Weinick, R.M., and Hasnain‐Wynia, R. (2011). Quality improvement efforts under health reform: how to ensure that they help reduce disparities – not increase them. Health Affairs, 30(10): 1837‐1843. Affordable Care Act: Kaiser brief on women and Medicaid http://www.kff.org/womenshealth/7213.cfm Commonwealth report by Kay Johnson http://www.commonwealthfund.org/~/media/Files/Publications/Issue%20Brief/2012/Au
g/1620_Johnson_addressing_womens_htl_needs_improving_birth_ib.pdf Commonwealth women and ACA brief updated http://www.commonwealthfund.org/News/News‐Releases/2012/Jul/Oceans‐Apart.aspx Federal factsheet for families with children http://www.healthcare.gov/news/factsheets/2011/08/families.html Coverage for young adults http://www.dol.gov/ebsa/faqs/faq‐dependentcoverage.html White House brief on ACA and women http://www.whitehouse.gov/files/documents/health_reform_for_women.pdf HHS women's preventive services guidelines http://www.hrsa.gov/womensguidelines/ Sebilius blog on women's clinical services http://www.healthcare.gov/blog/2012/07/prevention073112.html Substance Abuse and Mental Health: Mechanic, D. (2007). Mental health services then and now. Health Affairs, 26(6): 1548 1550. Barry, C.L. & Huskamp, H.A., (2011). Moving beyond Parity: Mental health and addiction care under the Affordable Care Act. New England Journal of Medicine; 365: 973‐ 975. 14 Wells, K., Klap, R., Koike, A., & Sherbourne, C. (2001). Ethnic disparities in unmet need for alcoholism, drug abuse, and mental health care. American Journal of Psychiatry, 158: 2027‐2032. McGuire, T.G., & Miranda, J. (2008). New evidence regarding racial and ethnic disparities in mental health: Policy Implications. Health Affairs, 27(2): 393‐403. doi: 10.1377/hlthaff.27.2.393 Additional Websites: The FAIR Database (http://www.solvingdisparities.org/fair) Finding Answers’ FAIR database is one of the most comprehensive collections of summaries and systematic reviews of racial and ethnic health disparities intervention literature available. Search by health topic (for instance: asthma, diabetes) or by strategy (for instance: pay for performance, nurse‐led interventions). (http://www.solvingdisparities.org/tools/roadmap) This section is a guide for healthcare organizations to improve minority health and foster health equity. Lessons learned from the results of other projects and literature is available and may be an invaluable resource for your final project. 15