Gerald R Ford School of Public Policy
University of Michigan
Sharon Maccini
Fall 2005
Public Policy 533
Public Health in Developing Countries
Class meetings:
Tuesdays and Thursdays 10-11:30 AM, Lorch Hall 473
Contact information: 457a Lorch Hall
office hours: Tuesdays 1-3 PM
e-mail: smaccini@umich.edu
phone: 734-764-7138
Course Description:
This course will focus on public health policy primarily in the developing world. We will begin by
reviewing epidemiological and demographic evidence on the leading causes of mortality and
morbidity globally. After establishing a theoretical framework for measuring health, we will
discuss the role of government in promoting population health. The course will then explore how
to evaluate the relative success of health policies. Next, we will cover in depth a series of specific
public health issues: nutrition, smoking, HIV control, the development of vaccines, and access to
medicines. Finally, we will consider the interaction between health and wealth at both the micro
(individual) and macro (national) levels.
Prerequisite:
A basic understanding of microeconomics at the level of the Ford school core sequence is required.
If you are unsure of your preparation, please see me.
Course Requirements:
Class participation (20 % grade).
Class discussions will be an important part of the seminar. Students are expected to come to class
prepared to discuss readings in detail. I reserve the right to call on individual students if necessary
to spark discussion. In addition to being actively involved in class, your participation grade will be
based on brief (one paragraph) response papers. I will hand out seven newspaper articles related to
public health throughout the semester. You will be responsible for responding in writing to any
five of these seven articles by the next class. Your responses can be quite brief, but should reflect
some careful thought about the issue and the application of relevant course readings. These
response papers will be handed in but not graded. A clear lack of effort will be reflected in your
participation grade.
Two position papers and in-class debates (15% grade for each paper and 5% for each
presentation).
The 3-5 page position papers will be designed to prepare you for the in-class debates scheduled for
October 13 and November 17.
Final paper (40% grade).
This 10-12 page paper will be due on the final day of class (December 13).
Course Policies:
I will distribute necessary information about writing assignments in advance. All papers should be
double spaced with one-inch margins and 12-point font. All writing assignments are due at the
beginning of class. For late papers, I will deduct ½ of a point each day after the due date, unless I
have granted an extension before the assignment due date.
Readings:
Most readings are available online. I have marked articles you can find on JSTOR
(www.jstor.org) with “*J” after the citation. Articles that are otherwise available electronically
through MIRLYN are listed with "*M." Otherwise, I list the exact address to find a reading on the
Internet.
There are 9 articles that are not available electronically. These will be available in a single course
pack at any of the three bookstores.
One book is required reading and will also be available in the bookstore:
 Kremer, Michael and Rachel Glennerster (2004). Strong Medicine: Creating Incentives for
Pharmaceutical Research on Neglected Diseases. Princeton University Press.
Course Outline and Reading List:
I. What is Health?
i. Is Health a Right?
Fuchs, Victor (1998). Who Shall Live? Health, Economics, and Social Choice. World Scientific
Publishing Company, Singapore. Pages 17-29 (second half of introduction).
World Health Organization Position Statements, selected readings from web site (to be handed
out).
Annas, George J (2003). "The Right to Health and the Nevirapine Case in South Africa." The
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New England Journal of Medicine: 348 (8): pp. 750-754.
Available at: http://content.nejm.org/cgi/content/full/348/8/750
ii. What Causes Good Health?
Fogel, Robert (1994). "Economic Growth, Population Theory, and Physiology: The Bearing of
Long-Term Processes on the Making of Economic Policy." American Economic Review: 84 (3),
pp. 369-395. *J
Preston, Samuel (1996). "American Longevity: Past, Present, and Future." Syracuse University
Center for Policy Research Policy Brief #7.
iii. How Do We Measure Health?
Cutler, David and Elizabeth Richardson (1997). "Measuring the Health of the US Population."
