Intro to Health Disparities and Health Policy
PH 770E
Spring 2013
Instructor: Tetine Sentell, PhD
Course: PH 770E, Spring 2013
Time: Tues11:00-1:45 PM
Location: BioMed D207
Office Hours: Monday 10AM-12 NOON and by appointment
Office Location: BioMed D104-G
Email: tsentell@hawaii.edu
Course Description
The goals of this course are to introduce students to major components of public health
policy in the US, provide students with a firm grasp of the institutions that shape health
policy, and familiarize students with tools for policy analysis. The course will analyze
several federal health policy instruments and consider their development and
implementation in the context of the US political system. Policy outcomes will be
evaluated both in terms of their merits in achieving policy goals and in terms of the
democratic nature of the processes that produce those policy outcomes. The course
includes an assessment of US policy-making institutions as platforms for the creation and
modification of health policy as well as an overview of methods of policy analysis.
Students are expected to come to class prepared to discuss the reading. Student mastery
of the material will be evaluated based on a 15-page policy analysis and a final exam.
Additionally, as DrPH students, you will track bills, provide testimony and advocacy
around a health policy topic of your choice, lead two classes, and write an additional
paper for publication. You will also take turns giving us weekly updates regarding an
interesting health policy development.
Required Texts
1. Weissert CS and Weissert WG. 2006. Governing Health: The Politics of
Health Policy. Baltimore: The Johns Hopkins University Press.
2. Bardach, Eugene. 2008. A Practical Guide for Policy Analysis: The
Eightfold Path to More Effective Problem Solving. New York: Chatham
House Publishers.
3. Fritschler, A. Lee and Catherine E. Rudder. 2006. Smoking and Politics:
Bureaucracy Centered Policymaking, Sixth Edition. Upper Saddle River:
Prentice Hall.
4. Readings on Laulima course Website
1
5. Frontline Documentary: Obama’s Deal
(http://video.pbs.org/video/1468710007/)
Course Requirements (see end of syllabus for more information on assignments)
1) Participation
10%
2) Discussion leading (5% each)
10%
3) 15-page paper
30%
4) Public Health Hotline
10%
5) Final exam
30%
6) Advocacy (5% each)
10%
Course Schedule
Date
Jan 8
Bonus: Jan 16
Jan 15
Jan 22
Topic
Intro to the US Health Care System
Opening Day of HI Legislature
Theories of Policy Making
Policy Analysis
Jan 29
Problem Definition
Feb 5
Feb 12
Feb 19
Feb 26
Congress
Presidents
Legislative Activity
Health Policy in the Executive Branch
March 5
Interest Groups
March 12
March 19
Public Opinion, Health Care Reform
Fragmentation and Venue Change
March 26
April 2
April 9
April 16
Holiday!
Children’s Health Insurance
States
The role of the courts
April 23
Legislative Activity
April 30
Obesity
May 7
Final Exam Due
Meeting Notes
Reading lists due for Legislative
Activity class 1.
First student-led discussion
Led by DrPH Students
Policy Analysis Paper topics, thesis,
outline, bib, due in class
Public Health Hotline outline,
including authorship expectations.
Reading lists due for Legislative
Activity class 2.
Policy Analysis papers due in class
Public Health Hotline draft due.
Led by DrPH Students
Review questions handed out in
class
Public Health Hotline Article due in
Class
All advocacy pieces must be in
In-class review
2
Course Assignments
Discussions
All students are expected to come to class prepared to discuss that week’s readings. Participation
during these sessions will be factored into participation grades.
Individual papers: Policy Analysis
** The DrPH schedule is different than the MA schedule **
Write a 15-page policy analysis on a health policy issue of your choice. In this paper, you will
follow Gene Bardach’s 8-fold path to structure your approach. We will read and discuss the 8fold path in class so that you will be familiar with this approach. Your paper should define a
policy problem and critically analyze 2-3 alternatives for addressing the problem. You should
rely on data to make your argument and discuss the alternatives in light of their ability to satisfy
the criteria you have set out.
A more detailed guide for the individual papers will be handed out and discussed in class. I will
also post several excellent examples from last year’s papers to provide you with a model. You
should note this assignment makes a large percentage of your final grade as it your chance to
apply course concepts to a topic of interest to you.
