RUTGERS UNIVERSITY
Edward J. Bloustein School of Planning and Public Policy
Introduction to Health Disparities
Spring 2015
Friday 9:50am-12:50pm, Scott Hall 114
Professor: H. Shellae Versey, PhD
E-mail: shellae.versey@rutgers.edu
Office Hours: Fridays, 8:00 – 9:00am or by appointment
Office Location: IHHCPAR – 112 Paterson Ave, Rm. #412 (adjacent to School of Nursing and
across from RWJ Hospital) (*must use Sign-Up tool on Sakai*)
COURSE DESCRIPTION
The goal of this class is to provide a broad overview of health disparities in the United States,
with a focus on the three types of inequality - race/ethnicity (and nativity status), socioeconomic
position (SEP), and gender. Because social justice is a primary thrust of public health, it is
crucial to understand which groups are at higher risk of developing poor health outcomes. We
will use a multi-pronged approach to explore five key ways in which race-based health inequities
are created and sustained, with an ultimate focus on structural factors in the social and physical
environment.
GRADING
The final grade will be calculated as follows:
v 10 quizzes (30%)
v Attendance (10%)
v Participation (10%)
v Mid-Term (25%) and Final Exam (25%)
REQUIRED TEXTS
v LaVeist, T. A. (2005). Minority Populations and Health: An Introduction to Health
Disparities in the United States
o Other required readings will be posted on Sakai as PDF documents.
v All readings are mandatory and must be done before coming to class. The lectures
are not a substitute for reading the material.
FILMS: Both “Unnatural Causes: Is Inequality Making Us Sick?” and “Race: The Power of an
Illusion” can be streamed online from the Rutgers University Libraries website with a valid RU
login.
1 GRADING POLICY
• Please note that grades are earned. Assigned grades will not be reconsidered. Indicating
“hard work” in a class does not mean that you have earned an A. You are welcome to
attend office hours for more detailed feedback on how to improve your future grades.
•
There are NO extra credit opportunities for this class.
•
It is your responsibility to check your grades on Sakai in a timely fashion. If there is an
incorrect grade or a grade missing, you have one (1) week to dispute it. After that, the
grade will stand.
Criteria for Final Grades
90% - 100%
86% - 89%
80% - 85%
76% - 79%
70% - 75%
60% - 69%
< 60%
A
B+
B
C+
C
D
F
**GRADES WILL NOT BE NEGOTIATED UNDER ANY CIRCUMSTANCES**
2 COURSE REQUIREMENTS
WEEKLY QUIZZES (10 / 11 quizzes, 40% total)
There will be 11 online quizzes (via Sakai) throughout the term; the lowest score will be
dropped. Quizzes will be timed and only one submission is permitted. The open and due dates
for the online quizzes are posted below. Once a quiz has closed, you will be unable to take the
quiz for credit. If I determine that cheating has occurred, I will file a report with the Office for
Academic Integrity and all involved parties will receive a grade of “0” for the assignment.
Quiz Covers lectures from:
#
1
•
•
•
2
3
4
5
6
7
8
9
10
11
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
•
Quiz
Available
Quiz Due
Feedback
shown
Demographic Profile of the U.S.
Epidemiology of Health and Illness Among Whites and
POC in the U.S.
