GLOBAL HEALTH AFFAIRS: THEORY AND PRACTICE

INTS 4367 SPRING 2015

CLASS
BLACKBOARD
INSTRUCTOR
OFFICE HOURS

WEDNESDAY 9-12, STURM HALL 235

https://du.instructure.com/courses/4278
RANDALL KUHN / rkuhn@du.edu / 303.871.2061 / BCH 208D
TUESDAY/WEDNESDAY 12-3PM

Objectives and Overview

This course offers an entry point to Global Health from a social science perspective. The history
of global health action is littered with failure and disillusionment, due to a lack of theoretical or
empirical rigor and serious intentions. Success begins with identifying salient interventions to
problems of consequence, a surprisingly rare achievement. Even sensible interventions can fail
without an understanding of other aspects of human development that affect health directly,
that determine programmatic success or failure, and that are themselves impacted by health.
In the opening weeks we will explore and apply frameworks for global health analysis,
intervention, and evaluation. Having addressed the surprisingly daunting task of designing
effective interventions, we spend the final four weeks dissecting the forces of global trade,
security, and politics that further impede the path from good ideas to global change.
Our goals are three-fold: to engage in major debates regarding the where, how and why of
health interventions; to critique diverse frameworks for understanding and methods for
addressing issues in global health; to develop an intervention/research project embedded within
broader concerns of global health.

Grading
Research proposal (70%): You will propose, design, and justify an internship or project aimed
at improving the quality of a health service or addressing a health problem. This should be
work you could undertake in the next year. Details of proposal will be provided under a
separate handout. Progress will be monitored and your work evaluated throughout the quarter:

1-2 page partner overview due April 8 (10% of your grade)

2-3 page overview of global health problem due April 22 (10%)
Detailed scientific review of intervention background due May 6 (10%)
Outline draft due May 20 (10%)
Final proposal due June 1 at 5pm (30% of your grade)

Any citations and references used in the homework assignments or final paper must follow the
American Psychological Association (APA) style guide (visit http://www.apastyle.org/ or

http://duwriting.org/writing-center/services). The DU Writing Center is an excellent resource.

For further information, or to schedule an appointment, see http://duwriting.org/writing-center
Discussion Leader (20%): Each student must co-lead a case study discussion or debate. Case
studies relate to specific high-profile interventions. Leaders should present a well-organized
talk oriented around identifying the burden, risk factors, intervention, contextual issues, and
success. Talks should clearly connect the theoretical and practical aspects of the intervention.
They should cumulatively build on earlier course readings. Leaders should frame questions for
further class discussion. Presentations will be graded on relevance, substance, and creativity. In
the case of debates, you will also be graded on persuasiveness.
Participation (10%): I will track participation on the basis of class discussion, a small number of
quick response writing exercises, and attendance at research seminars. We will have seminars
after class for several weeks. Speak to me in office hours or by email if you have any concerns
about in-class discussion or attendance at seminars.
All readings are available through Canvas.

March 25: The Challenge of Global Health

Birn, Anne-Emanuelle. 2009. The stages of international (global) health: Histories of success or
successes of history? Global Public Health, 4(1): 50-68
Dybul, Mark, Peter Piot, and Julio Frenk. 2012. Reshaping Global Health. Policy Review 173,
Hoover Institution, Stanford University, 13 pages.
Fidler, David P. 2011. Rise and Fall of Global Health as a Foreign Policy Issue. Global Health
Governance IV(2), Special Issue: The Intersection of Health and Security, 6 pages.
Taplin, Dana H. and Helne Clark. 2012. Theory of Change Basics: A Primer on Theory of
Change. ActKnowledge: Theory to Results, 9 pages.

April 1: Health measurement and priority-setting

Rose, Nikolas. 2008. The value of life: somatic ethics and the spirit of biocapital. Daedalus 137(1):
36-48.
Institute for Health Metrics and Evaluation. The Global Burden of Disease: Generating
Evidence, Guiding Policy. Seattle, WA: IHME, 2013, pp. 1-30.
Stuckler, David and Martin McKee. 2008. Five metaphors about global-health policy. The Lancet
372: 95-97.
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.

