USP 147 S2021 syllabus PDF

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USP 147/FPM 260 (Spring 2021) Case Studies in Health Care Programs: Poor and Underserved Populations Tues/Thurs 9:30am-10:50am Instructor: Leslie R. Lewis, Ph.D., MPH E-mail: [email protected] Phone: 858-952-9691(cell, in case of urgent matters) Office hours: Tuesdays, 11am-12:30pm or by appointment Please schedule using this Calendly Link Here is the Zoom link where we will meet: https://ucsd.zoom.us/j/94714121013 ALL-STAR TEACHING ASSISTANT TEAM: Dan Driscoll Email: [email protected] Office hours: Thurs 1-2pm https://ucsd.zoom.us/j/53654 18332

Jennifer Thunstrom Email: [email protected] Office hours: Thurs 11am-12pm https://ucsd.zoom.us/j/91749251 715

Jonathan Ruiz Email: [email protected] Office hours: Wed 12:30-2pm https://ucsd.zoom.us/j/96054432822 ?pwd=U3pNTll3YWVISlZ1ZnB6T mJwWFBQZz09

COURSE OVERVIEW This course examines the significant problem of health inequities in the U.S.: their distribution across our population and within our healthcare system, the multiple ways they manifest, their underlying determinants, and programmatic and policy strategies to reduce or eliminate them. The aim of the first half of the course is to identify ways that health inequities manifest and disproportionately burden poor, marginalized, and underserved populations in the U.S. To do this, we will critically examine the complex, interrelated social and structural factors that contribute to health, and health disparities in this country. We will explore the connection between economic, social, political, cultural, environmental, and psychological determinants on the one hand, and health status, access to health care, and the quality of care provided on the other. Fundamental to this will be an examination of the ways that our intersecting systems of (racial, gender, and other) inequity and oppression manifest across our institutions and neighborhoods, and are written on our very bodies. An interdisciplinary approach will be used to analyze the relationships between and among poverty, unequal resources and opportunity structures, barriers to education, employment and fair housing, social inequity, stress, stigma, trauma, environmental injustice, cultural norms, and health beliefs as they play out in health harms to particular populations, and ultimately diminish us all as members of a purportedly decent, “civilized” equal society. The second half of the course will highlight various strategies for addressing the health burdens and access barriers faced by particular populations. A series of guest lectures and case studies will introduce students to specific populations in the San Diego area, including marginalized racial/ethnic groups, LGBTQIA individuals, immigrants, and people grappling with houselessness. We will examine key components of successful interventions, and discuss ways that we can catalyze change at multiple levels, so that health inequities can be eliminated, and all residents can flourish.

GOALS OF THE COURSE ❖ One goal of the course is that students come away with a nuanced understanding of the ways that social, economic and health inequity are linked to, and perpetuated by, public policies, institutionalized practices and whole systems, both historically and today. ❖ Following from this, the second goal of the course is to identify and evaluate intervention strategies, including specific research, program, policy and communications interventions meant to address health inequities. ❖ A third goal (more a hope) is that students will become sensitized to the needs, concerns, resiliency and humanity of individuals who bear the burden of health and social inequality, recognize the broad societal costs (social, economic and moral) of harmful policies and practices, and ultimately invest in altering and ameliorating the unjust systems and practices that create health inequities in the first place, and ultimately diminish us all. CLASS FORMAT This course involves a mix of lecture, film, and discussion, along with panels and presentations from local experts who have experience addressing the injustices endured by poor and underserved communities. Answers will not necessarily be laid out for you to memorize and regurgitate for an exam. You will certainly need to master material (vocabulary, concepts, etc.), however, you will also be expected to think critically about all that you hear and read: to make connections, compare and contrast different frames of analysis and intervention, and to draw your own conclusions. There is no single answer to the complex problems that we will be examining here, which include the ways that racism, sexism, classism, homophobia, xenophobia, and other structures of oppression shape our lives and get written on our bodies. As indicated above, my goal is that you come away with a richer, more nuanced understanding of some of the major issues facing us today, as well as the capacity to think both critically and creatively about proposed solutions. COURSE REQUIREMENTS Your course grade is based on the total points you earn in the course (out of a maximum of 1000); see grading scale below for details. “Written on the Body” Paper (Thurs 4/15 10pm) Exam I (Tues 4/27) Interview Analysis Paper (Due: Tues 5/13 10pm) Exam II (Thurs 6/3) _ Learning Summary & Reflection (Due: Tues 6/8 11am) Total points possible:

