Political Economy of Health and Marginalization UNI411 H1 - Fall 2012

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1 Political Economy of Health and Marginalization UNI411 H1 - Fall 2012 It is no measure of health to be well adjusted to a profoundly sick society. - J. Krishnamurti It is not inequalities that kill people; it is those who are responsible for these inequalities that kill people. - V. Navarro Course Instructor: Faraz Vahid Shahidi faraz.vahidshahidi@utoronto.ca Class Hours: Tuesday, 5:00-8:00 PM Class Location: University College, Room 177 Office Hours: Tuesdays, 4:00-5:00 PM and by appointment Office Location: University College, Room D-304 COURSE DESCRIPTION This course examines the social production and distribution of health and illness within and across populations, with a particular focus on the health and wellbeing of marginalized communities. The course undertakes a critical interrogation of marginality and its expression in the shape of social inequalities in health. A political economy framework is applied to the problem of social inequalities in health. The overarching themes of power and politics are employed to better understand the policy origins of these inequalities, the policy action that is required to tackle them, and the political obstacles that hinder such action. Throughout the course, an emphasis is placed on examining and confronting the determinants of the determinants of health. The course will equip students with theoretical and empirical tools from a range of disciplines -- including epidemiology, nursing, public policy, political science, and sociology -- in order to facilitate a critical examination of contemporary developments in research on the social determinants of population health. PREREQUISITES UNI209: Determinants of Health and Health Care HMB303: Health and Human Rights COURSE OBJECTIVES Upon completion of the course, students will be able to demonstrate considerable comprehension of:

2 The impact of political economics on population health. The health issues faced by marginalized populations. The relevance of power and politics to the study of social and health policy. Interdisciplinary and comparative approaches to the study of population health. In addition to these objectives, students will be expected to conduct research on a topic related to the course with the aim of generating a paper of publishable quality. Students will be encouraged to submit this paper for publication. COURSE STRUCTURE This course is organized as a series of seminar meetings. Each seminar will last three hours. The first two hours will consist of a facilitated discussion of the assigned readings. Along with the course instructor, students will share the responsibility of facilitating these in-class discussions. As with any seminar meeting, students will be expected to have read and reflected upon the assigned readings prior to class. Attendance is mandatory and participation is required. Students are encouraged to write down questions, criticisms, and comments while going through the readings and to share these during class discussions. The final hour will be spent discussing students final research papers. READINGS AND GROUP DISCUSSIONS Required readings have been assigned on a weekly basis and will be made available online. The course syllabus also includes a weekly list of further readings for students interested in engaging with additional material. When engaging with and discussing the readings, students should keep the following questions in mind. What are the authors main ideas? Is the scope of the authors thesis sufficient? What would you add to it? How is health, illness, and welfare conceptualized in the article? What does this tell us about its author? Critically appraise the strength of the authors arguments and the evidence cited. Do you agree with their interpretations and conclusions? How do they relate to the rest of the course readings? What are the policy implications for each reading? Are the policies that are recommended feasible given the current political climate? If not, why? What is missing from the analysis? What are the key assumptions underlying the analysis and how they differ from alternative interpretations? COURSE EVALUATION (Please note that the final drop date for this course is Sunday, November 4th.) Participation 20% Critical Seminar Paper 20% Deadline: October 14th, 11:59 PM