After class, there will be a talk by Mohammed Shaheen, Associate Professor and former Dean,
School of Public Health, al-Quds University, will speak about research on the impact of the
Israel-Palestinian conflict on health

April 8: Health transitions and structural drivers

1-2 page overview of partner organization due today
Kunitz, Stephen J. 1987. Explanations and Ideologies of Mortality Patterns. Population and
Development Review 13(3): 379-408.
Kuhn, Randall. 2010. Routes to Low Mortality in Poor Countries Revisited. Population and
Development Review 36(4): 655-692.
Weiss, Robin A. and Anthony J. McMichael. 2004. Social and environmental risk factors in the
emergence of infectious diseases. Nature Medicine 10: S70S76.
Sparrow, Annie. 2014. Syria: The Other Threat. New York Review of Books August 12, 2014. Some
of you may wish to read Save the Childrens response and Sparrows rebuttal.

April 15: Proximate risk factors and interventions

Institute for Health Metrics and Evaluation. The Global Burden of Disease: Generating
Evidence, Guiding Policy. Seattle, WA: IHME, 2013, pp. 31-43.
Jones, Gareth. 2003. How many child deaths can we prevent this year? The Lancet 362: 65-71.
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.

April 22: Intervention design and Theory of Change

2-3 page overview of health problem due today
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): 4766.
Campbell, Oona M R, Wendy J Graham. 2006. Strategies for reducing maternal mortality:
getting on with what works. The Lancet 368(9543): 1284-1299.
Taplin, Dana H., Helne Clark, Eion Collins, and David C. Colby. 2013. Theory of Change
Technical Papers. ActKnowledge: Theory to Results, 23 pages.
Maru, Duncan. 2012. Local Health Systems, Global Change: Revisiting Nyaya Healths Theory
of Change. Nyaya Health Blog. January 27, 2012, 2 pages.

Case Study: Matlab Family Planning and Health Services Project

April 29: Evaluation and Scaling up

Yamey, Gavin. 2011 Scaling Up Global Health Interventions: A Proposed Framework for
Success. PLoS Medicine 8(6): e1001049.
Ravallion, Martin. 2001. The Mystery of the Vanishing Benefits: An Introduction to Impact
Evaluation. World Bank Economic Review 15(1): 115-140
Tomlinson, Mark, Mary Jane Rotheram-Borus, Leslie Swartz, Alexander C. Tsai. 2013. Scaling
Up mHealth: Where Is the Evidence? PLoS Medicine 10(2): e1001382.
Banerjee, Abhijit V., Rachel Glennerster and Esther Duflo. 2008. Putting a Band-Aid on a
Corpse: Incentives for Nurses in the Indian Public Health Care System. Journal of the European
Economic Association 6(2/3): 487-500.
Case Study: Cohort effects and comorbidities

May 6: Systemic intervention and societal change

Scientific review of intervention background due today
Kim, Jim Yong, Paul Farmer, Michael E. Porter. 2013. Redefining global health-care delivery. The
Lancet 382(9897): 1060-1069.
Atun, Rifat, Thyra de Jongh, Federica Secci, Kelechi Ohiri, and Olusoji Adeyi. 2010a. Integration
of targeted health interventions into health systems: a conceptual framework for analysis. Health
Policy and Planning 25(2): 104-111
Bonita, Ruth, Roger Magnusson, et al. 2013. Country actions to meet UN commitments on noncommunicable diseases: a stepwise approach. The Lancet 381: S75-S84.
Rodrigo Moreno-Serra, Peter C Smith, Does progress towards universal health coverage
improve population health? The Lancet 380(9845): 814.
Case study debate: Partners in Health vs. the Mexican Secretara de Salud

May 13: Health in the Global Economic System

Amir Attaran, Canada Research Chair in Law, Population Health and Development Policy,
University of Ottawa, will join us for part of the class and give a seminar at 12pm on
challenges and opportunities in global pharmaceutical trade
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.
Buse, Kent and Sonja Tanaka. 2011. Global Public-Private Health Partnerships: lessons learned
from ten years of experience and evaluation. International Dental Journal 61: 210.
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Beall, Reed and Randall Kuhn. 2012. Trends in International Compulsory Licensing for
Pharmaceuticals since the Doha Declaration: A Database Analysis. PLoS Medicine 9(1): e1001154.
Novotny, T.E. and D. Carlin. 2005. Ethical and Legal Aspects of Tobacco Control. British Medical
Journal 14(Suppl II): ii26-ii30.