A+ = 98.5%-100% (i.e., 985-1000pts) B+ = 88.5%-89.9% (885-899) C+ = 78.5%-79.9%

A = 92%-98.4% (920-984) B = 82%- 88.4% C = 72%-78.4%

10% 25% 30% 25% 10%

(100 points) (250 points) (300 points) (250 points) (100 points) 1000 points

A- = 90%-91.9% (900-919) B- = 80%-81.9% C- = 70%-71.9% etc.

Course Readings There is no formal text for this course (hurray for saving money!). Instead, we will read a series of articles, chapters, and reports. All readings will be available either on Canvas or e-reserves (http://libraries.ucsd.edu/resources/course-reserves/).

EXAM REVIEWS The TAs & UGIAs will offer a review session prior to each of your two exams. Times, dates and locations will be announced in class and on Canvas.

INTERVIEW REPORT In an effort to provide a personal dimension to our examination of health inequities, students will complete an interview with a person of their choice who has faced barriers to access to healthcare, and/or health problems linked to experiences of discrimination, marginalization and structural violence. Students will then write a report describing and analyzing the individual circumstances and challenges of the interviewee using the concepts and frameworks of this course. The interview report is to be double-spaced and no more than 5-6 typewritten pages in length. A grading rubric for this assignment will be available by the second week of classes. In general, the report should cover the following: 1) Description of the person (without revealing the name or obvious personal identifiers of the individual), the health challenges faced (specific diagnoses or general illness/dis-ease) and/or the access problems encountered when trying to get healthcare (e.g. lack of insurance, transportation problems, language barriers, fear, cultural barriers, lack of information/misinformation, long wait, etc.). This section will also describe how the individual addressed, or attempted to address, these problem(s). The impact of these health harms and access barriers for the individual and his or her family should also be addressed. (1-2 pgs; 30-40% of the paper) 2) Analysis of the interview (3-4 pgs; 60-70% of the paper), drawing on information and conceptual frameworks from lecture and reading. This should consider: A) How the interviewee’s challenges arise out of current social policy and healthcare provision, and B) Whether, and to what extent, the individual’s access challenges are linked to and exacerbated by (or, alternately, mitigated by) other aspects of her/his life (e.g., related to SES, neighborhood, job, living situation, race/ethnicity, gender, sexual orientation, disability, social network, educational attainment, social status, religious and other social support, “lifestyle” behaviors, etc.) C) What conclusions might be drawn about gaps in policy, needs for change in the provision of services, additional research, or broader cultural and structural change in society? 3) Personal Reflection on the assignment and interview (½ page or so) Papers will be due May 13th at 10pm (uploaded to Canvas). Plan ahead: do not wait until the a few days before the assignment is due, and then panic when something goes wrong. You have to factor in the exigencies of life! Use those “executive function” skills (organization, planning, etc - these are better predictors of success even than IQ) – aim to get the paper done two days early, then enjoy the feeling of relief and peace this generates ☺)

Canvas: All course materials, assignments and Zoom recordings (of lectures) will be posted on Canvas. Check the site periodically for course announcements. You are also encouraged to use Canvas discussion features to communicate with fellow classmates. COURSE FILMS: All course films are available for viewing online through UCSD Course Reserves.

COURSE SCHEDULE & DESIGN This course is organized with learning modules (see below) that map onto the weeks of the quarter. All of the learning modules will be listed on Canvas, and each will have a combination of “inputs” of course material (readings, films, lectures) along with any assessments or assignments that are due that week. We will meet synchronously at the regular class time (T/Th 9:30am), class Zoom link here: https://ucsd.zoom.us/j/94323207744. I will record the Zoom session for students who are in a different time zone or who otherwise have trouble attending synchronously. The recording will always be made available via Modules as soon as possible following the lecture (occasionally this will be delayed by the madness of my life; feel free to nudge me with an email if you don’t see it posted by that evening; I won’t be bothered by this at all). I encourage you all to attend lectures “in person” (well, in-Zoomperson), and do really appreciate seeing your beautiful faces while I present material. Bless those of you who are willing to leave your cameras on (it makes me feel less like I am speaking to the air). At the same time, I understand how exhausting it is to be on screen and on camera so much; it sucks the lifeblood out of me too. Thus, if you need to attend with your camera off, I understand. I will probably build in some forms of break out discussions; turning on your camera during those times is really helpful because it feels more like meeting face-to-face.

