SPH 555

Foundations of Public Health [Research] Course Guide Code:

LEC A1 Fa16

Term:

Fall 2016

Time:

Wednesdays, 09:00-11:50

Place:

ECHA L1-220

Course Coordinator:

Kue Young [ [email protected] ]

Instructors:

Stephanie Montesanti [ [email protected] ] Zubia Mumtaz [ [email protected] ] Candace Nykiforuk [ [email protected] ] Kate Storey [ [email protected] ] James Talbot [ [email protected] ]

Teaching Assistant:

Hannah Brooks [ [email protected] ]

SPH 555

Aim The purpose of this course is to ensure that research thesis-based students with a variety of backgrounds and interests acquire a common core understanding of what public health is, what it does, and the different types of research methods that can be used to advance public health. We hope to instill a “population perspective” and illustrate the breadth of the science and practice of public health. Although the formal course title is “Foundations of Public Health Research”, we have put brackets around “Research” as the contents are broader than just about doing research in public health.

Learning objectives Upon completion of this course, students will be able to: • • • • • • • • • • • • • • • • • • • • •

Describe, explain and assess determinants of individual and population health Differentiate multiple targets and levels of intervention to improve public health Describe the paradigms and debates about health strategies to reduce inequities Describe individual, organizational and population level concerns, assets, resources and deficits for public health Recall history of Public Health Describe history, organization and financing of Canada’s healthcare system Describe and assess the core functions of the formal public health system and its contribution to the health of individuals, communities and populations Recognize and value different ways of knowing (epistemology) Identify paradigms and methodologies for inquiry into public health issues, differences between them, and how they may lead to differing questions and approaches Differentiate and identify research questions with appropriate methodologies and approaches (quantitative, qualitative and mixed-methods) Demonstrate how to frame a public health issue, define problems and clarify issues, and develop research questions to investigate these problems and issues Identify and interpret critical research concepts, from the range of disciplines and methods that contribute to public health Interpret key concepts of health and their implications for health research and practice Identify relevant and important research issues relating to Public Health Develop answerable research questions in Public Health Discuss the cycle of policy development and information needed for policy development Understand the essential elements, principles and strategies for creating effective partnerships for research, evaluation and planning Listen and encourage open exchange of information (facilitation) Discuss the key concepts and principles of knowledge mobilization and knowledge translation theory, and the importance of this concept to public health Demonstrate application of strategies for creating effective partnerships for research, evaluation and planning) Demonstrate application of the key concepts and principles of knowledge mobilization 2

SPH 555

Learning strategies This course employs an active learning approach with learning strategies that include whole class lectures, group discussions, individual and small group exercises, student presentations, and written assignments. After each class, students can post thoughts, questions, or responses related to the topics discussed. We shall learn from one another and share our insights. This course is team-taught. The instructors have different academic and professional backgrounds and they bring their unique perspectives to the course. Read their biographical sketches in the School’s website. Readings are assigned for each session. The first one on the list, enclosed in a box, is a “mustread”. While you are not “tested” on the readings, those who have done them will benefit the most from the lectures and be able to participate fully in the class discussions. PDFs of the readings are posted on eClass, where you will also find the powerpoint slides of the lectures and the assignments. Periodic announcements will also be posted [which will also be sent to your email address automatically]. This is a Pass/Fail course and no grades will be assigned. We want you to focus on learning, and not learning just enough to get a good grade. Comments will be provided on the assignments and presentations for your benefits.

Academic integrity Plagiarism is a serious offence! The University of Alberta is committed to the highest standards of academic integrity and honesty. Students are expected to be familiar with these standards regarding academic honesty and to uphold the policies of the University in this respect. Students are particularly urged to familiarize themselves with the provisions of the Code of Student Behaviour and avoid any behaviour which could potentially result in suspicions of cheating, plagiarism, misrepresentation of facts and/or participation in an offence. Academic dishonesty is a serious offence and can result in suspension or expulsion from the University. http://www.governance.ualberta.ca/CodesofConductandResidenceCommunityStandards/Codeof StudentBehaviour/303OffencesUndertheCode/3032InappropriateAcademicBehav.aspx

Course evaluations We want to hear your suggestions for improving this class. Please feel free to make constructive suggestions at any time. Towards the end of the course, you will receive a standardized summative evaluation. The standard University of Alberta course evaluation procedure will be followed. This will involve a standard questionnaire with anonymous responses returned to the Student Services Coordinator.

