Political Economy of Health and Marginalization UNI411 - Fall 2013 It is no measure of health to be well adjusted to a profoundly sick society.

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1 Political Economy of Health and Marginalization UNI411 - Fall 2013 It is no measure of health to be well adjusted to a profoundly sick society. Course Instructor: Faraz Vahid Shahidi faraz.vahidshahidi@utoronto.ca Class Hours: Tuesday, 5:00-8:00pm Class Location: UC 376 Office Hours: Tuesday, 4:00-5:00pm Office Location: D-302 COURSE DESCRIPTION - J. Krishnamurti This course examines the social production and distribution of health and illness within and across populations, with a particular focus on marginalized communities. The course undertakes a critical interrogation of marginality and its expression in the shape of social inequalities in health. A political economy approach is applied in order 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. The course will equip students with theoretical and empirical knowledge from a range of disciplines including epidemiology, political science, social policy, and sociology in order to facilitate a critical examination of current developments in research on the social determinants of health. COURSE OBJECTIVES This course will advance an understanding of: The impact of political economics on health and human welfare. The health and human welfare of marginalized populations. Interdisciplinary approaches to the study of health and human welfare.

2 PREREQUISITES Students enrolled in this course are required to have completed at least one of the following courses: UNI209: Introduction to Health HMB303: Global Health and Human Rights COURSE STRUCTURE This course is organized as a series of seminar meetings. There will be one seminar per week, and each seminar will last three hours long. Seminar time will be dedicated primarily to facilitated discussions that focus on the contents of readings assigned on a weekly basis. Students will share the responsibility of facilitating these class discussions with the course instructor. Given the centrality of these discussions to the course, students are expected to have read and reflected upon the assigned readings prior to each seminar. COURSE DROP DATE Please note that the final drop date for this course is Monday, November 4. Penalties may apply if students drop the course after this date. LATE PENALTIES Coursework that is handed in late is subject to a 5% penalty per day of lateness. COURSE COMMUNICATION Students should not hesitate to contact the course instructor if they have any questions or concerns. Students should make sure to use their University of Toronto address in all communications with the course instructor. Course updates and required readings will be posted on Portal. Please make sure to check the Portal page on a regular basis. GRADING For grading practices, please see the University of Toronto Faculty of Arts and Science Grading Policy: writing.utoronto.ca/advice/general/gradingpolicy. Additional guidelines will be made available throughout the course.

3 COURSE EVALUATION Participation (20%) As this is primarily a seminar course, students are expected to attend class and participate actively in class discussions. Participation grades will depend both on the quality of the student s class participation as well as on their ability to create a supportive pedagogical environment for their peers. Critical Seminar Paper (20%) Deadline: September 30 Students will complete one 1500 word critical seminar paper in response to the assigned readings from a week of their choice. Students will use this seminar paper as an opportunity to critically evaluate conceptual and methodological issues raised by the chosen set of readings. Students can seek guidance from the below section entitled Readings and Group Discussions for key questions that they may want to consider while formulating their seminar papers. Presentation (20%) Deadline: November 25 Students will work in pairs to prepare and deliver a 20 minute presentation on a marginalized population of their choice. The presentation should: (i) provide a definition of marginalization; (ii) introduce the marginalized population; and (iii) interrogate the health and human welfare of that population from a political economy approach. Students should make sure to leave the last five minutes of their presentation time to facilitate a question and answer period. Final Research Paper (40%) Deadline: December 17 Students will prepare a final research paper related to one or more themes covered in the course contents. The final paper should be between 3500 and 5000 words in length. This paper is expected to require a substantial amount of reading, research, and original thought. Students should aim to generate a paper of publishable quality and will be encouraged to submit their papers for publication.

4 ACADEMIC INTEGRITY All work submitted by a student should be the student s own work except where otherwise indicated. The University of Toronto treats every instance of academic dishonesty seriously. Students should review the following guidelines carefully: Should a student have any questions or concerns regarding standards of academic conduct, they are expected to seek out additional information. ACCESSIBILITY A range of disability-related 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. The Accessibility Services Office can be contacted at (416) or through disability.services@utoronto.ca. READINGS AND GROUP DISCUSSIONS Students should keep the following in mind as they engage with the course readings. How are health and illness conceptualized by the author and what does this tell us about their overall approach? What are the author s main ideas? What are the key assumptions underlying these ideas and how do they differ from those of others? Is the scope of the author s thesis sufficient? What is missing from the analysis? How would you change it? Critically appraise the strength of the author s 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 explicit and implicit policy implications presented by the author?

5 CORE TEXTS Armstrong, P., Armstrong, H., and Coburn, D. (eds.) (2001) Unhealthy Times: Political Economy Perspectives on Health and Care in Canada. Oxford: Oxford University Press. Bambra, C. (2011) Work, Worklessness, and the Political Economy of Health. Oxford: Oxford University Press. Doyal, L. (1983) The Political Economy of Health. London: Pluto Press. Krieger, N. (2011) Epidemiology and the People s Health: Theory and Context. Oxford: Oxford University Press. Navarro, V. (1976) Medicine Under Capitalism. New York: Prodist. Navarro, V. (ed.) (2001) The Political Economy of Social 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. Amityville: Baywood Publishing Company. O Campo, P. and Dunn, J. (eds.) (2011) Rethinking Social Epidemiology: Towards a Science of Change. New York: Springer Publishing. COURSE CURRICULUM Week 1: Introduction Week 2: Theorizing Marginalization Week 3: Theorizing Social Inequalities in Health Week 4: The Political Economy of Health Week 5: Income Inequality Week 6: Social Capital Week 7: Knowledge Production and Translation Week 8: Welfare Capitalism (I) Week 9: Welfare Capitalism (II) Week 10: Welfare Capitalism (III) Week 11: Student Presentations Week 12: Student Presentations

