Sociology 335
Health and Inequality
Professor: Sharon Bzostek
Office: 041 Davison Hall
Office Hours: TBA
Email: sbzostek@sociology.rutgers.edu
Course Website: TBA
Course Overview
This course is designed to provide students with an introduction to the study of the social
determinants of health. This semester, we will examine how health disparities are defined and
measured and explore issues such as how the structure of society affects who gets sick and who gets
care when they are sick. Although most of the course will focus on health disparities and
surrounding issues in the United States, we will also spend time discussing global health disparities
and policy efforts to eliminate such disparities.
Intended to be far more than a simple lecture course, this class will provide students will numerous
opportunities to deeply engage with the course material through response memos, small group
discussions, conversations with panels of experts on course topics, and an independent (group)
research project about the effects of neighborhoods and geographic space on health disparities.
Course Goals and Objectives
Upon successful completion of this course, students should be able to: 1) define health disparities,
and provide specific examples of current health disparities, both within the United States and
globally; 2) discuss the mechanisms through which social determinants of health may affect
individuals’ health status and health care; 3) describe ethical issues and debates that arise in the
study of health disparities; and 4) intelligently discuss the issue of health care provision and health
care reform in the United States context, with a particular focus on serving disadvantaged
populations.
Required Books
Berkman, Lisa and Ichiro Kawachi, eds. Social Epidemiology. 2000. NY: Oxford University
Press. ISBN: 978-0-19-508331-6 (Note – denoted by B&K in the syllabus).
Skloot, Rebecca. The Immortal Life of Henrietta Lacks. 2010. NY: Random House, Inc. ISBN13: 978-1400052189
The required books are available for purchase at the campus bookstore. All readings on the syllabus
except for these books will be available on Sakai.
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Course Requirements
Course grades will be determined by: 1) three original response memos of 3-4 pages each on
assigned course topics; 2) participation in three small group discussions based on response
memos; 3) one group project; 4) an in-class presentation based on the group project; and 5) class
attendance and participation.
Grade Allocation
Response memos
Small group discussions
Group project
In-class group presentation
Attendance and participation
Total
30%
15%
25%
10%
20%
100%
Grades (in accordance with Rutgers’ lettered grading system)
A
90-100
B+
86-89
B
80-85
C+
76-79
C
70-75
D
61-69
F
60 or below
Attendance and Participation
Students will be expected to regularly attend and participate in the class. Even the class periods
not devoted specifically to group discussions and activities will involve student participation and
interaction. This means that student attendance and participation is an essential, and expected,
component of the course.
Course Readings
It is essential that students complete all of the assigned course readings. Assigned readings
should be completed before class on the day the readings are listed. Students are encouraged to
look ahead in the syllabus and plan their time accordingly, since some days’ reading loads are
heavier than others.
Response Memos
Students will write three original response memos over the course of the semester. These memos
will serve as the basis for the three small group discussions during the semester (see below). In
the memos, students will respond to a prompt or question provided by the professor. The topics
for the three memos will be: 1) racial/ethnic health disparities and medical ethics; 2)
immigration-related health disparities and surrounding issues; and 3) health care for the poor and
underserved.
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Small Group Discussions
At the beginning of the semester, students will be divided into groups of three. These groups will
serve as the students’ small groups for the three class periods devoted to small group discussions.
Prior to each of these discussions, each student will submit an original response memo to the
professor and their group members. Students will be expected to read each others’ memos prior
to the discussion period, and will take turns being the group discussion leader. Grades for the
small group discussions will be based on both peers’ and the professor’s evaluation of each
student’s participation in the discussions.
Experts Panels
Over the course of the semester, we will have three panels of experts join us to discuss their
knowledge and expertise in relevant fields. Speakers will include prominent researchers, policy
experts, and health care practitioners. These panels will offer students an unusual opportunity to
pose questions and discuss course topics with experts in the field. Students will be required (as
part of their participation grade) to submit relevant questions for the speakers prior to the panels.
Group Project/Presentation
In teams of 4-5, students will assess two local neighborhoods – one of higher socioeconomic
status and one of lower socioeconomic status. Students will conduct observations and take
photographs of conditions in neighborhoods that impact health. Students will also utilize
secondary data sources (e.g., Census and environmental data) online to put together a
comprehensive portrait of each neighborhood. Each team will prepare a ten-minute presentation
for the class with their conclusions. More detailed instructions for the project and presentations
will be handed out in class.
Class Conduct and Ground Rules
The Department of Sociology encourages the free exchange of ideas in a safe, supportive, and
productive classroom environment. To facilitate such an environment, students and faculty must
act with mutual respect and common courtesy. Thus, behavior that distracts students and faculty
is not acceptable. Such behavior includes cell phone use, surfing the internet, checking email,
text messaging, listening to music, reading newspapers, leaving and returning, leaving early
without permission, arriving late, discourteous remarks, and other behaviors specified by
individual instructors. Courteous expression of disagreement with the ideas of the instructor or
fellow students is, of course, permitted and encouraged.