There are several pieces of graded work that will go into the final paper. Late assignments will
receive a grade penalty. Please keep track of the following deadlines:
Paper topics, thesis statement, outline,
working bibliography, and preliminary reading list
Due in class, Feb 26th
Final paper
Due in class, April 2
3
DrPH Activities
Current Health Policy
You will each pick two weeks to bring a current health policy event/issue into class that will be
introduced at the start of class. You should briefly share the event/issue with students and then
have one or two discussion questions regarding this topic. Please let me know the weeks you
intend to do by Jan 15.
Legislative Activity Classes
The DrPh students will specifically follow 2 state level initiatives and 1-2 federal level initiatives
during the course of the semester and will lead two full classes on these topics. This will provide
you will a more in-depth understanding of the process of health policy making on a state and
federal level.
One of the state-level bills will be the sugar sweetened beverage tax. You can pick the other state
level bill and you can pick the one or two federal bills you wish to follow.
On Jan 22, you will provide the class with at least one relevant, useful reading for each bill you
choose. You can provide either a link or a hard copy. This will provide the course readings for
the Feb 19th class.
On March 19, you will provide the class with at least one relevant, useful reading regarding the
policy making process. This can be regarding your specific bills, or more generally about the
policy making process. This will provide the course readings for the April 23rd class.
Some resources to track the bills:
Federal:
http://thomas.loc.gov/home/thomas.php
Hawaii:
http://www.capitol.hawaii.gov/
Besides online /library searches, feel free to interview interested parties to gain more information
about these bills. You can use these bills as the topic for your advocacy pieces (described below),
if you like.
Class 1:
You will introduce:
General history of each bill
o Rationale for this bill
o Organizations supporting and opposing this bill
Legislative history of bill
o Who introduced it
o When it was introduced
o Where it is now
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Current political context of each bill
Models of these bills in other states/other countries (if relevant).
All DrPH students should be an active participant in this class and it should be dynamic.
However, you do not all have to be active participants in all bills. Certain individuals can become
experts in certain bills.
Class 2:
You will introduce:
Updates regarding the bills you are following, including:
o Legislative history of bill
o Political context of each bill
Additional models of these bills in other states/other countries (if relevant).
Other models you might consider.
Any testimony you provided regarding this bill.
General thoughts regarding lessons learned from this exercise.
Discussion for the full class regarding the lessons learned. For instance, what if these
topics had been of a different subject.
Again, all DrPH students should be an active participant in this class and it should be dynamic.
However, you do not all have to be active participants in all bills. Certain individuals can become
experts in certain bills.
Advocacy
All DrPH students are required to submit two advocacy pieces by the final day of class. One of
these must be testimony for a Hawaii bill. The other can be on any topic of your choice. It can be
more testimony for a Hawaii bill, or a letter to the editor or to a federal policy maker. I am open
to whatever is most useful to your topics of interest.
Individual papers: Public Health Hotline
Based on your tracking of this bill this semester, you will write a Public Health Hotline article to
be published in 2013 based on the history and legislative history of the sugar sweetened beverage
tax in Hawaii. Details of the requirements of the Public Health Hotline are available on Laulima.
A final draft of this manuscript is due on the last day of class. However, if there are any updates
before the close of legislature, these should be included in the final version. All DrPH students
should be included as authors. You should decide the author order, particularly who will be the
lead as they should take responsibility for turning in drafts, organizing responsibilities, and
finalizing and submitting the manuscript. I will be the last author. This assignment will receive a
group grade.
Outline
Draft
Final version
Due in class, March 5th
Due in class, April 16th
Due in class, April 30th
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WEEKLY LECTURE TOPICS AND READINGS
Week 1: Introduction (Jan 8)
Introduction in Weissert, Carol S. and William G. Weissert. 2006. Governing Health:
The Politics of Health Policy. Baltimore: The Johns Hopkins University Press.
New York Times: Health Care Reform Overview
http://topics.nytimes.com/top/news/health/diseasesconditionsandhealthtopics/health_insur
ance_and_managed_care/health_care_reform/index.html
Also, from the “ARTICLES ABOUT HEALTH CARE REFORM” below, pick two
current articles to read.
