GLOBAL HEALTH AFFAIRS: THEORY AND PRACTICE INTS 4367 – AUTUMN 2010

CLASS THURSDAY 9-12, BCH 220

BLACKBOARD http://blackboard.du.edu/webapps/blackboard/execute/courseMain?course_id=_141328_1

INSTRUCTOR RANDALL KUHN / rkuhn@du.edu / 303.871.2061 / BCH 208D

OFFICE HOURS TUESDAY / THURSDAY 12-2 OR BY APPOINTMENT

Objectives and Overview

This course offers an entry point to the field of Global Health Affairs from a social science and

international relations perspective. Its main goal is to explore and apply theoretically-grounded

frameworks for understanding global health priorities, for designing local and national health

interventions, and for understanding the impact of health programs on a range of long- and

short-term outcomes. In the first half of the course we will explore the determinants and

impacts of health, working our way from the conceptual to the empirical, and from the macro to

the micro. In the second half, we will address a broad terrain of interventions, working our way

back up from the traditional disease control approach to more recent efforts in health systems,

security, trade reform, and governance.

Each of you must work individually and with the group to build and refine our own “theory of

change” for assessing and addressing health issues across a wide range of contexts. The ToC

approach emphasizes assumptions, and not merely the grand assumptions that give us the

audacity to pursue change in the first place. More important is mapping your programmatic

assumptions, the specific intermediate impacts that will be necessary for you to achieve your

goals. You will explore others' theory of change in case study discussions and build your own

by designing a service-based research proposal that could be carried out in the near future.

Grading

Research proposal (80%): You will propose, design, and justify a service-based research project

that you could actually undertake in the next year or so. It is hoped that this proposal will give

you a head start on your summer internship plans, a template for subsequent knowledge

acquisition, and an opportunity to undertake the kind of research that lies at the heart of true

change. Successful completion of the assignment will require the following

1) identify a specific program, project, or agency addressing a global health challenge

2) provide scientific background on significance, causes, and solutions to the challenge

3) describe geographic, social, political, or cultural context and assumptions of project

4) use background and context to synthesize uncertainties in project that require research

5) outline research questions and methods in as much detail as possible

6) identify clear goals for how the project could benefit global health science, the served

population, the service agency, your personal development, and your community at GSIS

2

We will talk about possible topics in Week 1, in class discussion, and in office hours. For ideas

on how to formulate your project, visit http://www.theoryofchange.org/.

You must schedule a half-hour appointment to talk about your project in the first two weeks.

Your progress will be monitored and your work evaluated throughout the quarter:

Two-page project summary/overview due on October 21 (15% of your grade)

Preliminary draft proposal due on November 11 (15% of your grade)

Final paper due November 22 at 5pm (50% of your grade)

Participation and Discussion Leader (20%): Each student must co-lead a case study discussion

and participate in class discussions, visiting lectures, etc. Case studies relate to specific, high-

profile interventions. Leaders will present a well-organized talk oriented around a “Theory of

Change” mapping exercise for the intervention in question. Talks should clearly address the

theoretical basis for the intervention, alternative approaches to the same issue, and ideological

or theoretical controversies surrounding the approach. They should relate to earlier course

readings. Leaders should frame a set of questions for further class discussion. Presentations will

be graded on relevance, substance, and creativity. They should last around 15 minutes.

I will track participation on the basis of class discussion and a small number of quick response

writing exercises. These will relate to basic facts of the case study and to its theory of change.

Speak to me in office hours or by email if you have any concerns about in-class discussion.

Course Materials

The one book we will use is our forthcoming Global Health Futures volume, a joint effort of the

Frederick S. Pardee Center for International Futures and Global Health Affairs.

Hughes, Barry B, Randall Kuhn, Cecilia Mosca Peterson, Dale S. Rothman, José Roberto

Solórzano. 2010. Patterns of Potential Human Progress Volume 3 – Improving Global Health.

Forthcoming, Paradigm Press and Oxford University Press.

Electronic readings are available through direct WWW links from the on-line syllabus (you

must be on the Virtual Private Network), through standard literature search, or from me. If you

bring your thumb drive to the first class I will give you a soft copy of every reading.

September 16: The Challenge of Global Health

Hughes et al. Chapter 1: Introduction, 1-8.

Benatar, Solomon R. 2005. Moral imagination: the missing component in global health. Public

Library of Science: Medicine 2: 1207-1210.

Garrett, Laurie. 2007. The Challenge of Global Health. Foreign Affairs 86(1): 14-38.

