September 18, 2014
University of Pennsylvania
Graduate Program in Public Health
MPH Degree Program
Course Syllabus – Fall 2014
Title: PUBH 519: Issues in Global Health- Addressing Health Disparities
Course Units: 1.0 c.u.
Course Description: This course presents an interdisciplinary approach to global health with emphasis
on addressing health disparities both global and local. Learning formats include case-based analysis,
small group discussion, faculty presentations, panels, and debates. Subjects include: measures of disease
burden; frameworks for health equity and rights; determinants of health; environmental health and safe
water; control of infectious diseases; non-communicable disease programs, nutritional challenges; harm
reduction and behavioral modifications; women's reproductive rights; health economics and cost-effective
interventions; health manpower and capacity development; globalization challenges and potentials.
Placement / Room Assignment:
Fall Semester. Lectures: Tuesday, 5:00 PM to 7:00 PM, Room: Fagin 214 (School of Nursing)
Students are required to select a discussion section on Tuesday 4-5pm or Tuesday 7-8pm
Course Director:
Discussion Section Faculty:
Carol McLaughlin, MD, MPH, MSc
Kent Bream, MD
Marjorie Muecke, PhD, RN
Christiaan Morssink, PhD, MPH
Faculty Office Hours: By Appointment
carolmc@upenn.edu
bream@mail.med.upenn.edu
muecke@nursing.upenn.edu
morssink@mail.med.upenn.edu
Course logistics: Dustin Utt, Global Health Programs Office, School of Medicine uttd@upenn.edu
Prerequisites: There are no prerequisites. The course is designed for graduate and professional students
in public health, health professions, social and behavioral sciences, business and law. SAS undergraduates
may register if they are juniors or seniors and have completed HSOC 010, Health and Societies: global
perspectives. Junior and Senior undergraduate nursing students can apply for permission.
NOTE: Cell phones must be turned off during class. Laptops are only permitted for class related use.
Course overview: This course provides an introductory survey of global health, with the primary aim to
engage and inspire students about the opportunities and challenges of global health. Using the lens of
health equity, it provides an overview of many current issues in global public health and frameworks to
address them. Interested students can follow this course with more specific in-depth courses in areas such
as research methods, global health policy, human rights and others.
Course objectives:
At the completion of this course, the student will be able to:

Understand that global health involves multiple academic disciplines, and identify many of these.

Understand that global health theory involves many, sometimes conflicting, belief systems, and
identify some of these.
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September 18, 2014



Understand that global health can be conceived as a complex ecosystem, which involves issues
that are much broader than the traditional health disciplines.
Be able to cite examples of specific issues and case studies in global health.
Understand some of the potential interventions that can be used to ameliorate problems in global
health, particularly in low-income countries.
Core competencies:
1. Understands the complexities of global health issues, particularly in low-income countries
and the sources that can be used to learn about them.
2. Employ critical thinking and appraisal of the literature to explain the global influences on
determinants of health.
3. Demonstrate ability to assess, describe, and analyze determinants of health in developing
countries.
4. Evaluate efficacy and cost effectiveness of public health interventions, programs, policies, and
health care systems within international setting and global health context.
Teaching methods:
Learning formats include case-based analysis, small group discussion, faculty presentations/lecture,
panels, debates, selected general and specific references, reflection questions and papers.
Required readings:
Required textbook:
Title: Understanding Global Health, 2E | Edition: 2, 2013.
Author: William Markle, Melanie Fisher, Jr., Ray Smego Ray
This is available for purchase at the University Bookstore or on-line.
This textbook is also available for free electronically through Access Medicine via Penn Library. URL is
http://accessmedicine.mhmedical.com/book.aspx?bookid=710 if you are on a Penn campus computer.
From a personal computer, you can access the book through the Penn Library
http://www.library.upenn.edu/biomed/ Under e-books, search for the title and log-in with your Pennkey
for full text.
There will be additional required reading for each session (articles, videos, or other) which will be posted
on Canvas as well as recommended/optional readings and resources.
Student Evaluation will be based on:
2-3 Short Reflections
Paper - part 1
Oct 7th
Paper - part 2
Dec 9th
Participation:
Breakout Session Presentations:
10%
20%
30%
20% (class discussions & breakout section, includes attendance)
10% group case
10% final paper briefing
Detailed instructions and due dates for the assignments are provided on Canvas in the “Assignments”
section. Paper instructions are also at the end of the syllabus. Completed written assignments should be
uploaded to canvas by the due date.
