ETHICAL ISSUES IN HEALTH POLICY: PUBLIC HEALTH AND HEALTH CARE Syllabus

306.625.01 | AY 2013-2014 - 2nd Term | 3 Credit(s)
M 1:30:00 PM
  • Course Format

    Lecture: Mondays 1:30-3:20 pm

    Case Discussion: Wednesdays 1:30-2:20 pm

  • Contact Information(from old syllabus)

    Faculty

    Holly Taylor, PhD, MPH

    Office: 1809 Ashland Ave., Deering Hall 205

    Tel: 410-614-5358

    e-mail: htaylor@jhsph.edu

    Teaching Assistants:

    Amy Paul, MPH

    e-mail: apaul@jhsph.edu

    Leila Jamal, ScM

    e-mail: ljamal@jhsph.edu

  • Course Learning Objectives

    Upon successfully completing this course, students will be able to:

    • Identify and consider ethical issues relevant to health policy, including analysis of Introduce students familiar with health policy to the role of ethics in assessment of policy options.
    • Identify and consider ethical issues relevant to health policy development and implementation.
    • Analyze policy options with new-found ethical skills and begin to reason through appropriate courses of action.
  • Course Description

    This course begins with an exploration of ethics, the moral relevance of health and the use of ethics in the assessment of health policy.  Students will become acquainted with a number of theories of justice.  Student will explore contemporary public health and health care policy issues using the lens of ethical analysis to supplement other approaches to policy analysis.  

     

  • Intended Audience
    Students interested in the ethical issues faced in the health policy arena.
  • Methods of Assessment

    Class Participation. You will come to class prepared to discuss articles assigned for each course session.  If at all possible, notify Instructor in advance if you know you will be absent.

    Article Assignment. Every week, starting Week 2 you will answer one question: What does this article have to do what we are learning in course? and develop one question for the class to consider - about one of the required readings assigned for that Week. You must complete this exercise for at least 4 of 7 sessions (Weeks 2-8).  There will be a drop box available for submissions.  Your assignment must be received by 12:00 pm EST the afternoon of class to receive credit.

    Paper. You will write a paper (at least 8 and no more than 10 pages double-spaced) of an ethics/health policy topic of your choice.  We will post well-written papers from past years.

    You will apply your newly acquired ethical analysis skills to a health policy topic.  The paper will be due on the last day of the term (11:59 pm EST, December 20, 2013). Any papers received late will be penalized one full grade for every 24 hours it is submitted after the deadline (e.g. an A paper will be given a B if received after 11:59 pm EST 12/21/13).   

    • By the December 9, 2013 (1:30 pm EST) you will submit a topic for review and approval by instructor.  Students are welcome to submit their proposed topics earlier in the term. 
    • You can also submit a proposed outline for review and feedback.  We will hold extra office hours during the week of 12/9/13 to meet with students.  Submission of an outline is recommended but not required.

     

  • Prerequisites
    Completion of 300.645.01 MAKING CHANGE THROUGH POLICY, or 300.600.81 INTRODUCTION TO HEALTH POLICY, or 300.651.01 INTRODUCTION TO THE U.S. HEALTHCARE SYSTEM, or equivalent.

    Additional Faculty Notes:

    Knowledge of health policy.

  • Grading Policy

    Article Assignment:  Assignments received after 12:00 pm on day of class will not receive credit.

    Paper Assignment.   The paper will be due on the last day of the term (11:59 pm EST, December 20, 2013). Any papers received late will be penalized one full grade for every 24 hours it is submitted after the deadline (e.g. an A paper will be given a B if received after 11:59 pm EST 12/21/13).   

  • Course topics

    Introduction

    Defining Terrain for Course/ Introduction to Framework for Analysis

    Justice/Social Justice

    Public Health Policy

    Access to Potentially Harmful Products

    Public Health Ethics and Screening Programs

    Preparedness

    Health Care Policy

    Allocation of Scarce Resources

    Evidence-based Decision-making

    Health Reform: Affordable Care Act

  • Course Schedule

    Please see the course Session for a full list of dates and items for this course.

  • Required Text(s)

    Readings will be posted via Welch Library Ares System.

    See bibliography for listing.

  • Course Bibilography

    Week1

    Readings:

    Churchill LR. 2002. What Ethics Can Contribute to Health Policy? Chapter 3 in Ethical Dimensions of Health Policy, edited by Marion Danis, Carolyn Clancy and Larry R. Churchill (New York: Oxford University Press): 51-64.

    Puts the ethics of health policy in context, relatively new enterprise.

    Baum NM, Gollust SE, Goold SE, Jacobson PD. 2007. Looking Ahead: Addressing Ethical Challenges in Public Health Practice.  Journal of Law, Medicine and Ethics 35(4): 657-667.

    Ethics framework to guide ethical decisions in practice, attention to role of state/local practitioners and policy makers.

    Recommended:

    Classic: Kass N. 2001. An Ethics Framework for Public Health. American Journal of Public Health 91(11):1776-1782.

    One of the first articles to propose a framework for evaluation of public health interventions. Cited by all efforts since.

    Kenny N, Giacomini M. 2005. Wanted: A New Ethics for Health Policy Analysis. Health Care Analysis 13(4) 247-260.