Conceptual and Historical Issues in the Study of Race,
Ethnicity, and Health I
Conceptual and Historical Issues in the Study of Race,
Ethnicity, and Health II
The Biology of Stress: Physical Health
Stress and Mental Health
Socioeconomic Status and Health I
Socioeconomic Status and Health II
Socioeconomic Status and Health III
History – Black Americans
M 1/26
F 1/30
M 2/2
M 2/2
F 2/6
M 2/9
M 2/9
F 2/13
M 2/16
M 2/16
F 2/20
M 2/23
Social Demography – Black Americans
Health Status – Black Americans I
Health Status – Black Americans II
History – American Indians/Alaska Natives
Social Demography – American Indians/Alaska Natives
Health Status I – American Indians/ Alaska Natives
Health Status II – American Indians/ Alaska Natives
Social Demography – Latinos
Health Status – Hispanics/Latinos I
Health Status – Hispanics/Latinos II
Social Demography – Asian Americans
Health Status I – Asian Americans
Health Status II – Asian Americans History and Social
History & Demography – Native Hawaiians and Other
Pacific Islanders
Health Status – Native Hawaiians and Other Pacific
Islanders
Structural Competency
M 2/23
F 2/27
M 3/2
M 3/2
M 3/23
F 3/6
F 3/27
M 3/9
M 3/30
M 3/30
F 4/3
M 4/6
M 4/6
F 4/10
M 4/13
M 4/13
F 4/17
M 4/20
M 4/27
F 5/1
M 5/4
3 MIDTERM (20%) and FINAL EXAM (25%) – in class
Exams are based on the text, lecture notes, films, in-class discussions, and assigned readings.
Exams will consist of a combination of multiple choice and true/false questions, and perhaps
short essay. Exams start at the beginning of class and will be concluded at the end of class. If
you arrive after the first exam is turned in, you will not be permitted to take the exam. You will
not be allotted extra time if you arrive late to an exam.
Requests for make-up exams are strongly discouraged. Makeup exams will only be permitted if
you provide the obituary for a family funeral you need to attend. If a Dean’s note is obtained, a
make-up will be considered; however, the final decision is at my discretion. Personal holidays,
vacations, broken alarm clocks, weddings, jobs, exams in other courses, traffic, bad weather, or
the Rutgers bus system are not acceptable reasons for missing or being late to an exam. Makeup
exams will consist of short-answer questions and according to my schedule. All makeup exams
will carry a minimum 15% point penalty (i.e., the highest grade you can earn is 85%).
PARTICIPATION (10%)
You are expected to complete all of the assigned readings (and film viewing, if applicable)
before the due date and be prepared to discuss them during lecture.
ATTENDANCE (10%)
ATTENDANCE IS MANDATORY. The quizzes and exams are derived largely from lecture
notes; therefore, it will be difficult to attain a good grade in this class if you do not attend class.
Please make every effort to be on time, as late arrivals are disruptive to everyone. If you will be
significantly late, please stay home. If you are consistently late, leave consistently early, or take
repeated bathroom breaks, it will harm your participation grade. If you are on social media or
using your cell phone during class, it will harm your participation grade. After two (2) absences,
your participation grade will begin to drop.
It is your responsibility to sign the attendance sheet. Do not email to say you forgot to sign the
attendance sheet. Again, it is your responsibility to sign the attendance sheet. If you miss a
lecture, you must acquire the lecture notes from a fellow classmate. It is not my policy to share
my personal notes. Additionally, I am unable to review a lecture during office hours if you
missed the class.
CLASS RULES
To foster a comfortable and respectful educational environment, please be mindful of the class
rules. Any/all phone use is disruptive. Be sure to turn your cell phone tones off before class
begins. It is also distracting and disrespectful to use a tablet or laptop for anything other than
taking notes or seeking answers to questions posed in class. Be sure to restrict your use to these
tasks only. Students answering email, texting, on social media (other than for class purposes), or
doing work for other classes will be asked to close their device and leave the class.
4 It is my fundamental goal to foster an intellectual environment that not only tolerates but
supports and affirms all types of diversity, including but not limited to race/ethnicity, gender,
nativity status, sexual orientation, age, religion, social class, and disability status. I will formally
address any instances in which these standards are violated.
You may notice that there is no designated lecture(s) for White Americans. Because we are
studying health and social inequality, we will compare each race/ethnic group to White
Americans as the majority group in the United States. Therefore, this group is covered
extensively throughout this course.
ACADEMIC INTEGRITY
All students are required to familiarize themselves with the university's full policy on academic
integrity. Visit http://academicintegrity.rutgers.edu for more information.
Principles of academic integrity require that every Rutgers University student:
• Properly acknowledge and cite all use of the ideas, results, or words of others.
• Properly acknowledge all contributors to a given piece of work.