Role of teaching assistant The TA is a current MSc student in global health and she took this course last year. She will be present at all classes and help set up the room, and ensure all audiovisual equipment is ready for use. She will be responsible for various administrative duties relating to assembling and posting the readings, and collecting and distributing the assignments. 3

SPH 555 She will keep track of class participation, monitor the online discussion, and help in moderating group discussions. She will also do the preliminary grading on the assignments – the final grade will be determined jointly between the TA and the course coordinator.

Course contents 1. Introduction to Public Health

Kue Young

The following topics will be covered: • • • •

Defining health, population, public health, health system and population health Objectives and uses of population and public health research The arts and sciences in Public Health Historical antecedents and future prospects

Readings: 1. Huber M, Knottnerus JA, Green L, Horst H vd, Jadad AR, Kromhout D, Leonard B et al. How should we define health? BMJ 2011;343:d4163 2. The Ottawa Charter for Health Promotion, 1986. Available from: http://www.who.int/healthpromotion/conferences/previous/ottawa/en/ 3. Evans RG, Stoddart GL. Producing health, consuming health care. Social Science and Medicine 1990;31:1347-1363. 2. Social Determinants of Health and Health Inequalities

James Talbot

The following topics will be covered: • • • • •

Frameworks that have been produced to categorize social determinants of health What is the evidence for the importance of social determinants of health on preventing disease and injury, promoting health and prolonging life expectancy? What are the mechanisms by which social determinants may achieve their effects? How do health inequities arise and how can they be measured? What interventions are possible to prevent or mitigate health inequalities?

Readings: 1. Mikkonen, J., Raphael, D. (2010). Social Determinants of Health: The Canadian Facts. Toronto: York University School of Health Policy and Management. 2. Daghofer, D., Edwards, P. (2009). Toward Health Equity: A Framework for Action, Working Document prepared for the Public Health Agency of Canada. 3. Inuit Tapiriit Kanatami (2007). Social Determinants of Inuit Health: A Discussion Paper. 3. The Canadian Health Care System

Stephanie Montesanti

The following topics will be covered: 4

SPH 555 •

•

•

The fundamental characteristics of health care § How is health care different from other goods and services? § How have governments responded to these differences? Overview of the Canadian health care system § Funding, delivery and governance of health care § Aboriginal health care Health policy developments post-World War II § Social insurance programs § The birth of Medicare § Retrenchment and disinvestment § Healthcare reforms

Readings: 1. Hutchison, B., Abelson., J., Lavis, J. (2001). Primary care in Canada: So much innovation, so little change, Health Affairs 20(3): 116-131 2. Béland, D. (2009). Ideas, institutions, and policy change. Journal of European Public Policy, 16(5), 701-718. 3. Hacker, JS. (1998). The historical logic of National Health Insurance: Structure and sequence in the development of British, Canadian, and U.S. medical policy, Studies in American Political Development, Volume 12 (1), 57-130. 3. Public Health Practice in Canada

James Talbot

The following topics will be covered: • • • • • •

Federal and provincial responsibilities Federal and provincial legislations What are the activities carried out in public health? Who carries out those activities? What are the current challenges in improving public health? What future pressures will challenge public health?

There are no recent reviews of public health in Canada. Please consult the following websites to understand the scope of activities of public health agencies at the federal, provincial, and municipal levels: Public Health Agency of Canada: http://www.phac-aspc.gc.ca/index-eng.php Alberta Health: http://www.health.alberta.ca/ Public Health Ontario: http://www.publichealthontario.ca/en/pages/default.aspx Toronto Public Health: http://www1.toronto.ca/wps/portal/contentonly?vgnextoid=a253ba2ae8b1e310VgnVCM100000 71d60f89RCRD 4. Measuring the Health of Populations

Kue Young

This session will cover: 5

SPH 555 • • • •

Health indicators and indices Sources and quality of health data Summary measures of population health Uses and pitfalls of international comparisons

Readings: 1. Etches V, Frank J, DiRuggiero E, Manuel D. Measuring population health: A review of indicators. Annual Review of Public Health 2006;22.1-22.27. 2. Karanikolos M, Khoshaba B, Nolte E, McKee M. Comparing population health. Chapter 5 in: Papanicolas I, Smith PC, eds. Health System Performance Comparisons: An agenda for policy, information and research. Open University Press for the European Observatory in Health Systems and Policies, 2013:127-156. 5. Engaged Scholarship

