Course Director:

Julia Field Costich, J.D., Ph.D.
College of Public Health
121 Washington Ave., Rm. 105
Phone: 257-6712
Fax: 257-2821

Course Description

This course will acquaint students with the major issues and challenges for public health in a variety of wealthy, emerging, and impoverished nations and with the impact of local or regional issues on national and global levels.

Course Learning Objectives

1. Discuss important health issues around the globe.
2. Gain insight into the relationship between cultural diversity and health.
3. Gain insight into the relationship between environmental conditions and health.
4. Compare different methods of financing and governing different types of health systems.
5. Compare and contrast the strengths and weaknesses of different health systems.
6. Describe the role of wealth and poverty as determinants of health.
7. Discuss why various tactics and reforms have been successful or unsuccessful in other nations.
8. Describe how the health priorities that are established by donor nations and organizations impact international health issues.
9. Discuss the role of gender in healthcare.
10. Discuss the role of Western development on global healthcare.

ASPH Public Health Competencies addressed

The course content will address a number of the ASPH public health competencies in core and cross-cutting areas including:

1. Discuss the policy process for improving the health status of populations.
2. Describe the roles of, history, power, privilege and structural inequality in producing health disparities.
3. Explain how professional ethics and practices relate to equity and accountability in diverse community settings.
4. Explain why cultural competence alone cannot address health disparity.
5. Differentiate among availability, acceptability, and accessibility of health care across diverse populations.
6. Cite examples of situations where consideration of culture-specific needs resulted in a more effective modification or adaptation of a health intervention.
7. Develop public health programs and strategies responsive to the diverse cultural values and traditions of the communities being served.
8. Analyze determinants of health and disease using an ecological framework.
9. Analyze the potential impacts of legal and regulatory environments on the conduct of ethical public health research and practice.
10. Distinguish between population and individual ethical considerations in relation to the benefits, costs, and burdens of public health programs.

Grade elements

• Class participation: 15%
• Final exam: 35%
• Presentations: 50%

Course materials

Textbook: Merson, Black & Mills: International Public Health, 2d ed. (Jones and Bartlett). A number of supplementary readings will be posted on Blackboard. Each student is responsible for becoming adequately proficient in Blackboard to access all course materials. Assistance for most problems can be found at http://www.uky.edu/Blackboard/student.html.

Papers and presentations

Each student will select one textbook chapter and prepare a 15-minute presentation for the class on the date when the chapter appears in the syllabus. A copy of the presentation will be submitted to the instructor at the time when it is made. Both the presentation materials and the quality of the oral presentation itself will be considered in the grade. (20% of course grade)

Each student will select a developing nation of interest and write an 8-10 page paper and 10-15 minute oral presentation covering the following topics:

1. Population health status and major health challenges
2. Health system
3. External supporters of health services within the nation
4. Impact of major environmental and sociopolitical forces such as war, globalization, drought, etc.
5. Specific strategies that have used to address the nation’s challenges, along with an evaluation of their effectiveness.

Include specific references, including URLs for web-based materials, in a standard reference format of your choice.

The paper topic is due Sept. 30.The paper itself and oral presentation are due Dec. 9.

Plagiarism

Quotation without attribution is plagiarism. Quotation from a published source must be noted with an appropriate citation. Quotation from an Internet-based source must be noted with a complete URL and date. Primary web-based materials used in class presentations and written summary should be retained in hard copy until the final class grade is issued. The instructor reserves the right to request inspection of source materials used in graded materials.

Attendance policy

Because this class meets only once a week, students with more than two unexcused absences will have their semester grades lowered by 5 percentage points for every additional absence. For these purposes, an absence is defined as missing one hour or more of the class period without an excuse approved by the instructor.

Communication devices

Students must turn off all pagers, cell phones, etc. in the absence of a compelling need to keep them on during class. If there is a compelling need to use the device, it must be switched to “vibrate” or a similar type of silent notification.

D R A F T

Course Schedule and Reading Assignments

Sept. 2: Introduction to International Health

Topic: Overview of International Health

Discussion Questions:

1. Why should Americans study international public health?
2. What do you as individuals hope to get out of a class on international health?
3. What health system models are you familiar with?
4. What do you think are the three most important topics in international health? Why?

Website: OECD Health Data

Video: “Sick Around the World”

Sept. 9: Measures of Health and Disease in Populations

Topics: How population health is measured, comparisons and trends, types of data, strengths and weaknesses

Visiting speaker: Claudia Hopenhayn, Ph.D., Dept. of Epidemiology

Readings:

Textbook: Introduction and Ch. 1 Blackboard postings: Constitution of the World Health Organization Murray et al. “Overall Health System Achievement for 191 Countries.” World Health Organization. 11th General Programme of Work.

Discussion questions: page 38.