3 Presentation 20% Deadline: November 27th, 5:00 PM Final research paper 40% Deadline: December 4th, 11:59 PM Participation (20%) This seminar course is designed to be highly interactive. Students will only become familiar with the course material by completing the assigned readings prior to class and participating in class discussion. Accordingly, class participation constitutes a significant portion of the course assessment. Participation marks will depend on the quality of participation as well as the student s ability to create a supportive and critical space. Critical Seminar Paper (20%) Deadline: Sunday October 14th, 11:59 PM Students will complete a 1500 word essay responding to the assigned readings from a week of their choice. The essay is meant to be reflective and critical of the assigned readings. Accordingly, students will be expected to make use of supplemental resources. Please see the above section on Readings and Group Discussions for some key questions that students will be expected to address in their essay. Presentation (20%) Deadline: Tuesday November 27th, 12:00 PM Students will prepare and deliver a 20 minute presentation on a specific marginalized population. The presentation should: (i) introduce the marginalized population; (ii) provide a definition of marginalization ; (iii) describe the health and welfare concerns relevant to the marginalized population; (iv) interrogate the political-economic forces shaping their health and welfare; and (v) assess the political obstacles that hinder attempts to confront these forces. Students should make sure to leave the last five minutes for a question and answer period. Final Research Paper (40%) Deadline: Tuesday December 4th, 11:59 PM Each student will produce an original piece of writing related to the themes of the course. This major piece of work is expected to require a substantial amount of research and original insight. The research paper will be between 3500 and 4500 words, excluding abstracts, tables, charts, and references. Potential methodologies include a comparative policy analysis, a systematic literature review, discourse analysis, media analysis, regression analysis, and so on. Students are encouraged to submit a statement of the problem that may include an outline and/or annotated bibliography. This should be submitted by Week 9 in order to ensure that the course instructor has adequate time to provide feedback. Students will also have the opportunity to meet with the course instructor in order to discuss their paper topics. The final product should aim to be of publishable quality; students are encouraged to consider submitting their work for publication. GRADING For grading practices, please see the University of Toronto Faculty of Arts and Science Grading Policy: Additional assessment guidelines will be made available.

4 COURSE COMMUNICATION Students should not hesitate to contact the course instructor if they have any questions or concerns. If a student is particularly interested in one or another element of the course content, or if they require additional support and resources, they are encouraged to communicate this to the course instructor. Students should make sure to use their University of Toronto address in all communications. Course updates and required readings will be posted online -- please check the Portal page on a regular basis. Weekly announcements will be sent via Portal. Students should ensure to read these announcements, as they will contain important information regarding the weekly readings and assignments. ACADEMIC INTEGRITY Academic integrity is essential to the pursuit of learning and scholarship. All work submitted by a student should be the student s own work except where otherwise indicated. The University treats every instance of academic dishonesty seriously. Students should review the following guidelines carefully: Should a student have any questions or concerns regarding standard academic conduct and behaviours, they are expected to seek out additional information from the course instructor. ACCESSIBILITY Students with diverse learning styles and needs are welcome in this course -- accessibility will be treated as a collective responsibility shared by all course participants. A range of services and resources are available to students. If a student requires specific accommodations, they can contact the course instructor and/or the Accessibility Services Office. The St. George Campus Accessibility Services Office is located on the first floor of Robarts Library. Staff are available by appointment to help with assessing specific needs, providing referrals, and arranging for appropriate accommodations. (416) or disability.services@utoronto.ca. LATE PENALTIES AND MEDICAL CERTIFICATES All coursework must be handed in on time. With the exception of medically-related incidents, a penalty of 10% per day will be applied to all coursework that is handed in late. For proper documentation, please see: CORE TEXTS (The following texts are not required readings.) Armstrong, P., Armstrong., H, and Coburn, D (eds.) (2001) Unhealthy Times: Political Economy Perspectives on Health and Care. Oxford: Oxford University Press. Bartley, M. (2004) Health Inequality: An Introduction to Theories, Concepts, and Methods. Cambridge: Polity Press. Berkman, L. and Kawachi, I. (2000) Social Epidemiology. Oxford: Oxford University Press. Brady, D. (2009) Rich Democracies, Poor People. Oxford: Oxford University Press.

