Societies of the World 24: Global Health Challenges: Complexities of Evidence-based Policy Spring 2010, Harvard Hall 104 Monday and Wednesday, 10:00-11:00 a.m., with a weekly section

Instructor Sue J. Goldie, MD, MPH Roger Irving Lee Professor of Public Health Department of Health Policy and Management Director of the Center for Health Decision Science Harvard School of Public Health Email: [email protected]

Head Teaching Fellow: Ankur Pandya, [email protected]

Section Leaders Ankur Pandya, [email protected], Office hours: TBA Paula Chu, [email protected], Office hours: TBA Toby Anekwe, [email protected], Office hours: TBA Laura Faden, [email protected], Office hours: TBA Victoria Fan, [email protected], Office hours: TBA Natalie Carvalho, [email protected], Office hours: TBA Adriane Gelpi, [email protected], Office hours: TBA Sae Takada, [email protected], Office hours: TBA

Course Description This foundation course will introduce you to the principal health problems of different populations, ranging from their physiological basis to their epidemiological context. The course emphasizes the methods for measuring population health; the analytic tools necessary for decision making; and the evidence base for the effectiveness, risks, and costs of interventions, ranging from individual health services to population-based instruments of policy. You will learn about challenges posed by (1) an unfinished agenda of infections, malnutrition, maternal-child health problems, (2) emerging challenges of non-communicable diseases and injuries, and (3) emerging health risks that transcend national boundaries. You will examine patterns of global morbidity and mortality, identify social determinants of health inequalities; and study the organized social response to these challenges structured through communities, national health systems, international consortia and alliances. Particular attention will be paid to the challenges and responsibility to provide health services to the most vulnerable, including populations of failed or fragile states, refugees, and victims of humanitarian crises. Through case studies and comparative exercises you will confront ethical challenges associated with priority setting, learn how real world policy is critically influenced by cultural norms, systemic factors, health system capacity, and the economic, social and political climate, and consider the complex process of how knowledge is translated to evidence-based policy.

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General Education Curriculum This course is approved to count for "Societies of the World" or "Empirical and Mathematical Reasoning" in the General Educational Curriculum. There are no prerequisites. Required Textbooks

(1) Levine R. Case Studies in Global Health. Millions Saved. Series Editor. Richard Riegelman (2007) Jones and Bartlett Publishers; (2) Skolnik Richard. Essentials of Global Health. Series Editor. Richard Riegelman. (2008) Jones and Bartlett Publishers.

You are welcome to share textbooks. The material in Essentials of Global Health will be supplemented substantially by assigned readings and short multimedia assignments. Most assigned readings are short and many are just a few pages. Course Website

http://isites.harvard.edu/k67417 Lecture notes will be posted before each class. Problem sets, problem set solutions, some readings, and other handouts will be available on the website. Research Guide and Supplemental Resources

A Research Guide will be unveiled in the second week of class. It has been developed to help you navigate the wide range of resources available to learn about global health. Ranging from key data sources to influential policy documents to the "state of the art" peer-reviewed papers on specific health conditions, the guide has been designed to support different course assignments. Most importantly, it provides a mechanism for you to explore beyond what we will be able to cover in class. Similarly, Supplementary Resources are provided for every class. These are NOT required. The purpose of providing these carefully chosen websites, reports, and articles is to accommodate students with a wide range of backgrounds, prior knowledge of global health (e.g., previous courses), and interests, and to facilitate engagement in self-directed learning. Occasionally, you will draw on these resources in sections to explore an issue in depth as well as to practice ‘scanning material” for main points. Writing Guide

During this course you will be developing the skills required to write a policy brief about a global health problem. Despite it being just 2-3 pages, a policy brief can be deceptively challenging to write. A writing guide for this course has been designed to help you with three short writing assignments. The first two assignments are intended to familiarize you with different components of a policy brief. The third assignment, writing a 3-page policy brief, will serve as your final exam. We will provide the writing guide to you in the third week of class.