Brookings Papers on Economic Activity: Microeconomics. *J
Strauss, John and Duncan Thomas (1998). "Health, Nutrition and Economic Development."
Journal of Economic Literature: 36 (June), pp. 789-798 only (section 4). *J
Further reading:
Torrance, George (1986). "Measurement of Health State Utilities For Economic Appraisal."
Journal of Health Economics: 5, pp. 1-30. *M
II. What is Public Health?
i. Overview
World Bank (1993). World Development Report 1993: Investing in Health. Oxford University
Press: Oxford, pp. 52-107 (Chapter 3 "The Roles of the Government and the Market in Health" and
Chapter 4 "Public Health").
Jeffrey Hammer (1997). "Economic Analysis for Health Projects." The World Bank Research
Observer: 12 (1) February, pp. 47-71. *M
ii. Perception of Risk
Slovic, Paul (1987). "Perception of Risk." Science: 236 (April 17), pp. 280-285. *J
Stable URL:
http://links.jstor.org/sici?sici=0036-8075%2819870417%293%3A236%3A4799%3C280%3APO
R%3E2.0.CO%3B2-N
Viscusi, Kip (1992). Fatal Trade-offs: Public and Private Responsibilities for Risk. Oxford
University Press: New York. Pages 17-33 (Chapter 2 "Strategic and Ethical Issues and Evaluation
of Life").
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Weinstein, Neil D (1989). "Optimistic Biases About Personal Risks." Science: 246 (December 8),
pp. 1232-1233. *J
Stable URL:
http://links.jstor.org/sici?sici=0036-8075%2819870417%293%3A236%3A4799%3C280%3APO
R%3E2.0.CO%3B2-N
iii. Regulation of Health Risks: The Case of Automobile Safety
Graham, John D (1993). "Injuries from Traffic Crashes: Meeting the Challenge." Annual Review
of Public Health: 14, pp. 515-43. *M
http://arjournals.annualreviews.org.proxy.lib.umich.edu/doi/pdf/10.1146/annurev.pu.14.050193.
002503
Graham, John D and Steven Garber (1984). Journal of Policy Analysis and Management: 3 (2),
pp. 206-224. *M
Landsburg, Steven E. (1993). The Armchair Economist: Economics & Everyday Life. The Free
Press: New York. Pages 3-9 (Chapter 1 "The Power of Incentives: How Seatbelts Kill").
III. Health Policy Evaluation
i. General Framework
Behrman, Jere and James Knowles (1998). "Population and Reproductive Health: An Economic
Framework for Policy Evaluation." Population and Development Review: 24 (4), December, pp.
697-719 (first half of article only). *J
ii. Causal Inference
Don Rubin (1974). "Estimating Causal Effects of Treatments in Randomized and Nonrandomized
Studies." Journal of Educational Psychology: 66 (5): 688-690 (only the first three pp.).
IV. Specific Public Health Issues
i. Nutrition
Barker, D.J.P. (1998). Mothers, Babies and Health in Later Life. Churchill Livingstone:
Edinburgh. Pages 1-12 (Chapter 1 "Clues from Geography"), 43-62 (Chapter 3 "From Birth to
Death"), and 181-212 (Chapter 11 "Preventing Chronic Disease: The Future").
Almond, Doug (2005). "Is the 1918 Influenza Pandemic Over? Long-Term Effects of In Utero
Exposure in the Post-1940 US Population."
Available at: http://www.nber.org/~almond/jmp3.pdf
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Almond, Doug and Kenneth Chay (2003). "The Long Run and Intergenerational of Poor Infant
Health: Evidence from Cohorts Born during the Civil Rights Era."
Available at: http://www.nber.org/~almond/cohorts.pdf
Maccini, Sharon and Dean Yang (2005). "Returns to Health: Evidence from Exogenous Height
Variation in Indonesia."