5 De Maio, F. (2010) Health and Social Theory. New York: Palgrave Macmillan. Dorling, D. (2010) Injustice: Why Social Inequality Persists. Bristol: Policy Press. Doyal, L. (1983) The Political Economy of Health. London: Pluto Press. Esping-Andersen, G. (1990) The Three Worlds of Welfare Capitalism. Princeton: Princeton University Press. Galea, S. (ed.) (2007) Macrosocial Determinants of Population Health. New York: Springer. Gough, I. (1979) The Political Economy of the Welfare State. London: Macmillan Press. Hofrichter, R. (ed.) (2003) Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease. Indianapolis: Jossey-Bass. Krieger, N. (2011) Epidemiology and the People s Health: Theory and Context. Oxford: Oxford University Press. Navarro, V. (ed.) (2001) The Political Economy of Social Inequalities: Consequences for Health and Quality of Life. Amityville: Baywood Publishing Company. Navarro, V. (ed.) (2007) Neoliberalism, Globalization, and Inequalities: Consequences for Health and Quality of Life. Amityville: Baywood Publishing Company. Navarro, V. and Muntaner, C. (eds.) (2004) Political and Economic Determinants of Population Health and Well- Being: Controversies and Developments. Amityville: Baywood Publishing Company. O Campo, P and Dunn, J. (eds.) (2011) Rethinking Social Epidemiology: Towards a Science of Change. New York: Springer Publishing. Room, G. (1979) The Sociology of Welfare: Social Policy, Stratification, and Political Order. Oxford: Basil Blackwell. Scambler, G. (2002) Health and Social Change: A Critical Theory. Maidenhead: Open University Press. Shoeni, R.F. et al. (eds.) (2008) Making Americans Healthier: Social and Economic Policy as Health Policy. New York: Russell Sage Foundation. Teeple, G. (2000) Globalization and the Decline of Social Reform: Into the Twenty-First Century. Atlantic Highlands: Humanities Press. RELEVANT ACADEMIC RESOURCES American Journal of Public Health Canadian Journal of Public Health Critical Public Health Critical Social Policy Health and Canadian Society Health Promotion International International Journal of Health Services Journal of Epidemiology and Community Health Journal of Health Politics, Policy, and Law

6 Policy and Politics Politics and Society Social Policy and Society Social Science and Medicine Social Theory and Health Sociology of Health and Illness CURRICULUM Week 1: Theorizing Population Health Week 2: Theorizing Marginalization Week 3: The Health of Marginalized Populations Week 4: The Political Economy of Health: A Framework Week 5: The Political Economy of Health: Income Inequality Week 6: The Political Economy of Health: Social Capital Week 7: The Political Economy of Welfare Capitalism Week 8: Welfare State Regimes and Population Health Week 9: Power, Politics, and Policy Week 10: Population Health and Social Change Week 11: Student Presentations Week 12: Student Presentations COURSE READINGS Week 1: Theorizing Population Health (1) Rothstein, M. (2002) Rethinking the meaning of public health. The Journal of Law, Medicine & Ethics, 30 (2), (II) Goldberg, D. (2009) In support of a broad model of public health: Disparities, social epidemiology and public health causation. Public Health Ethics, 2(1), (III) Rothstein, M. (2009) The limits of public health: A response. Public Health Ethics, 2(1), De Maio, F. (2010) Health and Social Theory. Basingstoke: Palgrave Macmillan. Krieger, N. (2011) Epidemiology and the People s Health: Theory and Context. Oxford: Oxford University Press. McKinlay, J.B. (2000) To boldly go... American Journal of Public Health, 90(1), Rose, G. (1985) Sick individuals and sick populations. International Journal of Epidemiology, 14(1),

7 Week 2: Theorizing Marginalization (I) Elyssa, V. (2005) Examining the margins: A concept analysis of marginalization. Advances in Nursing Sciences, 28(3), (II) Perlman, J.E. (1975) Rio s favelas and the myth of marginality. Politics & Society, 5, Week 3: The Health of Marginalized Populations (I) Hofrichter, R. (ed.) (2003) Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease. Jossey-Bass. (Read pages 1-14.) (II) Farmer, P. (2008) Challenging orthodoxies: The road ahead for health and human rights. Health and Human Rights, 10(1), (III) Whiteis, D.G. (2000) Poverty, policy, and pathogenesis: Economic justice and public health in the US. Critical Public Health, 10(2), Braveman, P. (2006) Health disparities and health equity: Concepts and measurement. Annual Review of Public Health, 27, Hofrichter, R. and Bhatia, R. (eds.) (2010) Tackling Health Inequities Through Public Health Practice: Theory to Action. Oxford: University of Oxford Press. Week 4: The Political Economy of Health: A Framework (I) Bambra, C., Fox, D. and and Scott-Samuel, A. (2007) A politics of health glossary. Journal of Epidemiology and Community Health, 61, (I) Minkler, M., Wallace, S.P. and McDonald, M. (1994) The political economy of health: A useful theoretical tool for health education practice. International Quarterly of Community Health Education, 15(2), (II) Poland, B. et al. (1998) Wealth, equity and health care: A critique of a population health perspective on the determinants of health. Social Science and Medicine, 46(7), Armstrong, P., Armstrong, H., and Coburn, D. (eds.) Unhealthy Times: Political Economy Perspectives on Health and Care. Oxford: Oxford University Press.