Zubia Mumtaz, Candace Nykiforuk

The first part of the session will cover the following topics: • • • •

What is engaged scholarship? Different ways to engage with the community, policymakers; History and theory underlying engaged scholarship. Complexities and challenges of engaging with various stakeholders

Dr. Mumtaz and Dr. Nykiforuk will then share their experiences of engaging with community and policymakers in a lower and middle income country and in Canada respectively. Readings: 1. Bowen S: Engaged Scholarship. Concept Paper prepared for the School of Public Health. 2. Graham I, Tetroe JM. Getting evidence into policy and practice: Perspective of a health research funder. J Can Acad Child Adolescent Psychiatry 2009;18 (1): 46-50. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2651211/pdf/ccap-18-1-46.pdf 3. Canadian Institutes of Health Research. Guide to Knowledge Translation Planning at CIHR: Integrated and End-of-Grant Approaches. 2012. 4. Bowen S, Graham I. From knowledge translation to engaged scholarship. Archives of Physical and Rehabilitation Medicine 2013;94(1 Suppl 1):S3-8. 5. Stoecker R (1999). Are academics irrelevant? Roles of scholars in participatory research. American Behavioural Scientist 42(5): 840-854 6. Ontology and Epistemology

Kate Storey

This session involves the following: • • •

Think/pair/square/share and large group discussion to orient ourselves to different ways of knowing Paired activity to demonstrate implications for research Large group discussion – ontology and epistemology unpacked 6

SPH 555 Readings: 1. Carter, S., & Little, M. (2007). Justifying knowledge, justifying method, taking action: Epistemologies, methodologies, and methods in qualitative research. Qualitative Health Research, 17(10), 1316-1328. 2. Ellis, C., Bochner, A., Denzin, N., Lincoln, Y., Morse, J., Pelias, R., & Richardson, L. (2008). Talking and thinking about qualitative research. Qualitative Inquiry, 14(2), 254-284. 7. Critical Research Concepts and Methods

Kate Storey

This session will cover the following: • • •

Paired reflections (for mid-point evaluation of individual in-class participation) Large group discussion – introduction of research methods Proposal speed dating (own MSc work)

Readings: 1. Baum, F. (1995). Researching public health: Behind the qualitative-quantitative methodological debate. Social Science & Medicine, 40(4), 459-468. 2. Charmaz, K. (2004). Premises, principles, and practices in qualitative research: Revisiting the foundations. Qualitative Health Research, 14(7), 976-993. 3. McGuire, W. (2005). Beyond EBM: New directions for evidence-based public health. Perspectives in Biology and Medicine, 48(4), 557-569. 8. Matching Public Health Research Questions

Kate Storey

This session will involve: • • •

Large group discussion on data generating strategies Paired activity to practice interviewing (if time) Small group activity – armchair walkthrough

Readings: 1. Starks, H. and Brown-Trinidad, S. (2007). Choose your method: A comparison of phenomenology, discourse analysis, and grounded theory. Qualitative Health Research, 17(10), 1372-1380. 2. Mantzoukas S. (2008). Facilitating research students in formulating qualitative research questions. Nursing Education Today, 28, 371-377. 3. Morse, J.M. (1999). The armchair walkthrough. Qualitative Health Research, 9(4), 435-436. 4. Morse, J. M., Niehaus, L., Wolfe, R. R., & Wilkins, S. (2006). The role of theoretical drive in maintaining validity in mixed-method research. Qualitative Research in Psychology, 3(4), 279291. 9. Assignment 1: Discussion

Kue Young 7

SPH 555 10. Policy Analysis

Stephanie Montesanti

The following topics will be covered: • • • •

The cycle of policy development and information needed for policy development Policy frameworks and their value and limitations The nature and importance of public health policy Public health issues underpinning policy needs and policy change

Readings: 1. Fafard, P. (2012). Public health understandings of policy and power: lessons from INSITE. Journal of Urban Health, 89(6) 905-914 2. Howlett, M. and Wellstead, A. (2011). Policy analysts in the bureaucracy revisited: The nature of professional policy work in contemporary government. Politics & Policy, 39(4), 613–633. 3. Yanow, D., 2007. Interpretation in policy analysis: On methods and practice. Critical Policy Analysis, 1(1), 109–121 4. Kearns A and Lawson L (2009) (De)constructing a policy ‘failure’: Housing stock transfer in Glasgow. Evidence and Policy, 5(4), 449–70 11. Mixed Methods

Zubia Mumtaz

The following topics will be covered: • • • •

The terminology of mixed methods research The conditions under which mixed methods research is appropriate The many ways of conducting mixed methods research The rules that ensure legitimacy of using research methods located in different epistemologies