May 20: Global Health Security and Foreign Policy

Outline Draft due today
Katz, Rebecca, Sarah Kornblet, Grace Arnold, Eric Lief, Julie E. Fischer. 2011. Defining health
diplomacy: changing demands in the era of globalization. The Milbank Quarterly 89(3):503-23.
Enemark, Christian. 2009. Is Pandemic Flu a Security Threat? Survival 51(1): 191-214.
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.
Case study debate: How many SDGs do we need?

May 27: Global Health Governance: Making it happen

Hill, Peter S. 2011. Understanding Global Health Governance as a Complex Adaptive System.
Global Public Health 6(6): 593-605.
Frenk, Julio and Suerie Moon. 2013. Governance Challenges in Global Health. New England
Journal of Medicine 368: 936-942.
Gostin, Lawrence O. 2012. A Framework Convention on Global Health: Health for All, Justice
for All. JAMA 307(19): 2087-2092
Harmer, Andrew, Y. Xiao, E. Missoni, and F. Tediosi. 2013. BRICS without straw? A systematic
literature review of newly emerging economies influence in global health. Globalization and
Health 9:15, 11pages.

Case Studies and Debates

Case Study: The Bangladesh Miracle and the Matlab Project
Question: What do the Matlab interventions and the broader Bangladesh experience teach us
about evidence-based intervention, integration, outreach, and understanding social context?
What challenges remain?
Bangladesh
Chowdhury AMR, Bhuiya A, Chowdhury ME, Rasheed S, Hussain Z, Chen LC. 2013. The
Bangladesh paradox: exceptional health achievement despite economic poverty. Lancet 382:
1734-1745.
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Ahmed SM, Evans TG, Standing H, Mahmud S. 2013. Harnessing pluralism for better health in
Bangladesh. Lancet 382: 1746-1755.
El Arifeen S, Christou A, Reichenbach L, et al. Community-based approached and partnerships:
innovations in health-service delivery in Bangladesh. Lancet 382: 2012-2026.
Adams AM, Rabbani A, Ahmed S, et al. Explaining equity gains in child survival in Bangladesh:
scale, speed, and selectivity in health and development. Lancet 382: 2027-2037.
Cash RA, Halder SR, Husain M, et al. Reducing the health eect of natural hazards in
Bangladesh. Lancet 382: 2094-2103.
Adams AM, Ahmed T, Arifeen SE, Evans TG, Huda T, Reichenbach L. Sustaining innovation in
pursuit of Universal Health Coverage: a call to action for Bangladesh. Lancet 382: 2104-2111.
Matlab
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.
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.

Case Study: Cohort effects and life course health

Uauy, Ricardo, Juliana Kain, and Camila Corvalan. 2011. How can the Developmental Origins
of Health and Disease (DOHaD) hypothesis contribute to improving health in developing
countries? The American Journal of Clinical Nutrition 94(6): 1759S-1764S.
Deeks, Steven G., Sharon R. Lewin, and Diane V. Havlir. The end of AIDS: HIV infection as a
chronic disease. Lancet 382: 1525-1533.
Rook, Graham A. 2013. Regulation of the immune system by biodiversity from the natural
environment: An ecosystem service essential to health. Proceedings of the National Academy of
Sciences 110(46): 18360-18367.

Leist, Anja K. and Johan P. Mackenbach. Social, Behavioral, and Contextual Influences on
Cognitive Function and Decline over the Life Course. Chapter 8 in A.K. Leist et al. (eds.) Health
and Cognition in Old Age: From Biomedical and Life Course Factors to Policy and Practice.

Debate: Partners in Health vs. the Mexican Secretara de Salud

Question: Which is the more appropriate basis for the national health care policy of a low
resource nation: the diagonal integration approach pioneered by the Mexican Secretara de
Salud or the social justice approach of Paterns in Health?
Economists: Secretara de Salud, Mexico
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.
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.
Anthropologists: Partners in Health
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.

Case study debate: How many SDGs do we need?

New case, more readings coming
UN. 2013. Health in the post-2015 development agenda: need for a social determinants of health
approach. Joint statement of the UN Platform on Social Determinants of health.
Alleyne, George, Agnes Binagwaho, et al. 2013. Embedding non-communicable diseases in the
post-2015 development agenda. The Lancet 381: 566-574.