THE UNIVERSITY OF NORTH CAROLINA AT CHAPEL HILL
SCHOOL OF SOCIAL WORK
COURSE NUMBER:
COURSE TITLE:
SEMESTER AND YEAR:
SOWO 836
Examining Health Access and Health Disparities
Spring 2010
MEETING TIME/LOCATION:
Tuesday, 9-10:30am; Room 101
INSTRUCTOR:
Lisa de Saxe Zerden, MSW, PhD
Email: Lzerden@email.unc.edu
Phone: (919) 843-6284
OFFICE HOURS:
370B; By appointment
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 resolution of disparities.
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 highquality, 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.
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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. The adult learning method will be used. Therefore,
students are expected to complete all assigned readings before each class begins. 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
report on the progress of their individual or group health disparities project.
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 5 th 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 (http://www.lib.unc.edu/index.html?searchtab=ejournals) or posted on Blackboard in
advance.
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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, information
about class content, etc., 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 to discuss and apply them.
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 POLICY:
Cell phones are a disruption to the learning process. Please turn off cell phones during class.
COURSE OVERVIEW:
1/11/11
1/18/11
1/25/11
2/1/11
2/8/11
2/15/11
2/22/11
3/1/11
3/8/11
3/15/11
3/22/11
3/29/11
4/5/11
4/12/11
4/19/11
4/26/11
Class 1: Introduction and course overview; why study health disparities?
Class 2: Patterns and causes of health disparities—past and present
Class 3: Pattern and causes of health disparities (cont.): SES, employment and neighborhood
Class 4: Frameworks and theories to understand racism and health disparities
Class 5: Overview of Healthcare in the U.S.—How the system is financed and related policies
Class 6: Improving health and access to quality health care
Class 7: Health Care Disparities in Developing Countries ** Guest Speaker**
Class 8: Impact of social injustice in healthcare: Examples and interventions
SPRING BREAK
Class 9: How immigration, acculturation and national origin influence health
Class 10: Substance abuse and mental health disparities ** Guest Speaker**
Class 11: Disparities related to gender and sexual orientation & Discussion on policy memos
Class 12: The role of social workers in addressing health disparities
Class 13: Interventions to Reduce Disparities in an Age of Scarce Resources
Class 14: Final presentations
Class 15: Final presentations (cont.) and class wrap-up
Requirement
COURSE REQUIREMENTS OVERVIEW:
% of Grade
Date/Due Date
Class Participation
Writing Reflections
Midterm Assignment: Health Disparity Outline
Policy Memo Final Assignment
Health Disparities Presentation
15 points
10 points each
20
20 points
20 points
Ongoing
Weeks 4 & 10
Week 9
Week 14
Weeks 14 & 15
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COURSE READINGS AND COURSE OUTLINE:
JAN 11, 2011
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:
Healthy People 2010. A Systematic Approach to Health Improvement. Available on
Blackboard. (*Focus on pages 11-26).
Krieger, N. (2001). A glossary for social epidemiology. Journal of Epidemiology and
Community Health, 55, 693-700.
JAN 18, 2011
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:
Mechanic Ch. 5: Fundamental Sources of Health Inequalities (Link & Phelan)
Mechanic Ch. 8: Patterns & Causes of Disparities (Williams)
JAN 25, 2011
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:
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.
Williams, D.R., & Collins, C. Racial residential segregation: A fundamental cause of racial
disparities in health. (2002). In T.A. LaVeist (Ed.), Race, Ethnicity, and Health—A public
health reader (369-390). San Francisco: Jossey-Bass.
Recommended not required:
The John D. and Catherine T. MacArthur Foundation Research Network on
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Socio-economic Status and Health (2008). Reaching for a healthier life: Facts on
Socio-economic status and health in the U.S. Available:
http://www.macses.ucsf.edu/News/Reaching%20for%20a%20Healthier%20Life.pdf
FEB 1, 2011
Week 4: Frameworks and theories to understand racism and health disparities

Writing reflection #1 due
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
Blackboard).
FEB 8, 2011
WEEK 5: Overview of Healthcare in the U.S.—How the system is financed and related policies
1. Medicaid
2. Medicare
3. Private sector healthcare and reform
Readings:
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.