Citizens Guide to Testimony (Laulima)
Smith: Writing Public Policy (Laulima)
Optional:
Not Covered by Jeffrey Toobin
http://www.newyorker.com/talk/comment/2009/11/23/091123taco_talk_toobin
Baby Food: If breast is best, why are women bottling their milk?
by Jill Lepore
http://www.newyorker.com/reporting/2009/01/19/090119fa_fact_lepore
Big Med by Atul Gawande
http://www.newyorker.com/reporting/2012/08/13/120813fa_fact_gawande
Week 2: Theories of Policy Making (Jan 15)
Chapters 6 in Weissert, Carol S. and William G. Weissert. 2006. Governing Health: The
Politics of Health Policy. Baltimore: The Johns Hopkins University Press.
Lindblom, Charles E. 1959. The Science of Muddling Through. Public Administration
Review 19 (Spring): 79-88.
http://www.polsci.chula.ac.th/pitch/planningtheory2009/lindblom.pdf
Week 3: Policy Analysis (Jan 22)
Bardach, Eugene. 2008. A Practical Guide for Policy Analysis: The Eightfold Path to
More Effective Problem Solving. New York: Chatham House Publishers.
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Optional:
Previous Student Papers to be posted on Laulima
Dahlia K. Remler, Joshua Graff Zivin and Sherry Glied. (2002) Modeling Health
Insurance Expansions: Effects of Alternative Approaches NBER Working Paper# 9130
http://www.nber.org/papers/w9130.pdf
Week 4: Problem Definition (Jan 29)
Chapters 7 in Weissert, Carol S. and William G. Weissert. 2006. Governing Health: The
Politics of Health Policy. Baltimore: The Johns Hopkins University Press.
Chapter 1 in Nelson, Barbara. 1984. Making an Issue of Child Abuse: Political Agenda
Setting for Social Problems. Chicago: The University of Chicago Press. LAULIMA
Week 5: Congress (Feb 5)
Chapter 1 in Weissert, Carol S. and William G. Weissert. 2006. In Governing Health:
The Politics of Health Policy. Baltimore: The Johns Hopkins University Press.
Oliver Thomas R., Philip R. Lee, and Helene L. Lipton. 2004. A Political History of
Medicare and Prescription Drug Coverage. The Milbank Quarterly 82 (June): 283-354.
http://www3.interscience.wiley.com.eres.library.manoa.hawaii.edu/cgibin/fulltext/118784100/PDFSTART
Slaughter, Louise M. 2006. Medicare Part D—The Product of a Broken Process. The
New England Journal of Medicine, v 354 (June 1): 2314-15.
http://content.nejm.org/cgi/reprint/354/22/2314.pdf
Steinmo, Sven and Jon Watts. 1995. It’s the Institutions, Stupid! Why Comprehensive
National Health Insurance Always Fails in America. Journal of Health Politics, Policy
and Law 20, 2: 329-372.
http://stripe.colorado.edu/~steinmo/stupid.htm
Week 6: Presidents (Feb 12)
Chapter 2 in Weissert, Carol S. and William G. Weissert. 2006. In Governing Health:
The Politics of Health Policy. Baltimore: The Johns Hopkins University Press.
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Health Aff (Millwood). 2010 Jun;29(6):1096-100.
Presidents and health reform: from Franklin D. Roosevelt to Barack Obama.
Morone JA.
http://content.healthaffairs.org.eres.library.manoa.hawaii.edu/content/29/6/1096.long
Skocpol, Theda. 1995. The Rise and resounding Demise of the Clinton Health Plan.
Health Affairs (Spring): 66—85.
http://content.healthaffairs.org/cgi/reprint/14/1/66.pdf
Heclo, Hugh. 1995. The Clinton Health Plan: Historical Perspective. Health Affairs
(Spring): 86—98.
http://content.healthaffairs.org/cgi/reprint/14/1/86.pdf
Week 7: Legislative Activity (Feb 19)
*** TBA
Week 8: Health Policy in the Executive Branch (Feb 26)
***Paper topics and preliminary reading list due in class***
***Thesis statement, paper outline, and working bibliography due in class***
Chapter 4 in Weissert, Carol S. and William G. Weissert. 2006. In Governing Health:
The Politics of Health Policy. Baltimore: The Johns Hopkins University Press.