• Make sure that all work submitted as his or her own in a course or other academic
activity is produced without the aid of unsanctioned materials or unsanctioned
collaboration.
• Obtain all data or results by ethical means and report them accurately without
suppressing any results inconsistent with his or her interpretation or conclusions.
• Treat all other students in an ethical manner, respecting their integrity and right to pursue
their educational goals without interference. This requires that a student neither facilitate
academic dishonesty by others nor obstruct their academic progress.
• Uphold the canons of the ethical or professional code of the profession for which he or
she is preparing.
Adherence to these principles is necessary in order to ensure that:
• Everyone is given proper credit for his or her ideas, words, results, and other scholarly
accomplishments.
• All student work is fairly evaluated and no student has an inappropriate advantage over
others
• The academic and ethical development of all students is fostered.
• The reputation of the University for integrity in its teaching, research, and scholarship is
maintained and enhanced.
• Failure to uphold these principles of academic integrity threatens both the reputation of the
University and the value of the degrees awarded to its students. Every member of the
University community therefore bears a responsibility for ensuring that the highest
standards of academic integrity are upheld.
COMMUNICATION
Students should regularly access their Rutgers e-mail and/or the course website at
sakai.rutgers.edu. Important information will be disseminated to your Rutgers account (unless
you change your e-mail address through the Rutgers system) and will be posted on the Sakai
course website.
5 E-MAIL
E-mail is the best way to reach me (shellae.versey@rutgers.edu). If you have questions about
the class material, I am more than happy to help you. However, I do expect that you will first
make a concerted effort to find the answer yourself in the class or book material. Regardless of
the purpose, I am happy to correspond by e-mail within the following guidelines:
1. Please use an email account that lists your name as the sender. Include an
informative subject with the course name (i.e., "Health Disparities question") and
make sure your full name is included in the text of the e-mail.
2. I will only use your registered email address to send you email. It is your
responsibility to check this account for important course updates/announcements.
Saying, "I only check my G-mail account" is not an adequate excuse for missing
course announcements. If you send me email from another account, I will respond to
that account but will not send other email/class announcements to that address.
3. Please do not e-mail me with administrative questions that can be answered by
reviewing the syllabus. If it is a substantive question about class material, please first
look for the answer in the book and lecture notes. After that, I'm happy to help you.
4. Please do not email me less than 24 hours before exams or deadlines with last-minute
substantive questions about class material. Be sure to plan ahead and request help in
a timely manner, which I am happy to provide.
5. Allow 24-48 hours for a response. An immediate response is not likely; however, do
email again 48 hours after the initial email if I have not yet responded.
6 Semester At-a-Glance
LEC
DATE
1
1/23
2
1/30
3
2/6
4
2/13
5
2/20
6
2/27
7
8
3/6
3/13
3/20
3/27
9
4/3
10
4/10
11
4/17
12
4/24
13
5/1
TOPIC
Demographic Profile of the United States
Epidemiology of Health and Illness Among Whites and People of Color (POC) in
the U.S.
Conceptual and Historical Issues in the Study of Race, Ethnicity, and Health I 1
Conceptual and Historical Issues in the Study of Race, Ethnicity, and Health II
The Biology of Stress – Physical Health
Stress and Mental Health
Socioeconomic Status and Health I 2
Socioeconomic Status and Health II
Socioeconomic Status and Health III
History: Black Americans 3
Social Demography: Black Americans
Health Status: Black Americans I
Health Status: Black Americans II 4
MID-TERM*
SPRING RECESS
History: American Indians/Alaskan Natives
Social Demography: American Indians/Alaskan Natives
Health Status I: American Indians/Alaskan Natives5
Health Status I: American Indians/Alaskan Natives
Social Demography: Hispanics/Latinos
Health Status: Hispanics/Latinos I 6
Health Status: Hispanics/Latinos II
Social Demography: Asian Americans7
Health Status I: Asian Americans 8
Health Status II: Asian Americans
History and Social Demography:
Native Hawaiians and other Pacific Islands (NHoPI) 9
Health Status: Native Hawaiians and other Pacific Islands (NHoPI)
Structural Competency
FINAL EXAM –Friday, May 8th
1
Race: The Power of an Illusion – Part 1 (The Differences Between Us (60 min) Unnatural Causes – In Sickness and Wealth (56 min) 3
Race: The Power of an Illusion – The Story We Tell (57 min) 4
Unnatural Causes – When the Bough Breaks 5
Unnatural Causes – Bad Sugar (29 min) 6
Unnatural Causes – Becoming American (29 min) 7
Unnatural Causes – Place Matters (29 min) 8
A Village Called Versailles 9
Unnatural Causes – Collateral Damage 2
7 Lecture 1: Friday, January 23rd*
1.1 - Demographic Profile of the United States
1.2 - Epidemiology of Health and Illness Among
Whites and People of Color (POC) in the U.S.