**Additional Readings to be posted on Blackboard
FEB 15, 2011
WEEK 6: Improving health and access to quality health care
1. Ideological and cultural issues to tackle
2. Brief history of health Insurance in the U.S.
3. Health reform
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Readings:
Kaiser Family Foundation [KFF] (2009). National health insurance—a brief history of reform
efforts in the U.S. Available: http://www.kff.org/healthreform/upload/7871.pdf
KFF (2009). Massachusetts Health Care Reform: Three Years Later. Available:
http://www.kff.org/uninsured/upload/7777-02.pdf
Recommended not required:
Guendelman, S., Angulo, V., & Oman, D. (2005). Access to health care for children and
adolescents in working poor families: Recent findings from California. Medical Care,
43(1), 68-78.
FEB 22, 2011
WEEK 7: Health Care Disparities in Developing Countries
1. Global health inequality
2. Structural approaches to reducing health disparities
3. Guest Lecturer: Kumi Smith, MPH
Gill, B. ,& Oakie, S. (2007). China and HIV -- A Window of Opportunity. New England Journal
of Medicine, 356(18): 1801-1805.
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-globalhealth
MAR 1, 2011
WEEK 8: Impact of social injustice in healthcare: Examples and interventions
1. Impact of social injustice on the health of marginalized populations
2. Addressing racial inequality in healthcare through civil rights
3. Brainstorming health disparities topic for final (in class)
Readings:
Gamble, V. N. (1997). Under the shadow of Tuskegee: African Americans and health care.
American Journal of Public Health, 87, 1773-8.
Isaac, E., Rowland, M., & Blackwell, L. (2007). Fighting health disparities: The educational
role of the African American church. Cross Currents, 57(2), 261-265.
MAR 8, 2011 : NO CLASS, ENJOY YOUR SPRING BREAK
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MAR 15, 2011
WEEK 9: How immigration, acculturation and national origin influence health
 Midterm assignment due
1.
2.
3.
4.
Effects of immigration and acculturation on health
The Latino Health Paradox
Case example: Latino injection drug users
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.
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.
Recommended not required:
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 22, 2011
WEEK 10: Substance abuse and mental health disparities
 Reflection #2 due
1. Substance abuse and mental health disparities among racial/ethnic groups
2. Treatment and interventions tailored towards minority and vulnerable populations;
Guest Speakers Robert Childs, MPH and Natasha Bowditch, MSW.
Readings:
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.
Amaro, H., Raj, A., Vega, R.R., Mangione, T.W., & Perez, L.N. (2001). Racial/ethnic disparities
in the HIV and substance abuse epidemics: communities responding to the need.
Public Health Reports, Sep-Oct; 116(5): 434-48.
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MAR 29, 2011
WEEK 11: Disparities related to gender and sexual orientation & Discussion on policy memos
 Writing reflection #2 due
1. Women and health inequity
2. LGBT health disparities
3. Policy memo workshop
Readings:
Readings to be posted on Blackboard
APR 5, 2011
WEEK 12: The role of social workers in 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:
McDonough-Figueira, J. (1993). Policy Practice: The Neglected Side of Social Work
Intervention. Social Work, 38(2),179-188,
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.
Recommended not required:
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 12, 2011
WEEK 13: Interventions to Reduce Disparities in an Age of Scarce Resources
1. System and policy intervention efforts to address health disparities
2. Case examples: tobacco policy, obesity epidemic, and HIV/AIDS in the U.S.
Readings:
Mechanic Ch. 7: Tabacco Policy in the U.S.: Lessons for the Obesity Epidemic (Warner)
Rosenberg T, J. Alperen, J.K., & Chiasson, M.A. (2003). Why do WIC participants fail to pick
up their checks? An urban study in the wake of welfare reform. American Journal of
Public Health, 93: 477-481.
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Recommended not required:
Fullilove, R.E., Green, L., & Fullilove, M.T. (2000). The Family to Family program: A structural
intervention with implications for the prevention of HIV/AIDS and other community
epidemics. AIDS, 14, S63-S67.