Garrett, Laurie. 1994. Feminine Hygiene (As Debated, Mostly, by Men). In The
Coming Plague: Newly Emerging Diseases in a World Out of Balance. New York :
Farrar, Straus and Giroux: 390-410. LAULIMA
Optional
Neustadt, Richard E. and Harvey V. Fineberg. 1978. The Swine Flu Affair: Decisionmaking on a Slippery Disease. Washington, D.C.: U.S. Dept. of Health, Education, and
Welfare: 1-115. LAULIMA
Week 9: Interest Groups (March 5)
Chapter 3 in Weissert, Carol S. and William G. Weissert. 2006. Governing Health: The
Politics of Health Policy. Baltimore: The Johns Hopkins University Press: 110-153.
Peterson, Mark. 2001. From Trust to Political Power: Interest Groups, Public Choice,
and Health Care. Journal of Health Politics, Policy and Law 26 (October): 1145-63.
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http://jhppl.dukejournals.org/cgi/pdf_extract/26/5/1145
Epstein, Stephen. 2000. Democracy, Expertise and AIDS Treatment Activism. In
Daniel Lee Kleinman, ed., Science, Technology and Democracy. Albany: State
University of New York Press: 15-32. LAULIMA
Week 10: Public Opinion/Health Care Reform (March 12)
Downs, Anthony. 1972. Up and Down with Ecology: The Issue Attention Cycle. The
Public Interest 28: 38—50.
http://www.nationalaffairs.com/doclib/20080527_197202804upanddownwithecologythei
ssueattentioncycleanthonydowns.pdf
Blendon, Robert J. and John M. Benson. 2001. Americans’ View on Health Policy: A
Fifty Year Historical Perspective. Health Affairs (March/April): 33—46.
http://content.healthaffairs.org/cgi/reprint/20/2/33.pdf
West, Darrell M., Diane Heith, and Chris Goodwin. 1996. Harry and Louise Go to
Washington: Political Advertising and Health Care Reform. Journal of Health Politics,
Policy and Law, v21 (Spring): 35-68.
HTTP://JHPPL.DUKEJOURNALS.ORG.ERES.LIBRARY.MANOA.HAWAII.EDU/C
GI/REPRINT/21/1/35?VIEW=LONG&PMID=8708342
FRONTLINE DOCUMENTARY: OBAMA’S DEAL
Week 11: Fragmentation and Venue Change in US Policymaking (March 19)
Fritschler, A. Lee and Rudder, Catherine E. 2007. Smoking and Politics: Bureaucracy
Centered Policy-Making. Upper Saddle River, NJ: Pearsons, Prentice Hall.
Week 12: Children’s Health Insurance (April 2)
***Policy Analysis Papers Due***
Dubay, Lisa, et al. 2007. Medicaid At The Ten-Year Anniversary Of SCHIP: Looking
Back And Moving Forward. Health Affairs 26: 370—81. On-line.
Halfon, Neal, Helen DuPlessis and Moira Inkelas. 2007. Transforming the U.S. Child
Health System. Health Affairs 26: 315—30. On-line.
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Kronebusch, Karl and Brian Elbel. 2006. Simplifying Children’s Medicaid and SCHIP.
Health Affairs 23:233—46. On-line.
Iglehart, JK. (2009). Expanding Coverage for Children — The Democrats' Power and
SCHIP Reauthorization Volume 360, 9:855-857
http://content.nejm.org/cgi/content/full/360/9/855
Oberlander, JB and Lyons, B. (2009) Beyond Incrementalism? SCHIP And The
Politics Of Health Reform Health Affairs, 28, no. 3 (2009): w399-w410
http://content.healthaffairs.org.eres.library.manoa.hawaii.edu/cgi/reprint/28/3/w39
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Week 13: The Role of States (April 9)
Chapter 5 in Weissert, Carol S. and William G. Weissert. 2006. Governing Health: The
Politics of Health Policy. Baltimore: The Johns Hopkins University Press: 110-153.