MODULES: Week 1 (3/30 & 4/1)

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Introduction to course; meeting one another (building a learning community) Overview of health disparities (inequities)

Week 2 (4/6 & 4/8)

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Roots I: Class & Inequality Matters Roots II: Place Matters

Week 3 (4/13 & 4/15)

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Roots III: Racism(s) & (some) Intersections

Week 4 (4/20 & 4/22)

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Roots IV: Adverse Childhood Experiences (ACEs) & Cumulative Impacts Roots V: Historical Disenfranchisement, Structural & Interpersonal Violence, and Culture Loss

Week 5 (4/27 & 4/29)

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Roots VI: Health Impacts of Marginalization, (non)Citizenship, “Misrecognition” & Fractured Identities Exam 1 (on Canvas under “Quizzes” - available 4/29 8am; closes 12pm)

Week 6 (5/4 & 5/6)

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Overview of strategies and solutions Theory of change and translating science to action

Week 7 (5/11 & 5/13)

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Guest: Dr. Ana Navarro (Por La Vida Program) Guest: Jorge Gonzalez (Environmental Health Coalition)

Week 8 (5/18 & 5/20)

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Guests: Jay Reed & Martha Robles (Christie’s Place) Guest: Jackie Andrzejewski (LGBTQ Health Inequities)

Week 9 (5/25 & 5/27)

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Guests: HEAL Network Panel (on homelessness/houselessness) Guest: Dr. Ellen Beck (The Role of the Doctor-Patient Relationship in Improving Access to Care)

Week 10 (6/1 & 6/3)

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Course summary Exam 2

Details on reading, activities, assignments and assessments related to each module are on Canvas.

Student Resources for Support and Learning Library Help For questions about eReserves and research tools: https://library.ucsd.edu/ask-us/triton-ed.html Message from our librarian: As a reminder, if your students are off-campus, they will need to set up their VPN to connect to licensed library content. If you use Canvas for your courses and point students to licensed items such as eBooks or online journal articles, the students will also need to be using the campus VPN. Learning Resources Writing Hub

Supplemental Instruction

Tutoring

Mental Health Services

Community Centers Learn about the different ways UC San Diego explores, supports and celebrates the many cultures that make up our diverse community. https://students.ucsd.edu/student-life/diversity/index.html Accessibility UC San Diego is committed to providing reasonable accommodations for all persons with disabilities. Students requesting accommodations for this course due to a disability must provide a current Authorization for Accommodation (AFA) letter issued by the Office for Students with Disabilities (OSD) which is located in University Center 202 behind Center Hall. Students are required to email their AFA letters to Faculty and to the OSD Liaison in the department in advance so that accommodations may be arranged. Contact the OSD for further information: https://disabilities.ucsd.edu/. [email protected] | 858. 534.4382 Inclusion I am deeply committed to creating a learning environment that supports diversity of thought, perspective, experience, and identities. I encourage all students to participate in (virtual) discussion thoughtfully and civilly, and to be open to hearing other individuals’ perspectives and experiences. Office of Equity, Diversity, and Inclusion: 858.822.3542 | [email protected] | https://diversity.ucsd.edu/ https://students.ucsd.edu/student-life/diversity/index.html https://regents.universityofcalifornia.edu/governance/policies/4400.html Basic Needs Any student who has difficulty accessing sufficient food to eat every day, or who lacks a safe and stable place to live is encouraged to contact: [email protected]| [email protected] | (858)246-2632 Here is the link to different kinds of assistance: https://basicneeds.ucsd.edu/forms/index.html Technical Support For help with accounts, network, and technical issues: https://acms.ucsd.edu/contact/index.html For help connecting to electronic library resources such as eReserves and e-journals: https://library.ucsd.edu/computing-and-technology/connect-from-off-campus/