Sept. 16: No class—students to attend Foundation for a Healthy Kentucky policy forum

Sept. 23: Culture, Behavior and Health

Readings:

Textbook chapter 2

Additional material recommended by visiting speaker

Visiting speaker: Linda Alexander, Ed.D., Dept. of Health Behavior and Assoc. Dean for Academic Affairs

Discussion Questions: Be prepared to respond to the questions on page 64.

The Design of Health Systems/Management and Planning for Public Health

Readings: Textbook ch. 11, 12

OECD world health systems materials (handouts)

Visit OECD health website

Discussion Questions: page 547 and 594

Visiting speaker: Dr. Ray Hill, Dept. of Health Services Management

Sept. 30: Maternal-Child Health Paper topic due

Readings:

Texbook ch. 3 (Anne Goodenow) Blackboard: WHO 2005 Report: Making Every Mother and Child Count

Visiting speaker: Thomas L. Young, M.D., FAAP (pending)

Discussion Questions: Page 114 and

1. Does gender play a role in health access and equity in the United States?
2. How does access to education relate to healthcare for women? Is this different than for men?
3. Why are gender roles important to understanding health status?
4. Why do you think women are responsible for most health-related decisions in any country?

Oct. 7: Emergencies and Disasters

Reading: Textbook ch. 10 (Amanda Lawrence)

Visiting speaker: Dan Harper, MPH, Capt. USN (ret.), Dept. of Environmental Health, EKU

Oct. 14: Nutrition

Reading: Textbook ch. 5 (Janie Leech) Other materials recommended by visiting speaker

Visiting speaker: Mark Swanson, Ph.D., Dept. of Health Behavior Discussion Questions: page 239.

Oct. 21: Unintentional Injuries and Violence/Mental Health

Readings: Textbook chs. 7-8

Blackboard: Projections of Global Mortality and Burden of Disease, 2002-2030

Discussion Questions: pages 347 and 383.

Oct. 28: Environmental Health

Readings: Textbook chs. 9-10 (Jessica Rinsky) Supplemental materials as recommended by Dr. Brion

Visiting speaker: Gail Brion, Ph.D., Dept. of Preventive Medicine and Environmental Health/Dept. of Environmental Engineering

Discussion Questions: see pages 438 and 505

Nov. 4: No class—Presidential election holiday

Nov. 11: Infectious Diseases

Topic: The AIDS Pandemic

Visiting speaker: Patricia Cupp, Ph.D., Pacific Institute for Research and Evaluation

Readings: Textbook ch. 4 (Rob Clemons) Blackboard: WHO 3 by 5 campaign report, June 2005

Discussion Questions: In addition to the questions on page 177:

1. How does the AIDS crisis differ in developed and LDC nations?
2. In the U.S. many people argue that AIDS has become a manageable disease with the creation of medicines (“the cocktail”) that can greatly slow the progression of HIV disease. If this is the case, why is AIDS considered such a crisis around the world?
3. Provide examples of the role of culture in preventing and treating AIDS.

Nov. 18: Aging and Chronic Diseases

Readings: Textbook ch. 6 Blackboard: Wahdan. “The Epidemiological Transition.”

Visiting speaker: David Mannino, M.D., Dept. of Epidemiology Discussion Questions: page 313

Nov. 25: Health and the Economy/Globalization and Public Health

Readings: Textbook ch. 13 (Anna Barry), 14, 15

Blackboard: World Trade Organization. WTO Agreements and Public Health: A Joint Study by the WHO and the WTO Secretariat. Executive Summary. Pages 11-22 and 57-134.

Discussion Questions: pages 638 and 704

Dec. 2: More on refugee and disaster assistance

Dec. 9: Oral presentations; papers due; final exam distributed

Dec. 16: Final exam due

Julia Field Costich, J.D., Ph.D.
College of Public Health
121 Washington Ave., Rm. 105
Phone: 257-6712
Fax: 257-2821

Class schedule and location

The class will meet Tuesday, 12-2:30 pm in room 115 of the College of Public Health Building.

Course description

CPH 653-001 is an introductory course for non-lawyers in selected aspects of law and policy related to public health. Major attention is paid to fundamental legal principles and legal reasoning, recurring legal issues confronted by public health agencies, the use of law to advance a public health agenda, and public health policy development. Emphasis is placed on giving students tools to use when they encounter law-related problems in their professional careers. The course is intended for students in all divisions of the College of Public Health.

Prerequisites

Graduate standing in the College of Public Health and CPH 663, or consent of instructor to waive either requirement. No previous legal experience or training is necessary.

Instructional Methods

Class sessions typically consist of brief introductory lectures by the instructor, a visiting lecturer, or students, followed by guided discussion of assigned textbook readings and original source materials such as court decisions and statutes. The purpose of this instructional method is to expose students to laws and legal concepts in context, and to develop skills in reading and understanding legal materials. Advance preparation and active participation are important.