Class participation:
Students are expected to prepare for each class by reading assigned chapter/articles; students are expected
to attend and participate in lecture and small group breakout discussions each week. Unexcused absences
will result in decreased participation grades.
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Reflections of Readings (2-3 during the semester):
A week before the due date, 1-2 questions will be posted on canvas for the following week's in class
discussion. Students should answers these questions briefly based on the readings and their own
viewpoints.
Expected Length: 1 paragraph or bulleted half page or less for each question
Upload to canvas prior to class
Grading: complete/incomplete (no numerical grade)
Discussion Sections (start Sept 9th)
Sections will meet from 4-5 PM before lecture or 7-8 PM after lecture. The main purpose of these
sections is for group discussion and analysis of material presented in the lectures, assigned reading, and
case studies. Additionally, the groups will provide an opportunity for students to receive peer and
instructor feedback as they select, research, and present their individual critical analysis paper.
Discussion Section Activities:
 Discussion and reflection of lectures and weekly assigned readings
 Peer feedback and input as each student prepares their individual papers
 Critical analysis of global health problems – group case assignment
Each student will:
 Lead 1-2 discussion sections. This will require close reading of chapters/articles assigned for
the week. Student discussion leader will be expected to prepare and email out discussion
questions from the readings and lead the group through a critical reflection of the issues raised.
Leader may also choose a major issue/challenge from in the lecture/reading and lead students in
examining best ideas/solutions on how to approach or solve the problem.

Present his/her paper topic to the group for feedback. This will entail brief discussion of the
chosen topic and questions for analysis (early October) and longer (5-7 minute) presentations
weeks 12-14.

Participate in a group problem solving case:
- Preparation: Some in class work time (~ 1-2 hours) and outside of class as needed
- Group presentation: Teams of 4-5 students present in section Week 9 or 10. Presentation time is
10 minutes max, students/instructor vote on winning ideas /team leaders & members to represent
their section in class-wide session to be held at 5pm on Tuesday December 2nd
Academic Integrity: Students are expected to adhere to the University’s Code of Academic Integrity.
Care should be taken to avoid academic integrity violations, including: plagiarism, fabrication of
information, and multiple submissions. Students who engage in any of these actions will be referred to the
Office of Academic Integrity, which investigates and decides on sanctions in cases of academic
dishonesty. See link for more information: http://www.upenn.edu/academicintegrity/index.html
Master of Public Health - Grading Policy
Any course in which the student receives a grade of “C+” or below will not be applied toward the Master
of Public Health degree. Please see the MPH Handbook for a detailed description of the grade policy.
Courses taken as pass/fail will not be applied to the MPH degree.
The MPH grading policy is at the discretion of the individual course instructors.
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September 18, 2014
Please find below the generally used grading scale for the MPH Program.
A+ 97-100
B+ 87-89
C+ 77-79
A
93-96
B
83-86
C
73-76
A- 90-92
B- 80-82
C- 70-72
F
Please note that an A+ carries the same weight (4.0) as an A.
0-69
Incomplete Grade: It is expected that a matriculated MPH student shall complete the work of a course
during the semester in which that course is taken. A student who fails to complete a course within the
prescribed period shall receive at the instructor’s discretion either a grade of I (incomplete) or F (failure).
If the incomplete is given, the instructor may permit an extension of time up to one year for the
completion of the course. In such cases, any course which is still incomplete after one calendar year from
its official ending must remain as incomplete on the student’s record and shall not be credited toward the
MPH degree. Students who receive two or more incompletes within a semester may not register for the
subsequent semester(s) without the permission of the MPH Program Director and the Director of
Education.
For additional information on academic policies, please refer to the corresponding sections in the Student
Handbook.