UC San Diego Academic Policies Academic Integrity Academic Integrity is expected of everyone at UC San Diego. This means that you must be honest, fair, responsible, respectful, and trustworthy in all of your actions. Lying, cheating, or any other forms of dishonesty will not be tolerated because they undermine learning and the University’s ability to certify students’ knowledge and abilities. Thus, any attempt to get, or help another get, a grade by cheating, lying or dishonesty will be reported to the Academic Integrity Office and will result in sanctions. Sanctions can include an F in the class and suspension or dismissal from the University. So, think carefully before you act. Before you act, ask yourself the following questions: a: is my action honest, fair, respectful, responsible, and trustworthy, and b) is my action authorized by the instructor? If you are unsure, don’t ask a friend, ask your instructor, instructional assistant, or the Academic Integrity Office. You can learn more about academic integrity at academicintegrity.ucsd.edu. (Source: Bertram Gallant, T. (2017). Teaching for integrity. UC San Diego Academic Integrity Office.) (Virtual) Classroom Behavior Policy I hope to foster a positive learning environment and community for all of us, even in this virtual classroom context. During any synchronous Zoom lectures, or interactions in breakout rooms, please engage with intellectual curiosity and civility, and set your “default” to respect and compassion. Please do not be afraid to ask questions, either during Zoom lectures or virtual office hours. (When I was a student, I was often afraid of asking questions, for fear of appearing stupid; now I realize the folly of that thinking). Nobody knows everything (and we all know something), so aim to learn something from, and perhaps teach something to, every person you meet in life, including your peers in this class. The UCSD Student Conduct Code and Principles of Community are good resources for how we can all engage with one another. Religious Accommodation It is the policy of the university to make reasonable efforts to accommodate students having bona fide religious conflicts with scheduled examinations by providing alternative times or methods to take such examinations. If a student anticipates that a scheduled examination will occur at a time at which his or her religious beliefs prohibit participation in the examination, the student must submit to the instructor a statement describing the nature of the religious conflict and specifying the days and times of conflict. For final examinations, the statement must be submitted no later than the end of the second week of instruction of the quarter. For all other examinations, the statement must be submitted to the instructor as soon as possible after a particular examination date is scheduled. If a conflict with the student’s religious beliefs does exist, the instructor will attempt to provide an alternative, equitable examination that does not create undue hardship for the instructor or for the other students in the class. Discrimination and harassment The University of California, in accordance with applicable federal and state laws and university policies, does not discriminate on the basis of race, color, national origin, religion, sex, gender, gender identity, gender expression, pregnancy (including pregnancy, childbirth, and medical conditions related to pregnancy or childbirth), physical or mental disability, medical condition, genetic information, ancestry, marital status, age, sexual orientation, citizenship, or service in the uniformed services (including membership, application for membership, performance of service, application for service, or obligation for service in the uniformed services). The university also prohibits harassment based on these protected categories, including sexual harassment, as well as sexual assault, domestic violence, dating violence, and stalking. The nondiscrimination policy covers admission, access, and treatment in university programs and activities. If students have questions about student-related nondiscrimination policies or concerns about possible discrimination or harassment, they should contact the Office for the Prevention of Harassment & Discrimination (OPHD) at

(858) 534-8298, [email protected], or reportbias.ucsd.edu. Campus policies provide for a prompt and effective response to student complaints. This response may include alternative resolution procedures or formal investigation. Students will be informed about complaint resolution options. A student who chooses not to report may still contact CARE at the Sexual Assault Resource Center for more information, emotional support, individual and group counseling, and/or assistance with obtaining a medical exam. For off-campus support services, a student may contact the Center for Community Solutions. Other confidential resources on campus include Counseling and Psychological Services, Office of the Ombuds, and Student Health Services. CARE at the Sexual Assault Resource Center 858.534.5793 | [email protected] | https://care.ucsd.edu Counseling and Psychological Services (CAPS) 858.534.3755 | https://caps.ucsd.edu Copyright Protections All lectures and course materials, incl...