3

September 23: Concepts, Measurement, and Significance of Health

Hughes et al. Chapter 2: Understanding Health: Concepts, Relationships, and Dynamics, 9-16.

McMichael, Anthony J, Martin McKee, Vladimir Shkolnikov, Tapani Valkonen. 2004. Mortality

Trends and Setbacks: Global Convergence—or Divergence? Lancet 363: 1155-1159.

Elbe, Stefan. 2008. Our Epidemiological Footprint: The circulation of avian flu, SARS, and

HIV/AIDS in the world economy. Review of International Political Economy 15(1): 116-130.

Sen, Amartya. 1998. Mortality as an Indicator of Economic Success and Failure. The Economic

Journal 108(446): 1-25.

Braveman, Paula and Sofia Gruskin. 2001. Poverty, equity, human rights and Health. Bulletin of

the World Health Organization 81(7): 539-545.

If you are not familiar with basis health indicators you may want to look at World Health Report. 2006.

Annex Table 1: Basic Indicators for All Members States.

September 30: Broader Health Determinants and Trajectories

Hughes et al. Chapter 2: Understanding Health: Concepts, Relationships, and Dynamics, 16-28.

Kuhn, Randall. 2010. Routes to Low Mortality in Poor Countries Revisited. Manuscript.

Brundtland, Gro Harlem. 2004. “The Globalization of Health”. Whitehead Journal of Diplomacy

and International Relations 4(2): 7-12.

Farmer, Paul. 1996. Social Inequalities and Emerging Infectious Diseases. Emerging Infectious

Diseases 2(4): 259-269.

Further reading: Chapters 3 and 4 of Hughes, et al. for distal driver forecasts; Stephen Kunitz's 1987

Explanations and Ideologies of Mortality Patterns for philosophical basis of the diseases v. systems debate.

October 7: Proximate Determinants of Health

Black, Robert E, Saul S Morris, Jennifer Bryce. 2003. Where and why are 10 million children

dying every year? The Lancet 361(9376): 2226-2234.

Smith, Kirk R. 1995. Environmental Hazards During Economic Development: the Risk

Transition and Overlap. In E.G. Reichard & G.A. Zapponi, Assessing and Managing Health Risks

from Drinking Water Contamination, IAHS, Wallingford, UK, 3-13.

Mosley, W. Henry and Lincoln C. Chen. 1984. An Analytical Framework for the Study of Child

Survival in Developing Countries. Population and Development Review 10: 25-45.

ActKnowledge and Aspen Roundtable. Theory of Change. See www.theoryofchange.org. Read

all sub-sections under “Toc Background” and “ToC Process”.

Further reading: Chapters 5 and 6 of Hughes, et al. to see the proximate driver forecasts and impacts.

4

October 14: Health Impacts

Case Study #1: Matlab Project

Hughes et al., Chapter 7: Forward Linkages, 173-208.

Chen, Lincoln and Vasant Narasimhan. 2003. Human Security and Global Health. Journal of

Human Development 4(2): 181-190.

Youde, Jeremy. 2005. “Enter the Fourth Horseman: Health Security and International Relations

Theory”. Whitehead Journal of Diplomacy and International Relations 6(1): 193–208.

October 21: Economics and Cost-Effective Disease Prevention

Two-page project summary/overview due today

Case Study #2: Disease Eradication Campaigns

Filmer, Deon , Jeffrey S. Hammer, and Lant H. Pritchett. 2000. Weak Links in the Chain: A

Prescription for Health Policy in Poor Countries. World Bank Research Observer 17(1): 47–66.

Prabhat Jha, Anne Mills, Kara Hanson, et al.. 2002. Improving the Health of the Global Poor.

Science 295 (5562): 2036-2039.

October 28: From Diseases to Health Systems

Case Study #3: on Progresa and the Mexican Epidemiologic Transition

WHO. 2000. World Health Report 2000, Health systems: Performance Improvement. Chapter 1: Why

Do Health Systems Matter?, 1-19.

Mullan, Fitzhugh and Leon Epstein. 2002. Community-Oriented Primary Care: New Relevance

in a Changing World. American Journal of Public Health 92(11): 1748-1755.

Victora, Cesar G., Kara Hanson, Jennifer Bryce, and J Patrick Vaughan. 2004. Achieving

universal coverage with health interventions. The Lancet 364(9444): 1541-1548.