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September 18, 2014
PUBH 519 FOR CY14: LECTURES, READINGS, and ASSIGNMENTS
2014
TOPIC
SPEAKER
READINGS
INTRODUCTION – Week 1
Markle - Chapter 1
SEP 02
WK 1
Important issues in global
health: an overview of the
course
Video:Hans Rosling TED talk – Let my dataset change
your mind. 2009
http://www.ted.com/talks/hans_rosling_at_state
Carol
McLaughlin
Players, structures, group
case
Sections
Jeffrey P Koplan, et al. "Towards a common definition of
global health," The Lancet 2009; 373: 1993–95
Response - Linda P Fried, et al. "Global Health is Public
Health," The Lancet, 2010, 375: 535 – 537
No discussion sections this week
DETERMINANTS OF GLOBAL HEALTH
Week 2
Markle - Ch. 2 and Ch.16
SEP 9
WK 2
Sections
The Global Burden of
Disease
Carol
McLaughlin
Determinants of health:
Political economy of global
health – historical
perspective
Lee
Cassanelli,
PhD SAS
Video: Chris Murray TEDMED talk on Global Burden,
May 2013 http://www.youtube.com/watch?v=mususVjMFk
Recommended:
IHME. The Global Burden of Disease: Generating
Evidence, Guiding Policy. 2013.
Sections start this week
Week 3
Markle - Chapter 6
SEP 16
WK 3
Global Environmental Challenges: Food
security, water scarcity, population, and the
right to health
Panel and discussion on global
environmental challenges
Foley, J. 5 step plan to feed the world. National
Geographic. 2014
http://www.nationalgeographic.com/foodfeatures/feeding9-billion/
Sachs, Jeffrey. From Millennium Development Goals to
Sustainable Development Goals. Lancet 2012; 379:
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September 18, 2014
2206–11.
IATP Email.
Recommended:
UN Human Development Report 2011:Sustainability and
Equity
Due
Reflection #1
Week 4
Markle - chapter 21
Ruger, JP: Global Health Justice. Public Health Ethics
2(3): 261-275, 2009.
SEP 23
WK 4
Global Health Justice and
Equity
Jennifer Prah
Ruger, PhD
MSc MA
Bioethics and
Health Policy
Ruger, JP: Ethics and Governance of Global Health
Inequalities. Journal of Epidemiology and Community
Health 60(11): 998-1003, Nov 2006.
Ruger, JP, Kim, HJ: Global Health Inequalities: An
International Comparison.[Erratum appears in J
Epidemiology Community Health. 2007 Feb;61(2):175]
Journal of Epidemiology and Community Health 60(11):
928-36, Nov 2006
Ruger, JP: Toward a Theory of a Right to Health:
Capability and incompletely Theorized Agreements. Yale
Journal of Law and the Humanities 18(2): 273-326, 2006.
Equity- Gap Analysis –
case of child health
Carol
McLaughlin
Countdown to 2105 Equity Analyses - country profiles
and how to read them
Powerpoint - Cesar Victora – Inequalities in RMCNH
VULNERABLE POPULATIONS
Week 5
SEP 30
WK 5
Social determinants of
health – Global to Local
Immigrant health
Steve Larson
MD, SOM
Case Discussion and Debate: Addressing
Social Determinants locally – Puentes de
Salud
Video segment: Unnatural Causes
Link: http://puentesdesalud.blogspot.com/2008/07/pbsdocumentary-are-inequalities-making.html
Video: Education – it matters more to health than ever
before http://www.youtube.com/watch?v=C8N4wka3wak
Marmot M et al. Closing the gap. Lancet 2008, 372:
1661-1669.
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September 18, 2014
Panel: Larsen, Morssink, Muecke, Bream,
students
Recommended:
Marmot M. Social determinants of health inequalities.
Lancet 2005, 365: 1099-1104.
WHO 2008 Report on the Social Determinants of Health
Due
Reflection #2
Week 6
OCT 7
WK 6
Due
Humanitarian Assistance
and Disaster Relief Refugees and Displaced
Peoples
Lisa Hilmi,
RN MPH
SON
Markle Chapter 15
Articles from speaker
Paper – Part 1 due Oct 7th (see assignments section of canvas)
Week 7
OCT 14
WK 7
What saves lives? The roles
of medicine, public health,
and economic growth in
past and present.
Group discussion of case
studies: Finding and
allocating resources: the
role of the DALY through
case studies of AIDS and
TB treatment.
Due
Luke Messac,
SAS
Excerpt - Anne Becker et al, "Challenges of Mental
health and MDRTB: critical perspectives on metrics of
disease” from Farmer, P et al. Reimagining Global
Health. 2013
Case of MDR TB:
- ScienceSpeaks blog Zeke Emanuel
- Response by Salmaan Keshavjee and Paul
Farmer.