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Curriculum Overview         

Lectures twice per week – didactic material, case studies, current events Required readings (every session) Problem sets (on average, one per week) Multimedia assignments, e.g., short videos, computer-based data visuals Required sections (one per week) Writing assignments (two 1-2 page assignments in the second half of the course) Supplemental resources (not required reading, intended only as reference material) Midterm exam (in class, March 10) Final exam (take home written assignment – 3 page policy brief)

Curriculum Description

The course will follow a standard twice-weekly lecture and once-weekly section format. Whenever possible we will apply basic concepts and principles learned in class to the analysis of pressing global health problems in the news. Sections will be size restricted to allow for adequate discussion in a more intimate setting than the main lectures. Some sections will focus on analytics and quantitative methods and others will involve discussion about case studies and current events. Students will have assigned readings for every class, weekly problem sets, and assignments to prepare for weekly section. There will be an in class midterm exam. The final exam will consist of a three-page written assignment. Details about the final exam will be provided in the third week of class. Weekly Section. Mandatory sections will meet each week for 1 hour. Students will use electronic sectioning to select section times in the beginning of the semester. Sectioning will open on Thursday, Jan 28th at 5PM and close on Thursday, Feb 4th at 5PM. Section assignments will be emailed on or before Monday, Feb 8th and the first section will be held that week.

Grading. Grades will be based on lecture and section participation (15 percent), problem sets and written assignments (25 percent), midterm (30 percent), final exam writing assignment (30 percent). Problem sets will be available online one week before they are due. Problem set solutions will be posted just after they are due. Late assignments will not be accepted. In exchange for this, the lowest problem set grade will be dropped from the final grade calculation.

Questions. If you have questions regarding the timing of assignments, email the Head TF, [email protected]. If you have questions about the grading of an assignment, you should submit your question in writing to the Head TF, [email protected]. If you need special accommodations, you must bring your TF a copy of the letter from the Accessible Education Office: http://www.fas.harvard.edu/~aeo/ Collaboration. You are allowed to work with others on assignments and problem sets (unless otherwise specified), but you must write up the work yourself. Please indicate on your problem set who you worked with, and follow all rules about citing, etc.

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Class Schedule Monday

Session 1

January 25

Introduction to Global Health

Wednesday

Session 2

January 27

Vital Statistics and Health Indicators

Monday

Session 5

February 8

Health, Education, Poverty and Economics

Monday

Wednesday Wednesday Monday

Wednesday Monday

Wednesday Monday

Wednesday Monday

Wednesday Monday

Wednesday

Session 3 Session 4 Session 6 Session 7 Session 8 Session 9

Session 10 Session 11 Session 12 Session 13 Session 14

February 1 February 3

Global Burden of Disease and Risk Factors Inequalities and Determinants

February 10 Case Study and Review of Metrics and Measures February 15 No Class/President’s Day

February 17 Unfinished Agenda: Child Health

February 22 Public Health Failure: Maternal Mortality

February 24 Global Spectrum of HIV/AIDS/Tuberculosis March 1

Communicable Challenges: Malaria and ARI

March 10

March 15

Spring Break

March 17

Midterm Exam (in class)

Spring Break

March 3 March 8

Case Studies: Vaccine Preventable Diseases MDGs and Gender Differentials in Health

Monday

Session 15

March 22

Case Studies in Neglected Diseases

Wednesday

Session 18

March 31

Double Burden: Non-Communicable Diseases II

Wednesday Monday Monday

Wednesday Monday

Wednesday Monday

Wednesday Monday

Wednesday

Session 16 Session 17 Session 19 Session 20 Session 21 Session 22 Session 23 Session 24 Session 25 Session 26

March 24 March 29 April 5 April 7

April 12 April 14 April 19 April 21 April 26 April 28

Malnutrition and Micronutrient Deficiencies

Double Burden: Non-Communicable Diseases I Environment and Health: Key Intersections Humanitarian/Complex Emergencies

Burden of Disability/Unintentional Injuries

National Health Systems/Health Service Delivery Evidence-Based Policy/Priority Setting

Global Health System I/Actors and Stakeholders Global Health System II/Functions

Challenges/Opportunities for the 21st Century

Pervasive themes: Health as a human right, social justice, health inequities, gender disparities, poverty and health linkages, global governance. These themes will be covered throughout the course and in multiple sessions. 4