8 Coburn, D. (2006) Health and Health Care: A Political Economy Perspective. In: Raphael, D., Bryant, T. and Rioux, M.H. (eds.) Staying Alive: Critical Perspectives on Health, Illness, and Health Care. Toronto: Canadian Scholars Press. Doyal, L. (1983) The Political Economy of Health. London: Pluto Press. Galea, S. (ed.) (2007) Macrosocial Determinants of Population Health. New York: Springer. Week 5: The Political Economy of Health: Income Inequality (I) Lynch, J.W. et al. (2000) Income inequality and mortality: Importance to health of individual income, psychosocial environment, or material conditions. British Medical Journal, 320, (II) Coburn, D. (2004) Beyond the income inequality hypothesis: Globalization, neo-liberalism and health inequalities. Social Science and Medicine, 58(1), (III) Muntaner, C. et al. (2012) Social class, politics, and The Spirit Level: Why income inequality remains unexplained and unsolved. International Journal of Health Services, 42(3), Muntaner, C. and Lynch, J. (1999) Income inequality, social cohesion, and class relations: A critique of Wilkinson s new-durkheimian program. International Journal of Health Services, 29(1), Wilkinson, R. (1996) Unhealthy Societies: The Afflictions of Inequality. New York: Routledge. Wilkinson, R. (1999) Income inequality, social cohesion, and health: Clarifying the theory -- A reply to Muntaner and Lynch. International Journal of Health Services, 29(3), Wilkinson, R. and Pickett, K. (2010) The Spirit Level: Why Equality is Better for Everyone. London: Penguin Books. Week 6: The Political Economy of Health: Social Capital (I) Kawachi, I. et al. (1997) Social capital, income inequality, and mortality. American Journal of Public Health, 87(9), (II) Smith, S. S. and Kulynych, J. (2002) It may be social, but why is it capital? The social construction of social capital and the politics of language. Politics and Society, 30(1), (III) Muntaner, C. et al. (2001) Social capital, disorganized communities, and the Third Way: Understanding the retreat from structural inequalities in epidemiology and public health. International Journal of Health Services, 31(2),

9 Kawachi, I. and Berkamn, L. (2000) Social cohesion, social capital, and health. In: Berkman, L.F. and Kawachi, I. (eds.) Social Epidemiology. Oxford: Oxford University Press. Macinko, J. and Starfield, B. (2001) The utility of social capital in research on health determinants. Milbank Quarterly, 79(3), Navarro, V. (2002) A critique of social capital. International Journal of Health Services, 32(3), Lynch, John et al. (2000) Social capital Is it a good investment strategy for public health? Journal of Epidemiology and Community Health, 54, Week 7: The Political Economy of Welfare Capitalism (I) Esping-Andersen, G. (1990) The three political economies of the welfare state. Canadian Review of Sociology, 26(1), (II) Teeple, G. (2000) Globalization and the Decline of Social Reform: Into the Twenty-First Century. University of Toronto Press. (Read Introduction and Social Reform and Capitalism. ) (III) Coburn, David. (2000) Income inequality, social cohesion and the health status of populations: The role of neo-liberalism. Social Science & Medicine, 51(1), Bambra, C. (2011) Welfare state capitalism and health. In: Bambra, C. Work, Worklessness, and the Political Economy of Health. Oxford: Oxford University Press. Esping-Andersen, Gosta. (1990) The Three Worlds of Welfare Capitalism. Princeton: Princeton University Press. Ginsburg, N. (1979) Class, Capital, and Social Policy. London: Macmillan. Gough, I. (1979) The Political Economy of the Welfare State. London: Macmillan. Hicks, A. M. and Esping-Andersen, G. (2005) Comparative and historical studies of public policy and the welfare state. In: Janowski, T. et al. (eds.) The Handbook of Political Sociology. Cambridge: Cambridge University Press. Pulkingham, J. and Ternowetsky, G. (2006) Neo-liberalism and retrenchment: Employment, universality, safety-net provisions, and a collapsing Canadian welfare state. In: Shalla, V. (ed.) Working in a Global Era: Canadian Perspectives. Toronto: Canadian Scholars Press. Week 8: Welfare State Regimes and Health Outcomes