6 WEEK 1: INTRODUCTION 1. Freire, P. (1968) Pedagogy of the Oppressed. New York: Continuum. [Chapter 2] 2. Goldberg, D. (2009) In support of a broad model of public health: Disparities, social epidemiology, and public health causation. Public Health Ethics, 2(1), WEEK 2: THEORIZING MARGINALIZATION Who are the marginalized? How can we explain marginalization? What are the social, political, and economic implications of marginalization? 1. Vasas, E. (2005) Examining the margins: A concept analysis of marginalization. Advances in Nursing Sciences, 28(3), Perlman, J.E. (1975) Rio s favelas and the myth of marginality. Politics and Society, 5, WEEK 3: THEORIZING SOCIAL INEQUALITIES IN HEALTH How is marginalization linked to social inequalities in health? How can we conceptualize and understand social inequalities in health? What are the social, political, and economic origins of these inequalities? 1. Lofters, A. and O Campo, P. (2011) Differences that matter. In: O Campo, P. and Dunn, J. (eds.) Rethinking Social Epidemiology: Towards a Science of Change. New York: Springer Publishing. 2. Link, B. and Phelan, J. (1995) Social conditions as fundamental causes of disease. Journal of Health and Social Behaviour, 35(S), Navarro, V. (2009) What we mean by the social determinants of health. International Journal of Health Services, 39(3), WEEK 4: THE POLITICAL ECONOMY OF HEALTH What does it mean to study political economy? Can a political economy approach be applied to the study of health?

7 How does the political economy approach differ from alternative frameworks? 1. Waitzkin, H. (2007) Political economic systems and the health of populations: Historical thought and current directions. In: Galea, S. (ed.) Macrosocial Determinants of Population Health. New York: Springer. 2. Navarro, V. (1973) Medicine Under Capitalism. New York: Prodist. [Chapter 5] 3. 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), WEEK 5: INCOME INEQUALITY What does a political economic approach to income inequality imply? How can we best conceptualize the relationship between income inequality and health? 1. Wilkinson, R. and Pickett, K. (2010) The Spirit Level: Why Equality is Better for Everyone. London: Penguin Books. [Chapters 1, 2, and 3] 2. Muntaner, C. and Lynch, J. (1999) Income inequality, social cohesion, and class relations: A critique of Wilkinson s neo-durkheimian program. International Journal of Health Services, 29(1), Coburn, D. (2000) Income inequality, social cohesion and the health status of populations: The role of neo-liberalism. Social Science and Medicine, 51(1), WEEK 6: SOCIAL CAPITAL What is the relationship between social capital and health? Is social capital a useful concept for the study of social inequalities in health? Does the concept of social capital fit neatly within a political economy approach? 1. Hawe, P. and Shiell, A. (2000) Social capital and health promotion: A review. Social Science and Medicine, 51,

8 2. 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), Muntaner, C., Lynch, J., and Davey Smith, G. (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), WEEK 7: KNOWLEDGE PRODUCTION AND TRANSLATION What are the determinants of knowledge production and translation? How can we explain the existence of disparities between what we know about public health and how we practice it? 1. Muntaner, C. et al. (2012) Barriers to knowledge production, knowledge translation, and urban health policy change: Ideological, economic, and political considerations. Journal of Urban Health, 89(6), Murphy, K. and Fafard, P. (2011) Knowledge translation and social epidemiology: Taking power, politics and values seriously. In: O Campo, P. and Dunn, J. (eds.) Rethinking Social Epidemiology: Towards a Science of Change. WEEK 8: WELFARE CAPITALISM (I) What is welfare capitalism and how has it changed over time? Why and to what extfent does welfare capitalism differ across countries? Is welfare capitalism a useful concept for the study of social inequalities in health? 1. Pierson, C. (2006) Beyond the Welfare State? The New Political Economy of Welfare. Cambridge: Polity Press. [Chapters 1 and 2] WEEK 9: WELFARE CAPITALISM (II) What is welfare capitalism and how has it changed over time? Why and to what extent does welfare capitalism differ across countries? Is welfare capitalism a useful concept for the study of social inequalities in health?

9 1. Esping-Andersen, G. (1990) The three political economies of the welfare state. Canadian Review of Sociology, 26(1), Teeple, G. (2000) Globalization and the Decline of Social Reform: Into the Twenty- First Century. University of Toronto Press. [Introduction and Chapter 1] WEEK 10: WELFARE CAPITALISM (III) What is welfare capitalism and how has it changed over time? Why and to what extent does welfare capitalism differ across countries? Is welfare capitalism a useful concept for the study of social inequalities in health? 1. Jessop, B. (1999) The changing governance of welfare: Recent trends in its primary functions, scale, and modes of coordination. Social Policy & Administration, 33, 4, Sears, A. (1999) The lean state and capitalist restructuring: Towards a theoretical account. Studies in Political Economy, 59, WEEK 11: STUDENT PRESENTATIONS WEEK 12: STUDENT PRESENTATIONS

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