Academic Integrity
I follow the Rutgers University’s policy on academic integrity, and you can familiarize yourself with
this policy at this website: http://academicintegrity.rutgers.edu/academic-integrity-at-rutgers.
Cheating and plagiarism will not be tolerated, and I am obligated to report such conduct and
violations of this policy to the Undergraduate Director of the Sociology Department and the Dean of
your college.
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Students with Disabilities
Students with disabilities requesting accommodations must follow the procedures outlined at
http://disabilityservices.rutgers.edu/request.html. Full disability policies and procedures are
available at http://disabilityservices.rutgers.edu/.
Tentative Course Schedule & Assigned Readings
(subject to modification with advance notice)
Class 1
Introduction and Course Overview
Class 2
What is “Health?” What is “Disease?”
Readings:
1) B&K, pp. 3-12. “A Historical Framework for Social Epidemiology.”
2) Barker, 2010, “The Social Construction of Illness: Medicalization and
Contested Illness.”
3) Aronowitz, 2004, “When Do Symptoms Become a Disease?”
Class 3
Health Disparities Theory
Readings:
1) Link and Phelan1995, “Social conditions as fundamental causes of disease.”
2) Phelan, Link, and Tehranifar, 2010, “Social Conditions and Fundamental
Causes of Health Inequalities: Theory, Evidence, and Policy Implications.”
Class 4
Health Disparities Measurement
Readings:
1) Carter-Pokras & Baquet, 2002, “What is a ‘health disparity?’”
2) Kawachi, Subramanian, & Almeida-Filho, 2002, “A Glossary for Health
Inequalities.”
Class 5
Gender and Health Disparities
Readings:
1) Read & Gorman, 2010, “Gender and Health Inequality.”
2) Rieker, Bird, & Lang, 2010, “Understanding Gender and Health: Old Patterns,
New Trends, and Future Directions.”
3) Springer, Stellman, and Jordan-Young, 2012. “Beyond a Catalogue of
Differences: A Theoretical Frame and Good Practice Guidelines for
Researching Sex/Gender in Human Health.”
4) Umberson et al., 2006, “You Make Me Sick: Marital Quality and Health Over
the Life Course.”
Class 6
Social Relationships and Health Disparities
Readings:
1) Lovasi, Adams, & Bearman, 2010, “Social Support, Sex, and Food: Social
Networks and Health.”
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2) B&K, Chapter 7, “Social Integration, Social Networks, Social Support, and
Health.”
3) Umberson & Montez, 2010, “Social Relationships and Health: A Flashpoint
for Health Policy.”
Class 7
Experts Panel 1: Role of Gender and Social Support in Health Disparities
Class 8
Socioeconomic Status and Health Disparities, Part I
Readings:
1) B&K, Ch. 2, “Socioeconomic Position and Health.”
2) B&K, Ch. 4, “Income Inequality and Health.”
3) House, 2002, “Understanding Social Factors and Inequalities in Health: 20th
Century Progress and 21st Century Prospects.”
Class 9
Socioeconomic Status and Health Disparities, Part II
Readings:
1) Ross & Mirowsky, 2010, “Why Education is the Key to Socioeconomic
Differentials in Health.”
2) Lantz et al., 2001, “Socioeconomic Disparities in Health Change in a
Longitudinal Study of US Adults: The Role of Health Risk Behaviors.”
3) Pampel, Krueger, & Denney, 2010, “Socioeconomic Disparities in Health
Behaviors.”
4) Lutfey and Freese, 2005, “Toward Some Fundamentals of Fundamental
Causality: Socioeconomic Status and Health in the Routine Clinic Visit for
Diabetes.”
Class 10
Stress and Health Disparities
Readings:
1) B&K, Chapter 5, “Working Conditions and Health.”
2) Thoits, 2010, “Stress and Health: Major Findings and Policy Implications.”
3) Dowd, Simanek, & Aiello, 2009, “SES, Cortisol, and Allostatic Load: A
Review of the Literature.”
4) Almeida, Neupert, Banks, Serido, 2005, “Do Daily Stress Processes Account
for Socioeconomic Health Disparities?”
Class 11
Racial/Ethnic Health Disparities, Part I
Readings:
1) Hummer & Chinn, 2011, “Race/Ethnicity and U.S. Adult Mortality.”
2) Williams & Collins, 1995, “U.S. Socioeconomic and Racial Differences in
Health: Patterns and Explanations.”
3) Williams & Sternthal, 2010, “Understanding Racial-ethnic Disparities in
Health: Sociological Contributions.”