Case of HIV treatment
- Elliot Marseille et al, "HIV prevention before
HAART in sub-Saharan Africa," Lancet. 2002.
- Response: Paul Farmer. Bulletin of the WHO.
Reflection #3: Based on 2 cases studies in the assigned readings MDRTB and HIV treatment
Selected challenges: The Unfinished Agenda: Reproductive Health and Infectious Disease
Week 8
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September 18, 2014
Markle chapter 4
OCT 21
WK 8
Reproductive health in
developing countries
Bill McCool,
SON
Nour NM. Health consequences of child marriage in
Africa. Emerging infectious diseases 2006, 12: 16441649.
Markle chapter 10
HIV prevention – a case
study of social movement
mobilization in India
Section
Toorjo
Ghose, SP2
Brandt, Allen. How AIDS invented global health. NEJM
2013. Read and listen to audio interview (14 minutes)
http://www.nejm.org/doi/full/10.1056/NEJMp1305297
Topic for final paper - turn in to section leader
Week 9
Markle chapter 9
Video: malaria – human host
http://www.hhmi.org/biointeractive/malaria-human-host
OCT 28
WK 9
Carol
McLaughlin,
SOM
Malaria
How to beat Malaria once and for all. NYT Opinion. June
7, 2014
Markle chapter 12
Zoonotic diseases and
emerging infections
Section
Gary Smith,
SVM
Gibbs EPJ. Emerging zoonotic epidemics in the
interconnected global community. Veterinary record
2005, 157: 673-679.
Group case presentations (or week 10)
Selected emerging challenges: Non-communicable Disease
Week 10
Markle chapter 7
NOV 04
WK 10
The nutritional transition in
developing countries
Charlene
Compher,
SON
Bhutta Z et al. Evidence-based interventions for
improvement of maternal and child nutrition: what can be
done and at what cost? Lancet 2013; 382: 452–77
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September 18, 2014
Global child health: views from the field:
Maura Murphy MPH and CHOP global
health fellows
Section
Group case presentations (or week 9)
Week 11
Markle chapter 13
NOV 11
WK 11
Global Issues in tobacco
control
Jha, P et al. Global Effects of Smoking, of Quitting, and
of Taxing Tobacco N Engl J Med 2014; 370:60-68
Robbie
Schnoll,
PhD, SOM
Recommended:
Branas. Injury prevention in the developing world. Italian
J Public Health 2010, 7: 72-75.
Charlie
Branas, PhD,
SOM
Injuries and their
prevention
Hofman K et al. Addressing the growing burden of
trauma and injury in low- and middle-income countries.
Am J Public Health 2005, 95: 13-17.
INTERVENTION STRATEGIES – Delivery
Week 12
Markle chapter 18
NOV 18
WK 12
Innovations in global
health delivery:
telemedicine – global and
local
Carrie
Kovarik,
SOM
Littman-Quinn R, et al. Implementation of m-health
applications in Botswana: telemedicine and education on
mobile devices in a low resource setting. Journal of
Telemedicine and Telecare 2013, 19: 120-125.
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September 18, 2014
Markle chapter 8
Declaration of Alma-Ata, from the International
Conference on Primary Health Care, Alma-Ata, USSR, 612 September 1978
Community health
programs in low resource
settings
Carol
McLaughlin
Rosato M, et al. Community participation: lessons for
maternal, newborn, and child health. Lancet 2008, 372:
962-971.
Recommended:
Developing and Strengthening Community Health
Worker Programs at Scale. 2014 Chapters 1-2.
http://www.mchip.net/CHWReferenceGuide
Section
Individual presentations weeks 12, 13, 14
Week 13
Markle chapter 20
Articles from speaker
NOV 25
WK 13
Anna
Doubeni, MD
MPH,
SOM
Global Partnerships
Recommended:
Birn A-E. Gates’ grandest challenge: transcending
technology as public health ideology. Lancet 2005, 366:
514-519.
Jamison D et al. Global Health 2035: a world covering
within a generation. Lancet 2013; 382: 1898–955.
