NEW YORK UNIVERSITY
ROBERT F. WAGNER GRADUATE SCHOOL OF PUBLIC SERVICE
P11. 0030.001:
Fall, 2009
Prof. Victor Rodwin
Graders:
MEDICAL CARE AND HEALTH: COMPARATIVE
PERSPECTIVES
Tuesdays: 11:00-1:45p.m.Waverly 567
Office: Puck Bldg, 295 Lafayette St., #3006
212-998-7459, victor.rodwin@nyu.edu
Carrie Wood: clw326@nyu.edu
Julie Shahroudi: jls671@nyu.edu
Course description:
This course introduces undergraduates to the complex interplay of social factors
that affect population health in any society. It focuses on the social determinants and
distribution of health and disease across geographic areas, the organization and financing
of the health care system, and the relationship of one to the other. The course may be
thought of as consisting of the two parts summarized below.
In the first part, before the mid-term exercise, we will consider divergent
perspectives for thinking about health and society. We begin by comparing clinical and
public health perspectives on health and illness, reviewing alternative definitions of these
concepts, tools for their assessment, and the contributions of social and economic theory,
as well as health services research, to the study of health and society. For example, we
will examine key studies on health and health care among geographic areas and socioeconomic groups in society. We will also consider how these perspectives were
influenced by the evolution of public health, medicine and the health care system over the
course of the past century.
In the second part, we will draw on these perspectives to study the health care
system in the United States, how it compares to that of other nations and how population
aging, urbanization and globalization are raising new challenges for health and society,
worldwide. We begin by studying alternative approaches to health care financing and
organization and analyzing the U.S. health care system in this context. Next, we consider
how increases in human longevity and population aging will affect the organization and
financing of health and social services. Also, we consider two emerging areas of study
related to health and society: “urban health” and “global health.” Finally, we consider
issues of health care reform in the United States in light of the experience of other
wealthy nations abroad, which have developed systems of universal health care coverage.
Required books:
There are three required books: a collection of journal articles edited by
Harrington and Estes; a new book of essays on clinical approaches to disease
(Groopman); and a popular comparative analysis of the practice of medicine in the
United States, Great Britain, France and Germany (Payer). In addition, special readings
2
are posted on blackboard. The following books are available at NYU’s Bookstore located
at 18 Washington Place.




Harrington, C. and Estes, C. eds., Health Policy: Crisis and Reform in the U.S.
Health Care Delivery System. (5th Edition). Boston: Jones and Bartlett, 2004.
Groopman, J. How Doctors Think. New York: Houghton Mifflin, 2007.
Payer, L. Medicine and Culture: Varieties of Treatment in the United States,
England, West Germany and France. New York, Henry Holt and Co.1988.
Nuland, Sherwin B. How We Die: Reflections on Life’s Final Chapter. New
York: Alfred A. Knopf (1994).
In addition to these books, there are other required readings posted on blackboard,
which you may access through the internet at NYUhome. I shall also provide interested
students with a bibliography of optional readings.
Course format, requirements and grading:
This class will meet once a week for almost 3 hours. During the first class, we
will meet together for the full period and divide into two groups. Beginning with the
second class, we will all meet together for the first hour, during which I shall lecture and
organize some formal discussion and debate. After this introduction to each topic, we will
break for 10 minutes. Next, my “graders” (teaching colleagues) will conduct group
discussions. Finally, I shall meet with the whole group to answer questions and continue
our discussions.
All students must come to class having completed all of the required readings.
Students must complete three written exercises: 1-2 page essays about the readings
assigned to them by their group leader. These essays will be graded by the group leaders.
In addition, there will be a mid-term exercise and a final examination (essay questions)
based on the assigned readings.
The three assignments for group leaders will count for 40% of the grade; the
midterm for 20%; the final for 30%; and 10% for the quality of class participation.
Course Outline and Required Readings
I. INTRODUCTION
1. Health and Society: Overview
September 8
Blackboard:
Schroeder, S., “We Can Do Better—Improving the Health of the American
People,” New England Journal of Medicine, September 20, 2007; 357:1221-8.
McKinlay, J. and McKinlay, S., “The Questionable Contribution of Medical
Measures to the Decline of Mortality in the Twentieth Century,” Health and
Society, Summer 1977:405-428.
3
II. DIVERGENT PERSPECTIVES FOR THINKING ABOUT HEALTH AND
SOCIETY
2. Clinical Perspectives
September 15
Groopman, J. How Doctors Think. New York: Houghton Mifflin, 2007.
Blackboard:
Campo, R., “Just the facts,” NEJM, September 16, 2004; 351:12.
3. Epidemiologic and Public Health Perspectives
September 22
Blackboard:
Mokdad, A. et. al., “Actual Causes of Death in the U.S. 2000,” JAMA, March 10,
2004;291:10.
Marmot, M., “Status Syndrome: A Challenge to Medicine,” JAMA, March 15,
2006;295:11.
Rodwin, V. and Croce-Galis, M., “Population Health in Utah and Nevada: An
Update on Victor Fuchs’ Tale of Two States,” The Sociology of Health & Illness:
Critical Perspectives, 7th Ed. Brandeis University, Worth Publishers, 2004.
Smith, J., Marmot, M., Oldfield, Z. “Disease and Disadvantage in the United
States and England,” JAMA (295), 2006.