APR 19, 2011
WEEK 14: Final presentations

Final assignment due
APR 26, 2010
WEEK 15: Final presentations and class wrap-up
SOW0 836, HEALTH ACCESS & DISPARITIES CLASS ASSIGNMENTS:
Writing Reflections:
Students will complete 2 writing reflection assignments due at the beginning of classes 4 and 10.
Students can explore any topic of interest that relates to course content from any of the class
sessions. Reflections can stem from class discussion, course readings, from a journal or news
publication. Or perhaps a recent film sparked thoughts and relates back to course content. Each
reflection should be 2-3 pages and needs to demonstrate the student’s ability to think critically
about health policy information in a variety of contexts. Students may want to consider the
following kinds of questions when writing their reflections:
 What are the main health issues and related policies under discussion?
 Who is affected most? How and why?
 What are the article’s main conclusions? If you saw a film, how did it relate to health
disparities/access?
 What additional questions does this work raise? What are the ethical considerations to be
aware of?
 What are the implications for social work and other healthcare professionals?
 Was the information biased/flawed or did it serve as a model to be emulated? How, so?
Let these points serve as ideas to get your reflection started; not every point needs to be addressed.
Reflections do not need to written in APA format with outside literature or research. Think of this as
a critical reflection that synthesizes this material and your own thoughts.
MIDTERM ASSIGNMENT OVERVIEW:
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The midterm assignment will serve as a starting point to get your final policy memo and
presentation organized. This paper should be 5-7 pages in length and while all references need to
be included in APA format on the back, it could be handed in as a DETAILED outline, or essay format,
whichever the student prefers. There will be time in class to discuss this assignment in greater
detail.
The midterm paper will be due week 9, March 15th, 2011. These papers will critically examine a
health disparity within a particular population group. The paper 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.
Papers should provide the context for your topic, you should provide a through and critical literature
review with a synthesis of data highlighting the issues. As you choose your topic (there will be time
in class to discuss your ideas), focus on the following dimensions/questions to guide your paper:
 Describe the specific health disparity you have identified
 Who is affected and what comparison data can you offer to highlight this disparity?
 What are some theories or explanations as to why this disparity exists?
 What are the specific policies related to this topic, or lack thereof?
 What if any, has been the role of SW and other health practitioners?
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 to understand the disparities, who is affected, and related policies that shape or
exclude the population/group under discussion.
FINAL ASSIGNMENT: POLICY MEMO & PRESENTATION
In this assignment, students will have the opportunity to further explore a health disparity of their
choosing and present the topic to the class as though they are the expert(s). In groups of two, or
alone, students will utilize their midterm assignment about a health disparity and specific
population affected in order to create a policy memo or fact sheet on the topic. This memo will be
distributed to the class during final presentations—it will be your responsibility to provide copies for
all students. The policy memo or fact sheet and presentation will be graded separately.
PART 1: The policy memo or fact sheet should address a specific health disparity. It needs to be
informative and concisely, BRIEFLY, explain to the reader why this topic matters. Based on FigueiraMcDonough’s proposed four methods of social policy practice to be used by social workers in their
work toward social justice (and other sources from the course), students must discuss how certain
methods can be used to mitigate and/or possibly resolve their specific health disparity topic. The
policy memo or fact sheet should:
 Describe the health disparity and the target population affected
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


What social and health policies relate to this issue. Perhaps there is a lack of policy around
your issue
What are the suggested actions necessary to improve this disparity? Why are these public
policy methods valid in helping to resolve the identified problem and improve policy on the
issue?
How can these changes be achieved on a micro, mezzo, and macro level? Think about
change from an individual, agency and policy level to address this health disparity.
PART 2: During the last two weeks of class students will be given 7-10 minutes* to present their
health disparity topic and related policies to the class as though they are the expert. The time
allotted to each presentation will depend on the size and number of groups. Presentations must
address:
 Who is the intended audience the memo/fact sheet was created for?
 What are the policy practice recommendation(s) suggested.
 Why are these chosen methods effective strategies to promote positive change?
 Discuss obstacles and momentum that can hinder or facilitate change related to the topic.
 What is the role and potential for social workers to be involved in this issue?
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