Group work
Section
Individual presentations weeks 12, 13, 14
Week 14
Student case presentations
DEC 2
WK 14
Section
Markle chapter 22
Course wrap-up - future of global health
and next steps (courses and careers)
Individual presentations weeks 12, 13, 14
DEC 9: Final Papers Due December 9th
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September 18, 2014
CHOP Children’s Hospital of Philadelphia; SAS School of Arts and Sciences; SOM School of Medicine; SON
School of Nursing; SP2 School of Social Policy and Practice; SVM School of Veterinary Medicine
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September 18, 2014
Course Assignment: Situation Brief and Proposal to Address Health Disparities
In global health, skill sets you will need include defining the current state of health, identifying the primary drivers
of health, examining the evidence base for potential intervention to address health problems, considering challenges
to implementation, engaging partnerships needed, and communicating your findings to stakeholders.
Over the course of the semester, you will develop and apply these skills in a 2 part written assignment. You will
choose a country or geographic region (e.g., district of a country) to examine. First you will develop a short
situation brief (due Oct 7th) to describe the current health status of your chosen country including primary
determinants and markers of health equity. From your analysis, you will then choose one area to examine more
deeply and propose a program/action to address a health disparity in your chosen country.
For all assignments, you will need to search scientific articles, summarize data from websites and searches, and
integrate concepts from lectures and readings. For all assignments, literature must be cited using APA or
comparable standardized format. More details on each below.
Paper Part 1: Situational Brief - Describe the health situation in a country or region
Due: October 7th - to your section faculty leaders - upload to canvas
(20% Grade)
Choose a country (or area of a country such as a district) that you would examine for your paper. Develop a brief to
the Minister of Finance that summarizes the current health situation, burden of disease, key determinants of health,
and equity status
1.
Summarize the Burden of disease – Consider Death, DALYs, other indicators such as life expectancy,
fertility, education level, or other key indicators: environmental, political, economic. How has this changed
over time? How does this country compare to other countries in this region? Where are they in their
epidemiological transition? Demographic transition?
You can create tables /Graphics to summarize – can use Global Burden of Disease (GBD) data, Gap
Minder, Countdown to 2015, DHS data, or other data you find.
2.
Based on your country’s profile, what do you think are the major health determinants of health? What do
you think should be the investment priorities to improve health (i.e., what sectors or conditions)?
3.
Equity Analysis – Discuss the state of the country in terms of equity in coverage of key health interventions
by socioeconomic household wealth. Use 1-2 indicators as illustrative examples. You can use resources
such as equity profiles in the country profiles of the Countdown to 2015
http://www.countdown2015mnch.org/country-profiles or other materials you find.
This brief should be 5 pages or less (total), double-spaced, 1-inch margins. Sources should be cited at the end using
endnotes.
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September 18, 2014
Paper Part 2: Proposal to Address Health Disparities
- Proposal topic due October 21st - submit your topic to your section instructor for approval
- Paper Due: December 9th to your small group instructor via canvas
[ Students will also present their final paper (5min) to their discussion section in weeks 12,13, or 14]
Your Proposal – Using the same country or region as your situation brief, propose a program/action to address a
health disparity in your chosen country (or part of a country or vulnerable population). (If you would like to change
countries or regions for this paper, that is ok also).
-
Choose a public health problem/health disparity to analyze
Define the problem including magnitude, indicators, and key determinants
Discuss stakeholders
Suggest strategies to consider to decrease health inequity or disparity – include any evidence of past
success or potential success from the literature or other materials you find (e.g., field)
Recommend an approach to addressing the problem. Include indicators for monitoring success.
Note challenges/threats to success of this approach and how these might be mitigated.
Format of final paper
We expect final papers to be 8-12 pages in length, double-spaced, plus any illustrative figures and tables, and
references (10 to 20), using 1inch margins. Literature must be cited using APA or comparable standardized format.
The paper should be uploaded to canvas as a single document in either Word for Windows or pdf format, and the
file name should include your name, date submitted, and the course number.
Cover page:
Student’s name and contact information
Date final paper submitted
Title
An abstract (< 200 words)
Paper:
A statement of the health disparity/issue addressed
Background information with relevant references and documentation
A discussion of strategy options with a critique of merits and limitations
Your opinion (could be an action plan) supported with a reasoned justification
Examples of acceptable topics
(These examples are intended to convey the kind of subject appropriate for this course)



Making essential medicines available in Kenya: an action plan
Safe drinking water in Sudan: a program based on proven strategies
The health manpower crisis in Zambia: causes and a proposed solution
Not wanted: A review of the literature – by itself – would NOT be an acceptable final paper.
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