Lecture Objective: This lecture is intended to provide students with an overview of population
change during the 20th century and projections for the 21stcentury. Patterns suggest that the U.S. will
become a “majority-minority” population by the middle of the 21stcentury. That is, racial/ethnic
minorities (“people of color”) will comprise a larger proportion of the U.S. population than Whites.
These changes will have important implications for U.S. society and culture, including health status
and healthcare.
As a class, we will also explore the nature and magnitude of race/ethnic disparities in health status in
the United States. Topics covered include: historical trends in life expectancy, the leading causes of
death by race, ethnicity and age, changes in the leading causes of death over time, and the mortality
crossover.
Required Reading:
1. The Demography of American Racial/Ethnic Minorities (LaVeist, Ch. 3)
2. The Epidemiological Profile of Racial/Ethnic Minority Populations (LaVeist, Ch. 4)
Lecture 2: Friday, January 30th
2.1 - Conceptual and Historical Issues in the Study of
Race, Ethnicity, and Health I
2.2 - Conceptual and Historical Issues in the Study of
Race, Ethnicity, and Health II
Objectives: What exactly is race? How does race impact health? We will examine conceptual
problems with “race” conceptually and discuss the difficulty with composing a racial classification
system that accurately and meaningfully describes human variation.
Required Reading:
1. Historical Aspects of Race and Ethnicity/Conceptual Issues in the Study of Race, Ethnicity,
and Health (LaVeist, Ch. 1-2)
2. U.S. Census Looking at Big Changes in How it Asks About Race and Ethnicity” (Pew
Research Center, 3/14/14)
v http://www.pewresearch.org/fact-tank/2014/03/14/u-s-census-looking-at-big-changes-inhow-it-asks-about-race-and-ethnicity/
3. Study: Stereotypes Drive Perceptions of Race (NPR, Shankar Vedantam, 2/1/14)
http://www.npr.org/blogs/codeswitch/2014/02/11/275087586/study-stereotypes-driveperceptions-of-race
In-Class Viewing:
Race: The Power of an Illusion – The Differences Between Us (60 min)
Lecture 3: Friday, February 6th
3.1 - Biology of Stress, Physical Health & the concept of “Under the Skin”
3.2 - Stress and Mental Health
8 Objectives: This lecture will explore the biological mechanisms by which stress is hypothesized to
get “under the skin” and impact health.
Required Readings:
1. Green, T. L., & Darity, W. A. (2010). Under the Skin: Using theories from biology and the
social sciences to explore the mechanisms behind the Black-White Health Gap. American
Journal of Public Health, 100 (Suppl 1), S36-40.
2. Status and Stress (New York Times Opinionator, Velasquez-Manoff, Moises, 7/27/13)
3. Like All Animals, We Need Stress. Just Not Too Much. (NPR, Renee Montagne, 7/9/14)
v http://www.npr.org/blogs/health/2014/07/09/325216030/like-all-animals-we-need-stressjust-not-too-much
4. This is Your Stressed-Out Brain on Scarcity (NPR, Laura Starecheski, 7/14/14)
v http://www.npr.org/blogs/health/2014/07/14/330434597/this-is-your-stressed-out-brainon-scarcity
Lecture 4: Friday, February 13th
4. 1 - Socioeconomic Status and Health I
4.2 - Socioeconomic Status and Health II
Objective: Socioeconomic status or class is often as cited as a major influencer of health. We will
review the evidence regarding the role of socioeconomic status in producing health disparities. We
will also explore the debate that presents race differences in health status as merely socioeconomic
status differences (e.g., African Americans and Hispanics generally are lower than Asians and whites
in socioeconomic status and also have worst health status).