Klein, Ezra. 2007. Over Stated: Why the "laboratories of democracy" can't achieve
universal health care. Washington Monthly. July/Aug 2007. On-line:
http://www.washingtonmonthly.com/features/2007/0707.Klein.html
Derthick, Martha. 2001. Federalism and the Politics of Tobacco. Publius. (Winter): 4767. On-line
In Hawaii’s Health System, Lessons for Lawmakers
http://www.nytimes.com/2009/10/17/health/policy/17hawaii.html
Miike, L (1993). Health Insurance: The Hawaii Experience OTA-BP-H-108. NTIS order
#PB93-203743 http://www.fas.org/ota/reports/9327.pdf
D Neubauer (1993). State model: Hawaii. A pioneer in health system reform
Health Affairs, 12, no.2 (1993):31-39
http://content.healthaffairs.org/content/12/2/31.full.pdf
Week 14: The Role of the Courts (April 16)
Anderson, Gerard. 1992. The courts and health policy: Strengths and Limitations. Health
Affairs. : 95-110 On-line
content.healthaffairs.org/cgi/reprint/11/4/95.pdf
Chirba-Martin, Mary Ann and Brennan, Troyen A, (1994) The Critical Role of ERISA in
state health reform. Health Affairs,
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http://content.healthaffairs.org/cgi/reprint/13/2/142.pdf
Optional
Jacobson, PD. E. Selvin, S. Pomfret 2001. "The Role of the Courts in Shaping Health
Policy: An Empirical Analysis" Journal of Law, Medicine & Ethics 29 278-289.
Week 15: Legislative Activity (April 23)
*** TBA
Week 15: Obesity (April 30th)
**Public Health Hotline Due**
** All advocacy pieces must be turned in**
Kersh and Morone (2005). Obesity, Courts, and the New Politics of Public Health.
Journal of Health Politics, Policy and Law.2005; 30: 839-868
Michelle M. Mello, J.D., Ph.D., David M. Studdert, LL.B., Sc.D., M.P.H., and Troyen A.
Brennan, M.D., J.D., M.P.H. Obesity — The New Frontier of Public Health Law NEJM
Volume 354:2601-2610 http://content.nejm.org/cgi/content/full/354/24/2601
Couzin, Jennifer. 2005. A Heavyweight Battle over CDC’s Obesity Forecasts. Science,
v 308 (May 6): 770-771. On-line
McGinnis, J. Michael, Pamela Williams-Russo, and James R. Knickman. 2002. The
Case for More Active Policy Attention to Health Promotion. Health Affairs 21
(March/April): 78—93. On-line
Kuchler Fred et al. 2005. Obesity Policy and the Law of Unintended Consequences.
Amber Waves. US Department of Agriculture. Economic Research Service. On-line:
http://www.ers.usda.gov/AmberWaves/June05/Features/ObesityPolicy.htm
Kersh, Rogan and James Morone. 2002. How the Personal Becomes Political:
Prohibitions, Public Health, and Obesity. Studies in American Political Development 16
(Fall): 162—75. On-line
L Dorfman, et al. (2004) Accelerating Policy on Nutrition: Lessons from Tobacco,
Alcohol, Firearms, and Traffic Safety Media Studies Group.
http://www.reportingonrace.org/documents/AccelerationMtgReportPrelim.pdf
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***Take-home final exam passed out. Due May 7th. Details to follow. ***
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DrPH Competencies Addressed
Advocacy and Policy Development
1. Serve as a liaison and advocate to the policy community for the diverse pressing
public health issues.
2. Interact productively with stakeholders and decision-makers to have an impact on
public policy
3. Identify, develop, and apply policies, laws and regulations for public health
improvement
Critical Analysis and Systems Thinking
1. Critically analyze, use and synthesize information from multiple sources to address
public health problems/issues.
2. Analyze and evaluate the impact of inter-relationships among systems that influence
the quality of life of diverse populations in their communities.
3. Analyze the impact of local, national, and global trends and interdependencies on PH
related problems and systems.
Portfolio Items
1. A paper that critically analyzes public health policy
2. Two pieces of written advocacy, one of which is testimony to Hawai`i State
Legislature or other lawmaking body.
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