Chiasson, M. & Jonas, S., “Measuring Health Status.”
Frumkin, H., “Urban sprawl and public health,” Public Health Reports.
“Social Determinants of Health: The Solid Facts,” The World Health
Organization. (optional)
4. Socio-Cultural Perspectives
Payer, L. Medicine and Culture
September 29
Health Policy
Fiscella, K. and Williams, D. Health Disparities Based on Socio-Economic
Inequalities. Pp. 49-60
Sarto, G. The Gender Gap. Pp. 70-75.
Blackboard:
Zola, I. Medicine as an Institution of Social Control. Ch. 38. In Conrad, P. The Sociology
of Health and Illness: Critical Perspectives
5. Health Services Research Perspectives: Urban Health
October 6
Blackboard:
Horton, R., “The infected metropolis,” Lancet.
Wennberg, J., “Variations among regions and hospitals in managing chronic
illness: how much care is enough?” Policy Brief, Syracuse University (No. 34,
2006) -- http://www-cpr.maxwell.syr.edu
4
Wennberg, J, et. al., “Hospital Use and Mortality Among Medicare Beneficiaries
in Boston and New Haven,” NEJM, October 26, 1989; 321:17.
Wennberg, J., Freeman, J., & Culp, W., “Are Hospital Services Rationed in New
Haven or Over-Utilized in Boston?” The Lancet, May 23, 1987.
6. Economic Perspectives
October 13
Guest Lecturer: Karen Grepin, Assistant Professor, health economics, Wagner/NYU
Blackboard:
Hsiao, WC. (1995) "Abnormal economics in the health sector" Health Policy 32:
125-139.
Ellis, RP, McGuire, TG. (1993) "Supply-Side and Demand-Side Cost Sharing in
Health Care" Journal of Economic Perspectives 7(4): 35-151.
Health Policy (optional):
Max, W. “Economic Analysis in Health Care.”pp.260-270;
Bodenheimer, T. High and Rising Health Care Costs. Pp. 256-280.
HEALTH CARE, HEALTH SYSTEMS AND HEALTH
7. The U.S. Health Care System in International Perspective
Health Policy:
Ch 3, pp 83-112; Ch. 9, pp. 281-307; Ch. 11, pp.370-404.
October 20
Blackboard:
Thorpe, K, “Protecting the Uninsured,” NEJM.
Brown, Lawrence, “The Amazing Noncollapsing U.S. Health Care System—Is
Reform Finally at Hand?” NEJM, January 24, 2008; 358:4.
8. The Rise, Fall and Significance of Managed Care in the U.S.
Health Policy:
Ch. 10
October 27
Blackboard:
Robinson, J. The End of Managed Care, JAMA. 2001:285 pp. 2622-2628.
Mechanic, D. The Rise and Fall of Managed Care. J. of Health and Social
Behavior. 2004 (45)
9. Comparative Analysis and Performance of Health Care Systems
November 3
Health Policy:
Commonwealth Fund: “Why Not the Best? Results from a National Scorecard on
U.S. Health System Performance.” pp. 42-48.
Blackboard:
Schoen, Davis, How, & Schoenbaum, “U.S. Health System Performance: A
National Scorecard,” Health Affairs.
5
Goodman, Musgrave and Herrick. Lives at Risk: Single Payer National Health
Insurance Around the World. New York: Rowman and Littlefield, 2004.Ch. 2
and 4.
10. Global Health
November 10
Health Policy:
Lurie, N. “The Public Health Infrastructure. Rebuild or Redesign?” pp. 184-187;
Navarro, V. “Health and Equity in the World in the Era of ‘Globalization,’” pp.
372-380.
Blackboard:
Beck. D. “Health, Wealth and the Chinese Oedipus,” Society.
Garrett, L. “The Collapse of Global Public Health and Why It Matters to New
York,” J. of Urban Health; June 2001. Blackboard.
Garrett, L. “The challenge of global health,” Foreign Affairs; Jan/Feb 2007.
Farmer, P. and Garrett, L., “From ‘Marvelous Momentum’ to Health Care for
All,” Foreign Affairs; March/April 2007.
Harris and Keil, “Global cities and the spread of infectious disease,” Urban
Studies.
11. The Role and Impact of Patients on Health Care
November 17
Nuland, Sherwin B. How We Die: Reflections on Life’s Final Chapter
Blackboard:
Pitts, V. Illness and the Internet: Writing and Reading Breast Cancer in
Cyberspace
12. Forces of Change: Aging and Chronic Illness
Health Policy:
Ch. 4
November 24
Blackboard:
Hayfleck, L. and Moody, H., “Has anyone ever died of old age?” International
Longevity Center.
Shoven, J., “New Age Thinking: The aging of the world’s population won’t be the
crisis we fear.,” Foreign Policy, Jan/Feb 2008.
Gawande, A. “The Way We Age.” The New Yorker. April 30, 2007.
13. Patient Safety and Quality Assurance
Health Policy:
Ch. 7
December 1
Blackboard:
Gawande, A. The Bell Curve. New Yorker,Dec 6, 2004. Vol. 80, Issue 38.
6
14. Health Care Reform for the U.S.
Health Policy:
Ch 12, pp. 381-410
December 8
Blackboard:
Krugman and Wells, “The health care crisis and what to do about it?,” New York
Rev of Books.
More readings will be posted