Required Reading:
1. Socioeconomic Status and Racial/Ethnic Differences in Health (LaVeist, Ch. 8)
2. This is Why Poor People’s Bad Decisions Make Perfect Sense (Linda Tirado, Huffington
Post, 11/22/2013)
3. Reaching for a Healthier Life: Facts on Socioeconomic Status and Health in the U.S.
(MacArthur Foundation, 2008)
a. “Social Status Matters for Health, From Birth to Death” (pp. 4-12)
b. “Neighborhoods Matter” (pp. 16-18)
c. “Employment Conditions Matter” (pp. 19-22)
d. “Race Matters” (pp. 30-33)
e. “Stress Matters” (pp. 34-37)
f. “Our Bodies Pay the Price (pp. 38-41)
In-Class Viewing:
1. Unnatural Causes - In Sickness and Wealth (56 minutes)
9 Lecture 5: Friday, February 20th
5.1 - Socioeconomic Status and Health III
5.2 - History: Black Americans
Required Readings:
1. Policy Implications (pp. 42-48) in Reaching for a Healthier Life: Facts on Socioeconomic
Status and Health in the U.S. (MacArthur Foundation, 2008)
2. Executive Summary - Beyond Broke: Why Closing the Racial Wealth Gap is a Priority for
National Economic Security (Duke University & The Center for Global Policy Security,
2013)
3. African Americans (Chapter 7, pp. 168-207 in Racial and Ethnic Relations; Feagin and
Feagin, 2012, on Sakai)
In-Class Viewing:
1. Episode 2 of Race: The Power of an Illusion – The Story We Tell (57 min)
Lecture 6: Friday, February 27th
6.1 - Social Demography: Black Americans
6.2 - Health Status: Black Americans I
Required Readings:
1. African American Health Issues (LaVeist, Ch. 10)
2. King’s Dream Remains an Elusive Goal: Many Americans See Racial Disparities (Pew
Research Center, 2013)
3. The Unfinished March (Economic Policy Institute, 2013)
4. Geronimus, A. T. 2006. “Weathering and Age Patterns of Allostatic Load Scores Among
Blacks and Whites in the United States.” American Journal of Public Health 96:826-833.
Lecture 7: Friday, March 6th
Health Status: Blacks II
Required Readings:
1. Orsi, J. M., Margellos-Anast, H. & Whitman, S. (2010). Black-White Health Disparities in
the United States and Chicago: A 15-Year Progress Analysis. American Journal of Public
Health, 100, 349-356.
2. Read, J. G., Emerson, M. O., & Tarlov, A. (2005). Implications of Black Immigrant Health
for U.S. Racial Disparities in Health. Journal of Immigrant Health, 7(3): 205-212.
In-class viewing:
1. Unnatural Causes: When the Bough Breaks (29 min)
Friday, March 13th
MID-TERM
Friday, March 20th
NO – CLASS
SPRING RECESS
Lecture 8: Friday, March 27th
10 7.1 - History: American Indians/Alaska Natives
7.2 - Social Demography: American Indians/Alaska Natives
Required Reading:
1. American Indians: From Conquest to Tribal Survival in a Postindustrial Society (Chapter 5,
Diversity and Society: Race, Ethnicity, and Gender; Healy, on Sakai)
2. Mohatt, N. V., Thompson, A. B., Thai, N. D., & Tebes, J. K. (2014). Historical Trauma as
Public Narrative: A Conceptual Review of How History Impacts Present-Day Health. Social
Science & Medicine, 106: 128-136.