10 (I) Lundberg, O. et al. (2008) The role of welfare state principles and generosity in social policy programmes for public health: An international comparative study. The Lancet, 372(9650), (II) Navarro, V. et al. (2006) Politics and health outcomes. The Lancet, 368(9540), (III) Espelt, A. et al. (2008) Inequalities in health by social class dimensions in European countries of different political traditions. International Journal of Epidemiology, 37, (IV) Lundberg, O. Commentary: Politics and public health some conceptual considerations concerning welfare state characteristics and public health outcomes. International Journal of Epidemiology, 37, Bambra, C. (2006) Health status and the worlds of welfare. Social Policy and Society, 5(1), Beckfield, J. and Krieger, N. (2009) Epi+demos+cracy: Linking political systems and priorities to the magnitude of health inequities -- evidence, gaps, and a research agenda. Epidemiologic Reviews, 31, Dahl, E. et al. (2006) Welfare state regimes and health inequalities. In: Siegrist, J. and Marmot, M. (eds.) Social Inequalities in Health. Oxford: Oxford University Press. Eikemo, T. A. et al. (2008) Welfare state regimes and income-related health inequalities: A comparison of 23 European countries. European Journal of Public Health, 18(6), Eikemo, T.A. et al. (2008) Health inequalities according to educational level in different welfare regimes: A comparison of 23 European countries. Sociology of Health & Illness, 30(4), Muntaner, C. et al. (2011) Politics, welfare regimes, and population health: Controversies and evidence. Sociology of Health and Illness, 33(6), Navarro, V. and Shi, L. (2001) The political context of social inequalities and health. Social Science & Medicine, 52(3), Week 9: Power, Politics, and Policy (I) Raphael, Dennis. (2000) The question of evidence in health promotion. Health Promotion International, 15(4), (II) Bernier, N. F. and Clavier, C. (2011) Public health policy research: Making the case for a political science approach. Health Promotion International, 26(1), (III) Signal, L. (1998) The politics of health promotion: Insights from political theory. Health Promotion International, 13(3),

11 Bambra, C., Fox, D. and Scott-Samuel, A. (2005) Towards a politics of health. Health Promotion International, 20(2), Birn, A-E. (2009) Making it politic(al): Closing the Gap in a Generation: Health Equity through Action on the Social determinants of Health. Social Medicine, 4(3), Bryant, T. (2006) Politics, public policy, and population health. In: Raphael, D., Bryant, T. and Rioux, M. (eds.) Staying Alive: Critical Perspectives on Health, Illness, and Health Care. Toronto: Canadian Scholars Press. Navarro, V. (1989) Why some countries have national health insurance, others have national health services, and the U.S. has neither. Social Science and Medicine, 28(9), Stone, D. (1997) Policy Paradox: The Art of Political Decision Making. New York: Norton. Week 10: Population Health and Social Change (I) Raphael, D., Curry-Stevens, A. and Bryant, T. (2008) Barriers to addressing the social determinants of health: Insights from the Canadian Experience. Health Policy, 88, (II) Muntaner, C. et al. Barriers to knowledge production, knowledge translation, and urban health policy change: Ideological, economic, and political considerations. Journal of Urban Health. Advance Access. (III) Wainwright, D. (1996) The political transformation of the health inequalities debate. Critical Social Policy, 16, Hofrichter, R. (ed.) (2003) Health and Social Justice: Politics, Ideology, and Inequity in the Distribution of Disease. Jossey-Bass. Hofrichter, R. and Bhatia, R. (eds.) (2010) Tackling Health Inequities Through Public Health Practice: Theory to Action. Oxford: University of Oxford Press. Shoeni, R.F. et al. (eds.) Making Americans Healthier: Social and Economic Policy as Health Policy. New York: Russell Sage Foundation. Wallerstein, N. (2002) Empowerment to reduce health disparities. Scandinavian Journal of Public Health, 30, Week 11: Student Presentations Week 12: Student Presentations