PUBH4202: Public Health and Medical Systems

Public health engages in preventing disease, prolonging life, and improving quality of life. For most people, though, health care delivery organizations are a primary source of health-related information, and provide the means for protecting them in their journey toward a longer, and higher quality, life. Health care delivery in the U.S. accounts for 18% of national gross domestic product, 11% of US workers, and 24% of government spending. At 26%, health insurance is the largest portion of non-wage compensation, and one of the largest parts of consumer spending (over 8%). Yet despite the U.S. significantly outspending every other industrialized western country, the U.S. ranks last in important public health metrics in healthcare access and quality ratings. Further, at the population level, the U.S. has significantly more preventable deaths than comparable countries regardless of equivalent public health spending. This course takes a systems approach to survey how health care in the U.S., examining system foundations, resources, processes, and outcomes as they relate to population health. Ultimately, this course provides an introduction to how health care delivery supports public health efforts. We will use forms of inquiry from the sciences and humanities. It is designed, from a liberal education perspective, to provide opportunities to practice critical thinking skills for complex systems using hypothetical situations. This course was developed with two main audiences in mind: 1) students interested in using public health as a lens to explore complex societal problems affecting health, and 2) pre-health professional students interested in a grounded understanding of the health sector. This course is designed to encourage the give-and-take between the global-view emphasis of the first group, with the attention to system-level details of the second group. As we move through the course materials, you will be asked individually to critically examine the course materials for which lenses were used in writing the material; what perspective is being heightened; what voices or perspectives were missing; why might those choices have been made; and what are the consequences of those choices. We will use group work on student-chosen specific focus areas (for example, Long-term Care, Diabetes, Drug Safety, Telehealth for Maternal Health, People with Multiple Morbidities) to explore the impact and nuances of systems-level elements. This group work will culminate in a final presentation of the portfolio developed over the course of the term. If you want to learn more about health care and public health in the U.S., a public health or public policy graduate program (e.g. a Master’s of Public Health degree), would give you an opportunity to use the introduction developed here to move deeply into the topic areas using research-based approaches. This class will help you feel more confident with your path, should you decide to continue your education with graduate school. Finally, infrastructure is critical in the timely provision of both healthcare for those who are ill, as well as for public health programs for the prevention and early identification of disease. This course will describe how healthcare is structured and financed in the United States and other countries, and contrast how differences may impact national health indicators. Similarly, the role of our public health infrastructure including the responsibilities of local, state and federal public health agencies in equitable healthcare access and delivery will be described. Macro-level, systems-thinking models to address specific health issues that incorporate both healthcare and public health systems will be discussed.

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