Available at: http://www-personal.umich.edu/~deanyang/papers/papers.html
In-class debate #1: topic to be announced
ii. Smoking
Gruber, Jonathan (2001). "Tobacco at the Crossroads: The Past and Future of Smoking Regulation
in the United States." Journal of Economic Perspectives: 15 (2), Spring, pp. 193-212. *J
Manning, Willard and Emmett Keeler, Joseph Newhouse, Elizabeth Sloss, and Jeffrey Wasserman
(1989). "The Taxes of Sin: Do Smokers and Drinkers Pay Their Way?" JAMA: 261 (11), March,
pp. 1604-9.
Viscusi, Kip (1992). Smoking. Oxford University Press, New York. Pages 139-152 (Chapter 7:
"The Quest for Rational Risk-taking Decisions").
iii. HIV Control
Gertler, Paul, Manisha Shah and Stefano M Bertozzi (2005). "Risky Business: The Market for
Unprotected Commercial Sex." Journal of Political Economy: 113 (3), pp. 518-550.
Available at: http://www.journals.uchicago.edu/JPE/journal/issues/v113n3/30530/30530.web.pdf
Philipson, Tomas and Richard Posner (1993). Private Choices and Public Health: The AIDS
Epidemic in an Economic Perspective. Harvard University Press: Cambridge. Pages 1-16 and
126-142 (Chapter 1 "An Economic Model of Risky Sexual Behavior," and Chapter 5 "Regulatory
Interventions").
United Nations Department of Economic and Social Affairs Population Division (2005).
"Population, Development and HIV/AIDS With Particular Emphasis on Poverty: A Concise
Report ." United Nations: New York. Pages 1-16.
Available at: http://www.un.org/esa/population/publications/concise2005/PopdevHIVAIDS.pdf
iv. Vaccine Development
Kremer, Michael and Rachel Glennerster (2004). Strong Medicine: Creating Incentives for
Pharmaceutical Research on Neglected Diseases. Princeton University Press.
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v. Access to Medicines
Hoen, Ellen F M ‘t (2003). "TRIPS, Pharmaceutical Patents and Access to Essential Medicines:
Seattle, Doha and Beyond."
Available at: http://www.accessmed-msf.org/documents/chicagojournalthoen.pdf
In-class debate #2 -- topic to be announced
vi. Link between Health and Wealth
WHO Commission on Macroeconomics and Health (2001). "Macroeconomics and Health:
Investing in Health for Economic Development." World Health Organization: Geneva. Pages
1-40 (Executive Summary, sections on "Evidence on Health and Development," and "Channels of
Influence from Disease to Economic Development").
Available at:
http://www3.who.int/whosis/cmh/cmh_report/report.cfm?path=whosis,cmh,cmh_report&langua
ge=english#
Deaton, Angus (2002). "Policy Implications of the Gradient of Health and Wealth." Health
Affairs: 21 (2), March/April. *M
http://content.healthaffairs.org/cgi/reprint/21/2/13
Bloom, David and David Canning (2000). "The Health and Wealth of Nations." Science: 287,
February 18, pp. 1207-9. *M
http://proquest.umi.com.proxy.lib.umich.edu/pqdweb?index=59&sid=1&srchmode=3&vinst=PR
OD&fmt=6&startpage=-1&clientid=17822&vname=PQD&RQT=309&did=50351463&scaling=
FULL&ts=1127175877&vtype=PQD&aid=1&rqt=309&TS=1127175882&clientId=17822
vii. The Demographic Transition
Bloom, David E, David Canning and Jaypee Sevilla (2003). "The Demographic Dividend: A New
Perspective on the Economic Consequences of Population Change:" Chapters 1, 2 and 4.
Available at: http://www.rand.org/publications/MR/MR1274
Miller, Grant (2005). "Contraception as Development? New Evidence From Family Planning in
Columbia." Center for International Development at Harvard University Working Paper No. 9.
Available at: http://www.cid.harvard.edu/cidwp/pdf/grad_student/009.pdf
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