Course objectives

This class is intended to enable students to:

• Understand the structure and function of the U.S. legal system
• Understand the general concepts underlying tort and contract law
• Become familiar with the authority and responsibility of government to protect and promote community health, and the limitations imposed by the legal system
• Identify the constitutional and statutory foundations of core public health functions
• Acquire skills in identifying and analyzing legal issues
• Broaden critical reading, policy analysis and communication skills
• Develop an awareness of the role of law in advocacy for community health
• Work more effectively with legal counsel
• Understand how public health policy is developed and implemented
• Develop strategies to influence public health policy development

Course Materials

We will use Goodman et al., Law in Public Health Practice,Second Edition (Oxford Univ. Press 2007) and Gostin et al., Public Health Law, Second Edition (Univ. of Calif. Press 2008) as background reading, supplemented by material from the CDC Public Health Law News and original source materials in a course reader on the course website through Blackboard. Each student is responsible for becoming adequately proficient in Blackboard to access all course materials.

Course Grading

• Mid-term exam 20 percent
• Final exam 50 percent
• Class participation 10 percent
• Case presentation/summary 20 percent

The mid-term will be a relatively brief take-home short answer exam designed to tell the instructor and students how well they are progressing in their understanding of the course materials at that point. The final will be a short answer and essay exam that may be in a take-home format.

Public Health Competencies

This course is intended to develop the following public health competencies:

1. Analytical Assessment Skills:
   1. Define a problem
   2. Select and define variables relevant to defined public health problems
   3. Recognize how data illuminates ethical, political, scientific, economic, and overall public health issues
2. Policy Development/Program Planning Skill
   1. Collect, summarize, and interpret information relevant to an issue
   2. State policy options and write clear and concise policy statements
   3. Identify, interpret, and implement public health laws, regulations, and policies related to specific programs
   4. Articulate the legal, social, and political implications of each policy option

Plagiarism

Quotation without attribution is plagiarism. Quotation from a published legal opinion must be noted with an appropriate citation. Quotation from an Internet-based source must be noted with a complete URL and date. Primary web-based materials used in the case presentation and summary should be retained in hard copy until the final class grade is issued. The instructor reserves the right to request inspection of source materials used in graded materials. Students are advised to review the university policy on plagiarism, which will be posted on the course Blackboard site.

Attendance policy

Because this class meets only once a week, students with more than two unexcused absences will have their semester grades lowered by 5 percentage points for every additional absence. For these purposes, an absence is defined as missing one hour or more of the class period without an excuse approved by the instructor.

Communication devices:

Students must turn off all pagers, cell phones, etc. in the absence of a compelling need to keep them on during class. If there is a compelling need to use the device, it must be switched to “vibrate” or a similar type of silent notification.

Cases and other materials for presentation

Each student will select a case (either from the list below or with approval of the instructor) and prepare an in-class oral presentation of about 15 minutes and a written summary of 5-6 pages. The oral presentations will be made on the dates when the materials appear in the syllabus. The written summaries are due no later than April 3.

1. Pelman v. McDonald’s (obesity)
2. FDA v. Brown & Williamson (tobacco)
3. Kelo v. City of New London (takings clause)
4. U.S. v. Morrison (private right of action under VAWA)
5. Gonzalez v. Carhart (abortion)
6. Westside Mothers (legal status of Medicaid service access)
7. Castle Rock v. Gonzalez (enforcement of emergency protective order)
8. Gonzalez v. Raich (medical marijuana)

Course Outline - Legal Basis for Public Health

January 20

Course overview, introduction to the U.S. legal system, including the institutions of government at the federal, state, and local levels; sources of law; and concepts of legal rights. JLME articles

January 27

Nature and extent of government authority to protect the public's health, constitutional and other legal limitations. Introduction to constitutional principles of due process and equal protection.

Assigned reading: Goodman Intro and chs. 1 and 2; Gostin chs. 1 and 2, Reading a legal opinion/ Commonwealth v. Coffman

February 3

Visiting speaker: Joseph Fink, J.D., Pharm.D., Professor, UK College of Pharmacy

Assignment: Prepare a one-page synopsis of Prof. Fink’s lecture and submit electronically before the Feb. 10 class meeting.

February 10

Frontline public health: Challenges and dilemmas relating to confinement of individuals for prevention or treatment of disease; public health and law enforcement; legal issues posed by multidrug resistant tuberculosis; distinction between procedural and substantive rights. Public health and drug abuse. Role of the judiciary in public health.

Assigned reading: Judge Chezem essay on Blackboard; Goodman chs. 4 and 6, Gostin chapter 3 and 4; Speaker case materials

February 17

Student presentation: Gonzalez v. Raich

Concept of direct (command and control) regulation; legal rules governing the administration of government public health agencies; rulemaking process; administrative review of rulemaking; judicial deference to administrative agency determinations. . Specific examples of issues in public health regulation (e.g., controversy over FDA regulation of tobacco); comparison of legislative vs. administrative process in creating public health policy.