Class 12
Racial/Ethnic Health Disparities, Part II
Readings:
1) B&K, Ch. 3, “Discrimination and Health.”
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2) Geronimus et al., 2006, “’Weathering’ and Age Patterns of Allostatic Load
Scores among Blacks and Whites in the U.S.”
3) Williams, 1999, “Race, SES, and health: the added effects of racism and
discrimination.”
4) Carr et al., 2010, “How Much Time Do Americans Spend
Seeking Health Care? Racial and Ethnic Differences in Patient Experiences.”
Class 13
Racial/Ethnic Disparities and Medical Ethics
Readings:
1) Gamble, 1997, “Under the Shadow of Tuskegee: African-Americans and
Health Care.”
2) The Immortal Life of Henrietta Lacks, first half
Class 14
Small Group Discussions 1
Readings:
1) The Immortal Life of Henrietta Lacks, second half
Class 15
Neighborhoods, Communities and Health Disparities
Readings:
1) B&K, Chapter 14, “Ecological Approaches: Rediscovering the Role of the
Physical and Social Environment.”
2) Robert, Cagney, & Weden, 2010, “A Life-Course Approach to the Study of
Neighborhoods and Health.”
3) Boardman, Saint Onge, Rogers, & Denney, 2005, “Race Differentials in
Obesity: The Impact of Place.”
4) Kimbro, Brooks-Gunn, McLanahan, 2011, “Young Children in Urban Areas:
Links Among Neighborhood Characteristics, Weight Status, Outdoor Play,
and Television Watching.”
Class 16
Group Project Presentations
Class 17
Immigration and Health Disparities, Part I
Readings:
1) Cho, Frisbie, Hummer, & Rogers, 2004, “Nativity, Duration of Residence,
and the Health of Hispanic Adults in the U.S.”
2) Akresh & Frank, 2008, “Health Selection Among New Immigrants.”
Class 18
Immigration and Health Disparities, Part II
Readings:
1) Kimbro, 2009, “Acculturation in Context: Gender, Age at Migration,
Neighborhood Ethnicity, and Health Behaviors.”
2) Dubowitz, Bates, and Acevedo-Garcia, 2010, “The Latino Health Paradox:
Looking at the Intersection of Sociology and Health.”
3) Palloni & Arias, 2004, “Paradox Lost: Explaining the Hispanic Adult
Mortality Advantage.”
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Class 19
Small Group Discussions 2
Class 20
Global Health Disparities
Readings:
1) World Health Organization 2013. "World Health Statistics 2012." Summary
Report.
2) Casas-Zamora & Ibrahim, 2004. "Confronting Health Inequity: The Global
Dimension."
3) Social Science and Medicine Editors, 2002. “International Health in the 21st
Century: Trends and Challenges.”
Class 21
Global Health Disparities and Medical/Research Ethics
Readings:
1) Ruger, 2006. "Ethics and governance of global health inequalities."
2) Benatar, 2002. “Reflections and Recommendations on Research Ethics in
Developing Countries.”
3) Pang, 2002. “Commentary on ‘Reflections and Recommendations on
Research Ethics in Developing Countries’ by S.R. Benatar.”
Class 22
Experts Panel 2: Global Health Disparities and Medical/Research Ethics
Class 23
Public Policies to Address Social Disparities in Health
Readings:
1) B&K, Ch. 16, “Health and Social Policy.”
2) Braveman et al., 2011, “When Do We Know Enough to Recommend Action
on the Social Determinants of Health?”
3) Woolf & Braveman, 2011, “Where Health Disparities Begin: The Role of
Social and Economic Determinants – and Why Current Policies May Make
Matters Worse.”
4) Marmot et al., 2008, “Closing the Gap in a Generation: Health Equity
Through Action on the Social Determinants of Health.”
Class 24
Health Care for the Underserved in the United States
1) Kaiser Family Foundation, 2008, “The Uninsured, A Primer.”
2) Swartz, 2009, “Health Care for the Poor: For Whom, What Care, and Whose
Responsibility?”
3) Kolata, 2011, “First Study of its Kind Shows Benefits of Providing Medical
Insurance to Poor.” NYT.
4) Porter, 2013, “Health Care and Profits, a Poor Mix.” NYT.
Class 25
Health Care Reform in the United States
1) Buettgens et al., 2010, “Americans Under the Affordable Care Act.”
2) Oberlander, 2010, “Long Time Coming: Why Health Reform Finally Passed.”
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3) Cutler, 2010, “How Health Care Reform Must Bend the Cost Curve.”
4) Kaiser Family Foundation, 2012, "A Guide to the Supreme Court’s
Affordable Care Act Decision."
Class 26
Experts Panel 3: Medical Professionals' Perspectives on Caring for
Underserved Populations
Class 27
Small Group Discussion 3
Class 28
Course Wrap-Up and Conclusion
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