Course: Political Economy of Public Health

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Syllabus

Week One: Mutual Liberation

Objectives:

  • Critique hierarchical class-based modes of PH that dichotomize the rescuer and rescued
  • Evaluate prospects for community building as a standard approach to PH
  • Explain the difference between versions of rescue that dehumanize and versions that humanize
  • Identify modes of public health that oppress those they are meant to help
  • Appraise the pros and cons of interventions and programs as the currency of PH
  • Describe Unintended Negative Consequences of Programs, Campaigns, and Top Down Life Saving (Millions at a Time)

Readings:
Chapters 1 and 2 of Freire, P. (2000). Pedagogy of the oppressed. Bloomsbury Publishing.

Discussion Questions:

  • If oppression is so common, why does Freire say dehumanization is a "distortion"?
  • According to Freire, who are the oppressed and who are the oppressors?
  • Why do oppressors sometimes use pedagogy instead of straight up violence?
  • Interpret "Oppressors need an unjust social order to perpetuate false generosity"
  • How would Ann Coulter defend the claim that liberal Democrats are Freirian oppressors?
  • How would Alexandria Ocasio Cortez defend the claim that Republicans are Freirian oppressors?
  • What is the role of "prescription" in oppression and in maintaining oppressive social order?
  • What are occupational hazards for former oppressors who want to become liberators (end of Ch 1)?
  • Freire dislikes the "banking" model of education. What does he think will replace it?
  • What is the role of "intentionality" in Freirian pedagogy?

Week Two: From mutual liberation to community building

Objectives:

  • Articulate the case that the construction of social capital is core business for public health
  • Explain the difference between community based participatory research and community based public health practice
  • Locate platforms and currently existing structures in the community that can create community
  • Compare and contrast the goals and practices of community organizing and community building

Required Readings:

  • Kania, John, and Mark Kramer. "Collective impact." Stanford Social Intervention Review (2011): 36-41. Retrieved from: https://c.ymcdn.com/sites/www.lano.org/resource/dynamic/blogs/20131007_093137_25993.pdf
  • Labonte, Ronald. "Community, community development, and the forming of authentic partnerships: Some critical reflections." Community organizing and community building for health 2 (2005): 82-96 in Minkler, Meredith, ed. Community organizing and community building for health and welfare 3rd Ed. Rutgers University Press, 2015." (This is Chapter 6 in Minkler)
  • Taylor, Daniel C., and Carl E. Taylor. Just and lasting change: When communities own their futures. JHU Press, 2016.

Recommended Reading:

Discussion Questions:

Kania and Kramer Reading:

  • Critics of Kania and Kramer accuse them of repackaging old-fashioned coalition building so it will appeal to modern philanthropy. Defend them.
  • In collective impact cases, everyone wants to be the backbone. Why?
  • Contrast Kania and Kramer with Taylor and Taylor's three way partnerships.

Labonte:

  • Labonte notes (p 96) that language use keeps wanting to use "community" as an object not as a subject. What's going on?
  • True believers "romanticize" community while others "tokenize". What should we do?
  • Festering antiprofessionalism and why conflict is constructive for groups.
  • Why does Labonte suggest that organizers must append a strong advocacy component for macro-level policy changes (p99)?
  • What pitfalls lurk for public agencies that engage in community organizing?

QUOTES FROM LABONTE

  • "If practitioners presume without questioning that they are "equals" with community groups, they risk making invisible the types of power that they do hold"
  • "That intergroup conflict is healthy and perhaps essential to social change should not lead health workers to shun the necessity of uniting diverse, conflicting groups..."
  • "...pluralism without commitment to the common good is pluralism gone berserk."
  • "[A] ""Community development (or community organizing in the United States) incorporates both [new group creation and concerted action on a topic], but describes a particular practice in which both practitioner and agency are committed to broad changes in the structure of power relations in society through the support they give community groups.:"
    Page 107 Criteria for authentic partnerships

Taylor and Taylor:

  • What is the "three way partnership"--contrast with Kania-kramer and Labonte?
  • Taylors stress "hard data" as the basis for action--how does this affect power relations?