Assigned reading: Goodman ch. 3 and 8; Gostin ch. 5; Kentucky statutes and regulations; Gonzalez v. Raich.

February 24

Visiting speaker: Introduction to law of contracts, particularly government contracts. Overview of contract law principles and their application to public sector agency activity. Negotiation review. Health data collection. Reporting requirements, confidentiality and privacy, subpoenas of health records and scientific data, etc.

Assigned readings: CDC Negotiation module, PowerPoint materials on contracts; Goodman ch. 10, Gostin ch. 8; overview of HIPAA privacy regs, Hodge on research versus practice

March 3

Student presentations: FDA v. Brown & Williamson, Pelman v. McDonald’s, U.S. v. Morrison

Use of litigation in public health. Tobacco issues and public health law; introduction to the basic elements of a tort claim, corporate negligence, and strict liability. Individual, class action and government lawsuits against makers of harmful products.

Assigned reading: Goodman chs. 17 and 18, Gostin ch. 6; W. Parmet & R. Daynard, The New Public Health Litigation; FDA v. Brown & Williamson, Pelman v. McDonald’s; U.S. v. Morrison.

Midterm exam distributed

March 10

Midterm exam due.

Student presentation: Kelo v. City of New London

Law of nuisance and its impact on modern public health practice; tension between legal authority of public health professionals to identify and abate nuisances while not infringing on the rights of individuals. History and purpose of land use planning to protect public health and safety; legal methods used to regulate land use at the local, state and federal level. Federal and state environmental regulation to protect public health, focusing on environmental justice issues.

Assigned reading: Goodman chs. 9 and 20, Gostin ch. 12; US Constitution: Fifth, Tenth, Fourteenth Amendments; Kelo v. City of New London; environmental justice materials on website

March 24

Public health ethics. Identifying the distinction between medical ethics or bioethics and public health ethics, reviewing the Public Health Ethics Code, analyzing ramifications of public health ethics in the context of a series of case studies.

Assigned reading: Goodman ch. 5; Gostin ch. 13; Kass: An ethics framework for public health; Public Health Ethics Code and annotations; case studies posted on Blackboard

March 31

Legal issues in health communications. Health communication and behavior. Health promotion campaigns, their legal limitations and restrictions; regulation of advertising in relation to First Amendment rights; risk of defamation in product disparagement or counter-advertising.

Student presentation: Gonzalez v. Carhart

Reproductive health issues

Assigned reading: Goodman ch. 19; Gostin ch. 9; Roe v. Wade, Planned Parenthood v. Casey, Gonzalez v. Carhart.

April 7

Student presentations: Westside Mothers; Castle Rock v. Gonzalez

Injury, disability and the law. Review of public health approach to injury and its implications for law and policy; general overview of Americans with Disabilities Act with specific illustrations of its relationship to public health law; overview of emerging legal issues in disability rights with emphasis on telecommunications access.

Assigned reading: Goodman chs. 12 and 21; review Americans with Disabilities Act (selections) and cases; University of Alabama v. Garrett, Abbott v. Bragdon, PGA v. Martin, telecommunications access materials.

Statutory rights for vulnerable populations with focus on end-of-life issues, low-income populations, and immigrants.

Assigned reading: Goodman chs 13 and 14; Westside Mothers, Aliessa v. Novello, Castle Rock v. Gonzalez.

April 14

Public health policy development. Classic health policy development analysis as it relates to public health, tension between legal and epidemiological concepts of causation in evidence-based public health policy making; illustrations from expansion of quarantine regulations.

Assigned reading: Oliver: The politics of public health policy; Anderson et al.: Evidence-based public health policy; Gostin ch. 10; proposed quarantine regulations.

Written summaries due.

April 21

Public health policy analysis. Classic health policy analysis as it applies to public health with detailed examination of its application in quarantine regulation revisions.

Assigned reading: Collins: Health policy analysis; Quarantine regulation revisions and comments; Goodman ch. 16, Gostin chapter 11.

April 28

Health reform (materials under development)

May 5

Mental health law

Assigned reading: Goodman ch. 12; others on Blackboard site.

May 12

Legal issues in public health emergency preparedness and response. Identifying impact of emergencies on customary concepts of individual human and property rights, jurisdictional issues regarding health professional certification and deployment in the context of emergencies, legal strategies to improve the ability of public sector agencies to collaborate for response to natural and manmade disasters.

Assigned reading: Rosenbaum: Public health policy in the aftermath of Hurricane Katrina; Goodman ch. 11, Gostin ch. 7; Katrina materials

Distribution of final exams

May 19

Final exams due.