Farmer, Paul and Laurie Garrett. 2006. From "Marvelous Momentum" to Health Care for All:

Success Is Possible With the Right Programs. Foreign Affairs

If you are interested in reading more about the US health system, check out Krugman, Paul and Robin

Wells. 2006. The Health Care Crisis and What to do about it. New York Reviews of Books 53(5): 1-16.

November 4: Global Health Security and Biopolitics

Case Study #4: Partners in Health

Weiss, Robin A. and Anthony J. McMichael. 2004. Social and environmental risk factors in the

emergence of infectious diseases. Nature Medicine 10: S70–S76.

5

Fidler, David P. 2005. Health as Foreign Policy: Between Principle and Power. Whitehead Journal

of Diplomacy and International Relations 6(2): 179-194.

Shiffman, Jeremy. 2007. Has donor prioritization of HIV/AIDS displaced aid for other health

issues? Health Policy and Planning 23: 95-100.

Garfield, Richard. 2000. “The public health impact of sanctions: contrasting responses of Iraq

and Cuba”. Middle East Report 215: 16–19.

November 11: Health in the Global Economic System

Preliminary draft proposal due today

Case Study #5: The International Health Regulations

Bettcher, Douglas W., Derek Yach, and G. Emmanuel Guindon. 2000. Global trade and health:

key linkages and future challenges. Bulletin of the World Health Organization 78(4): 521-534.

The Economist. 2008. Operating Profit: Globalisation and Health Care. August 14, 2008.

Buse, Kent. 2004. Governing Public-Private Infectious Disease Partnerships. Brown Journal of

World Affairs 10(2): 225-242.

Marmot, Michael, Sharon Friel, Ruth Bell, Tanja AJ Houweling, Sebastian Taylor on behalf of

the Commission on Social Determinants of Health, Closing the gap in a generation: health

equity through action on the social determinants of health. The Lancet 372(9650): 1661-1669.

November 18: Global Health Governance and Diplomacy

Case Study #6: Global Framework Convention on Tobacco Control

Birn, Anne-Emanuelle. 2005. Gates's grandest challenge: transcending technology as public

health ideology. The Lancet 366(9484): 514-519.

Novotny, Thomas E., Ilona Kickbusch, et al. 2008. Global health diplomacy – a bridge to

innovative collaborative action. Global Forum Update on Research for Health Volume 5: Fostering

Innovation for Global Health: 41-45.

Beaglehole, Robert, Ruth Bonita, Richard Horton, Orvill Adams and Martin McKee. 2004. Public

health in the new era: improving health through collective action. Lancet 363(9426): 2084-2086.

Gostin, Lawrence O. 2007. Meeting the Survival Needs of the World's Least Healthy People: A

Proposed Model for Global Health Governance. JAMA 298: 225-228.

6

Case Studies

1) The Matlab Project

Bhatia, Shushum, W.H. Mosley, A.S.G. Faruque, J. Chakraborty. 1980. The Matlab Family

Planning Health Services Project. Studies in Family Planning 11(6): 202-212.

Simmons, Ruth, Marjorie A. Koblinsky, James F. Phillips. 1986. “Client Relations in South Asia:

Programmatic and Societal Determinants”. Studies in Family Planning 17(6): 257-268.

Simmons, George B., Deborah Balk, and Khodezatul K. Faiz. 1991. “Cost-Effectiveness Analysis

of Family Planning Programs in Rural Bangladesh: Evidence from Matlab”. Studies in Family

Planning 22(2): 83-101.

Caldwell, John C. and Pat Caldwell. 1992. “What Does the Matlab Fertility Experience Really

Show?”. Studies in Family Planning 23(5): 292-310.

Haaga, John G. and Rushikesh M. Maru. 1996. “The Effect of Operations Research on Program

Changes in Bangladesh”. Studies in Family Planning 27(2): 76-87.

Phillips, James F., Frank K. Nyonator, Tanya C. Jones, Shruti Ravikumar. 2007. Evidence-based

scaling up of health and family planning service innovations in Bangladesh and Ghana. In Ruth

Simmons, Peter Fajans, and Laura Ghiron, Scaling up health service delivery: from pilot innovations

to policies and programmes, Geneva: World Health Organization, 113-134.

2) Disease Eradication Campaigns

Henderson, Donald. 1998. Smallpox Eradication – A Cold War Victory. World Health Forum 19:

113-119.

Aylward, Bruce, Karen A. Hennessey, et al. 2000. When is a disease eradicable? 100 years of

lessons learned. American Journal of Public Health 90(10): 1515-1520.