Lecture 9: Friday, April, 3rd
9.1 - Health Status: American Indians/Alaska Natives I
9.2 - Health Status: American Indians/Alaskan Natives II
Required Readings:
1. American Indian and Alaska Native Health Issues (LaVeist, Ch. 11)
2. Rhoades, E. R., & Rhoades, D. A. (2014). The Public Health Foundation of Health Services
for American Indians & Alaska Natives. American Journal of Public Health 104: S278S285.
3. Johnson, K. (2013). “Health Care is Spread Thin on Alaskan Frontier” (NY Times, 5/28/13)
4. Landen, M., Naimi, T., Nielsen, L., & Sewell, M. (2014). Alcohol-Attributable Mortality
Among American Indians and Alaska Natives in the United States, 1999-2009. American
Journal of Public Health 104: S434-S349.
5. Berman, M. (2014). Suicide Among Young Alaska Native Men: Community Risk Factors
and Alcohol Control. American Journal of Public Health, 104, S329-S335.
In-Class Viewing:
1. Unnatural Causes - Bad Sugar (29 minutes)
Lecture 10: Friday, April, 10th
10.1 - Social Demography: Hispanics/Latinos
10.2 - Health Status: Hispanics/Latinos I
Required Readings:
1. Who is Latino? (The Washington Post, Carlos Lozada, 6/21/14)
2. Seven Major Immigration Myths Debunked (Huffington Post, Vargas Llosa, 2013)
3. Immigration Myths and Facts: Behind the Fallacies (U.S. Chamber of Commerce)
In-Class Viewing:
1. Unnatural Causes - Becoming American (29 min)
Lecture 11: Friday, April 17th
11.1 - Health Status: Hispanics/Latinos II
11.2 - Social Demography: Asian Americans
Required Reading:
1. Vega, W. A., Rodriguez, M. A., & Gruskin, E. (2009). Health Disparities in the Latino
Population. Epidemiologic Reviews, 31, 99-112.
11 2. Hispanic/Latino Health Issues (LaVeist, Ch. 13)
3. The Health Toll of Immigration (New York Times, Sabrina Tavernese, 5/18/13)
4. Social, Demographic, and Cultural Characteristics of Asian Americans (Tseng, 2004)
In-Class Viewing:
1. Unnatural Causes – Place Matters (29 minutes)
Lecture 12: Friday, April 24th
12.1 - Health Status: Asian Americans I
12.2 - Health Status: Asian Americans II
Required Readings:
1. Toward a Contextual Understanding of Asian American Health (Islam, et al., 2004)
2. Asian and Pacific Islander Health Issues (LaVeist, Ch. 12)
3. Frisbie, W. P., Cho, Y., & Hummer, R. A. (2001). Immigration and the Health of Asian and
Pacific Islander Adults in the United States. American Journal of Epidemiology 153:372380.
In-Class Viewing:
1. A Village Called Versailles
Lecture 13: Friday, May 1st
13.1 - Social Demography: Native Hawaiians & Other Pacific Islanders
13.2 - Health Status: Native Hawaiians and Other Pacific Islanders
13.3 – What to do about disparities? Structural Competency
Required Reading:
1. Social, Demographic, and Cultural Characteristics of U.S. Pacific Islanders (Panapasa, 2004).
2. (Review) Frisbie, W. P., Cho, Y., & Hummer, R. A. (2001). Immigration and the Health of
Asian and Pacific Islander Adults in the United States. American Journal of Epidemiology
153:372-380.
3. Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical
engagement with stigma and inequality. Social Science & Medicine, 103, 126-133.
4. Metzl, J. M., & Roberts, D. E. (2014). Structural competency meets structural racism: Race,
politics, and the structure of medical knowledge. Virtual Mentor, 16(9), 674-690.
In-Class Viewing:
1. Unnatural Causes – Collateral Damage
FINAL EXAM: Friday, May 8th (11am - 1:00pm)
.
*
I reserve the right to make any necessary changes to the syllabus, including but not limited to changing dates, topics, assignments, and readings.
An effective instructor must continually adapt to the conditions of the class and in that spirit, I may choose to add or remove items as needed. I
will announce these changes on Sakai and provide ample time when changes are needed.
12