QUOTE FROM TAYLOR:

  • "There are no universal solutions, but there is a universal approach for finding local solutions"

McCloskey et al:

  • Contrast McLoskey's definition [B] with Labonte's [A].
  • "Authors keep telling readers how community ""engagement"" will help with ""translation"" (p.4), funding (p. 8), and gaining knowledge and insights that can help with health promotion (p. 9). Who are their readers?"

QUOTES from McCloskey:

  • "[B] ""... the goals of community engagement are to build trust, enlist new resources and allies, create better communication, and improve overall health outcomes as successful projects evolve into long lasting collaborations"""

Week Three: Who, How, What, Where

Objectives:

  • Describe typical strategies and building blocks of community building
  • Explain pitfalls in community building networks that are over and under extended

Readings:

  • Shiffman, J (2014, Nov) (A). Knowledge and the Exercise of Power in Global Health. International Journal Health Policy Management 3(6): 297–299
  • Shiffman, J. (2015, July) (B). Global health as a field of power relations. International Journal Health Policy Management 4(7): 497–499

Discussion Questions:

  • What is the "problem" that Shiffman wants to call attention to and does it matter? In other words, is something wrong?
  • Shiffman introduces Foucault's idea of a "field"--what is a field and how is this concept helpful to us?
  • How would the "Welfare economics" paradigm shed light on Shiffman's problem?
  • Why did this short article generate so many letters to the editor?
  • What hope do you have that talking about power problems can make them better?
  • Are powerful actors doomed to get it wrong no matter what they do, or is there a way for them to get it right?
  • Look at the figure here - note the comparative size of the $46 billion--is power about what to do with $46 billion or about something else?
  • How would it feel to think you are a kind, powerful, wise, saver of lives and then to be called "an oppressor"?
  • Does non-oppression make one more powerful or less powerful?

Week Four: Obstacles

Objectives:

  • Explain the social forces that impede public health from building community
  • Explain forces that assist public health in community creation

Readings:

Discussion Questions:

  • Explain the new IRS requirements for hospitals to report Community Benefit.
  • How can community benefit reporting possibly improve public health?
  • How can community health needs assessments improve public health?
  • What factors would reduce the public health impact of CHNAs?
  • What hospital coalitions in the reading impressed you the most? Why?
  • What connections did you see between Prybil et al's cases and "collective impact" methods of Kania and Kramer?
  • How important is money for the work plans listed by Prybil's cases?

Week Five: Case Studies: Neopatricians in London

Objectives:

  • Explain the potential impact of cross-class coalitions between the powerful and the unpowerful

Reading:

  • Szreter, Simon. "The Importance of Social Intervention in Britain's Mortality Decline c. 1850? 1914: a Re-interpretation of the Role of Public Health." Social history of medicine 1.1 (1988): 1-38.

Discussion Questions:

Before answering the following questions, view this graph.

  • What is the McKeown thesis and what data observations support it?
  • What was actually happening to health in England from 1800-1870?
  • What does Szreter say was happening after 1870 and why was it happening?
  • Who was Edwin Chadwick? What was his sanitary idea? What was in the public health act of 1844? How did England react?
  • P. 23 " the ambiguity, or positive obstructionism of economizing ratepayers could all too easily prevail over public health arguments for expensive local facilities and services" How did Victorian sanitarians respond?
  • Describe the significance of Public Health Act of 1875.

Assignment: CHNA Data Extraction Form

Week Six: Case Study 2: Baltimore C4C

Objectives:

  • Explain factors that help a local health department practice community organizing

Reading:

Assignment:

Week Seven: Student Voice

Objectives:

  • Construct strategies to build local communities that bridge

Reading:

  • Voicethread

Week Eight: Student Voice

Objectives:

  • Construct strategies to build local communities that bridge

Reading:

  • Voicethread