Arita, Isao, Miyuki Nakane and Frank Fenner. 2006. Is Polio Eradication Realistic?. Science

312(5775): 852-854.

The Economist. Exterminate! Exterminate!. October 18, 2007.

Editorial Board. 2007. Is Malaria Eradication Possible. The Lancet 370(9597): 1459.

3) Progresa and the Mexican Epi Transition

Sepulveda, Jaime, Flavia Bustreo, et al. 2006. Improvement of child survival in Mexico: the

diagonal approach. The Lancet 368(9551): 2017-2027.

Frenk, Julio. 2006. Bridging the divide: global lessons from evidence-based health policy in

Mexico. The Lancet 368: 954-961.

7

Lagarde, Mylene, Andy Haines and Natasha Palmer. 2007. Conditional Cash Transfers for

Improving Uptake of Health Interventions in Low- and Middle-Income Countries: A Systematic

Review. Journal of the American Medical Association 298(16):1900-1910.

Carolina, Martinez S. and Leal F. Gustavo. “Epidemiological transition: Model or illusion? A

look at the problem of health in Mexico”. Social Science & Medicine 57(3): 539-550.

Molyneux, Maxine. 2006. Mothers at the Service of the New Poverty Agenda:

Progresa/Oportunidades, Mexico's Conditional Transfer Programme. Social Policy &

Administration 40(4): 425-449.

4) Partners in Health / Community-Based Health Delivery

Shin, Sonya, Jennifer Furin, et al. 2004. Community-based treatment of multidrug-resistant

tuberculosis in Lima, Peru: 7 years of experience. Social Science & Medicine 59(7): 1529-1539.

Walton, David A., Paul E. Farmer, et al. 2004. Integrated HIV Prevention and Care Strengthens

Primary Health Care: Lessons from Rural Haiti. Journal of Public Health Policy 25(2): 137-158.

Castro, Arachu and Paul Farmer. 2005. Understanding and Addressing AIDS-Related

Stigma:From Anthropological Theory to Clinical Practice in Haiti. American Journal of Public

Health 95:53-59.

Koenig, Serena P., Fernet Leandre, Paul Farmer. 2004. “Scaling-up HIV treatment programmes

in resource-limited settings: the rural Haiti experience”. AIDS 18(S3): S21-S25.

Farmer. Paul, et al. 2001. “Community-based approaches to HIV treatment in resource-poor

settings”. The Lancet 358(9279): 404-409.

Kidder, Tracy. 2010. Recovering from Disaster — Partners in Health and the Haitian

Earthquake. New England Journal of Medicine 362: 769-772.

5) International Health Regulations

Fidler, David P. and Lawrence O. Gostin. 2006. The New International Health Regulations: An

Historic Development for International Law and Public Health. The Journal of Law, Medicine &

Ethics 34(1): 85-94.

Plotkin, Bruce. 2007. Human Rights and Other Provisions in the Revised International Health

Regulations (2005). Public Health 121: 840-845.

Calain, Philippe. 2007. From the field side of the binoculars: a different view on global public

health surveillance. Health Policy and Planning. 22: 13-20.

Markel, Howard, Lawrence O. Gostin, and David P. Fidler. 2007. Extensively Drug-Resistant

Tuberculosis: An Isolation Order, Public Health Powers, and a Global Crisis. Journal of the

American Medical Association 298: 83-86.

8

6) Global Framework Convention on Tobacco Control

Novotny, T.E. and D. Carlin. 2005. Ethical and Legal Aspects of Tobacco Control. British Medical

Journal 14(Suppl II): ii26-ii30.

Shibuya, Kenji, Christina Ciecierski, Emmanuel Guindon, Douglas W Bettcher, David B Evans,

Christopher J L Murray. WHO Framework Convention on Tobacco Control: development of an

evidence based global public health treaty. British Medical Journal 327:154-157.

Taylor Allyn and Douglas Bettcher. 2000. WHO Framework Convention on Tobacco Control: a

global good for public health. Bulletin of the World Health Organization 78(7):920-929.

Mamudu, Hadii M., Ross Hammond, and Stanton Glantz. 2008. Tobacco industry attempts to

counter the World Bank report curbing the epidemic and obstruct the WHO framework

convention on tobacco control. Social Science & Medicine 67(11): 1690-1699.

The Economist. 2006. Less Mary Poppins: The World Health Organization needs to help sick

people, not be a nanny.