Readings: 1. Creswell JW, Fetters MD, Ivankova NY. Designing a mixed methods study in primary care. Annals of Family Medicine 2004;2:7-12 2. Mumtaz, Z, Nykiforuk, C, Bhatti A, Ataullahjan A, Salway S. The role of social geography on Lady Health Workers’ mobility and effectiveness in Pakistan. Social Science and Medicine 2013: 91:48-57. 3. Mumtaz Z, Cutherell, A and Bhatti, A. Saving mothers and newborns in communities: strengthening community midwives to provide high quality essential newborn and maternal care in Baluchistan, Pakistan in a financially sustainable manner. BMC Pregnancy and Childbirth 2014;14:131 12. Class Presentations

Kue Young

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SPH 555

Assignments There will be two assignments, one is to be done individually and the other in groups. Assignment #1 (Individual): Case Studies in Public Health A series of vignettes containing the key facts on important events or innovative studies in public health from the past to the present will be made available. You will be asked several questions [Note: some questions are more relevant for some cases] and submit a 1-2 page written reports based on those questions, with any additional insights you may want to include. In class, students who have chosen the particular case study will take the lead in the discussion. • • •

Is the public health issue still relevant today? What is the main lesson that we can learn from this case study? What are some recent events that show that we have/have not learned the lesson? Are there any ethical issues in the study, the intervention or the policy?

Each student can choose one case study from the list: 1. Ignaz Semmelweis and the prevention of puerperal fever (1860s) 2. Emile Durkheim – is religion a risk factor for suicide? (1897) 3. Joseph Goldberger and the prevention of niacin deficiency (1920s) 4. Fluoridation of community water supply to prevent dental caries (1940s to present) 5. Sickle cell trait and protection from malaria (1954) 6. The causal trail – smoking and lung cancer (1950s, 60s) 7. Mammography for women – experts disagree (1960s to present) 8. International comparative study of schizophrenia (1970s) 9. Changing health of Japanese migrants – the Ni-Hon-San Study (1970s) 10. Community based heart disease prevention in North Karelia, Finland (1970s – 1990s) 11. Randomized controlled trial of nurse-practitioners in primary care (1970s) 12. Economic evaluation of neonatal intensive care units (1970s) 13. An epidemic of murders on the wards of Sick Kids (1980s) 14. Peptic ulcer – a bacterial disease (1980s) 15. Health effects of the Chernobyl nuclear disaster (1980s and 1990s) 16. Return of diphtheria to Russia (1990s) 17. Mad cow disease in Britain (1990s) 18. An outbreak of anthrax bioterrorism (2001) 19. SARS in Canada (2003) 20. Global eradication of smallpox (18th – 20th century) Assignment #2 (Group): Focus on Populations You shall work in groups for this assignment. The intent is to apply what you have learned in this course to a specific, defined population of your choice. You should demonstrate your ability to seek out information from the scientific literature and statistical databases, appraise its worth, integrate and organize your thoughts and ideas, and finally produce a summary report that is coherent and concise.

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SPH 555 There are two deliverables from each group: • •

A written report, between 5 and 10 pages A powerpoint presentation in class, 10 minutes + 5 minutes Q&A

The population can be chosen on the basis of: •

• • • • • •

Geography – a country or region, or a group of countries or regions that share something in common [eg. Canada, sub-Saharan Africa, la Francophonie, lower and middle-income countries] Demography – age, sex, ethnicity [eg. children, elderly, women, African-Americans, Inuit] Migration status – eg. immigrants, refugees, temporary evacuees Occupation – eg. industrial workers, farmers, fishermen, office workers Health status – eg. disabled, hearing impaired Social conditions – eg. homeless, the working poor any other category that identifies a group of people as a “population”

You can also make your selection across categories – eg. homeless drug users in Vancouver’s Lower East Side. Once your group has agreed on a population, organize your report/presentation as follows: 1. The demographic situation: What is the estimated size of this population? What are its characteristics 2. Significant health problems: What is the health status of this population? What are its major health problems? Cite quantitative and/or qualitative data in support, critique the quality of the data, and identify data gaps. 3. Determinants of health: What are the factors that produce the health problems in this population? Is there any evidence that these factors are responsible? Are there competing theories or perspectives on the causes of health problems in this population? 4. Potential interventions: What can be done to improve the health of this population? What is the evidence that the interventions work? Are there alternatives?

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