    Follow-up to Churchill.  Where do we go from here?

    Week 2:

    Readings:

    Classic: Beauchamp, D. 1976. Public Health as Social Justice. Inquiry 13(1): 3-14.

    One of the first articles to argue for a ‘community’-based ethics for public health.  Previous efforts apply clinical ethics framework for population-based health problems.

    DeBruin D, Liaschenko J, Marshall MF. 2012. Social Justice in Pandemic Preparedness. American Journal of Public Health 102(4): 586-591.

    Public health preparedness through the lens social justice.  Theory applied to practical public health issue.

    Gostin L, Powers M. 2006. What Does Social Justice Require for the Public's Health? Public Health Ethics and Policy Imperatives. Health Affairs 25(4):1053-1060.

    Accessible version of Powers/Faden theory of social justice specific to public health.

    Recommended:

    Braveman P, Kumanyika S, Fielding J, LaVeist T, Borrell, LN, Manderscheid R, Troutman A. 2011. Health Disparities and Health Equity: The Issue is Justice. American Journal of Public Health 101(S1): S149-S155.

    Provides excellent review of meaning of language/terms we use to describe population differences related to health status.  Also makes link to disparities and social justice.

    Reference:

    Powers M, Faden R.  2006. Chapter 4, Justice and Well-Being. Social Justice: The Moral Foundations of Public Health and Health Policy (New York: Oxford University Press): 80-99.

    Extended and dense version of Powers/Faden theory of social justice.  Those with background/interest in justice/social justice may want to read.

    Week 3:

    Readings:

    Koh HK, Sebelius KG. 2012. Ending the Tobacco Epidemic. JAMA 308(8):767-768.

    Administration’s policy and programmatic approach to reduce tobacco use.

    Brandt A. 2012. Inventing Conflicts of Interest: A History of Tobacco Industry Tactics.  AJPH. 102(1): 63-71.

    A comprehensive review of the tactics the Tobacco Industry used to divert attention from tobacco’s risk to the nation’s health.  Written by one of foremost Historians of Science and Public Health.

    Recommended:

    Brownell K, Warner K. 2009. The perils of ignoring history: Big tobacco played dirty and millions died. How similar is big food. Milbank Quarterly. 87(2):259–294.

    Review of Tobacco Industry tactics similar to Brandt (2012 with nice comparison to Food Industry tactics.  Table on pp. 270-273.

    Week 4

    Readings:

    Classic: Bayer R, Moreno J. 1986. Health Promotion: Ethical and Social Dilemmas of Government Policy. Health Affairs 5(2):72-85.

    Classic article that reviews key concepts in ethics of public health policy.

    Childress J, Faden R, Gaare R, Gostin L, Kahn J, Bonnie R, Kass N, Mastroianni A, Moreno J, Nieburg P. 2002. Public Health Ethics: Mapping the Terrain, Journal of Law Medicine and Ethics 30(2): 170-80.

    Along with Kass article posted as reference for Week 1 (i.e. those interested might want to consider reading it now if you haven’t yet), an early presentation of ethical issues to consider when evaluating public health interventions.

    Dawson A. 2011. The Moral Case for Routine Vaccination of Children in Developed and Developing Countries, Health Affairs 39(6): 1029-33.

    Great example of thorough ethical analysis of public health policy intervention.

    Reference:

    Classic: Faden R, Kass N, Powers M. 1991. Warrants for Screening Programs: Public Health, Legal and Ethical Frameworks in Faden, R., Geller, G., and Powers, M., Eds. AIDS, Women and the Next Generation: Towards a Morally Acceptable Public Policy for HIV Testing of Pregnant Women and Newborns (New York: Oxford University Press):3-26.

    Week 5

    Readings:

    Colgrove J, Bayer R. 2005. Manifold Restraints: Liberty, Public Health, and the Legacy of Jacobsen v. Massachusetts. American Journal of Public Health 95(4): 571-576.

    Traces history of what is now a classic tension in public health between individual liberty and state interest in promoting individual actions that contribute to overall health of the community.

    Kenny N, Sherwin S, Baylis F. 2010. Re-visioning Public Health Ethics: A Relational Perspective Canadian Journal of Public Health 101(1):9-11.

    Defense of adopting relational view into the ethics of public health, our lives are highly influenced by whom we live in relationship with from our family to neighborhood etc...  Moral relevance of these relationships ought to be considered in our ethical analysis of public health issues.  Brief application to preparedness.

    Prematunge C, Corace K, McCarthy A, Nair RC, Pugsley R, Garber G. 2012. Factors Influencing Pandemic Influenza Vaccination of Health Care Workers – A Systematic Review. Vaccine 30(32):4733-4743.

    Review of empirical studies regarding HCW willingness to be vaccinated.  Summary of key factors relevant to uptake.

    Reference:

    Kinlaw K, Barrett DH, Levine RJ. 2009. Ethical Guidelines in Pandemic Influenza: Recommendations of the Ethics Subcommittee of the Advisory Committee of the Director, Centers for Disease Control and Prevention. Disaster Medicine and Public Health Preparedness 3 (Suppl 2):S185–S192.

    Extensive review of ethical issues relevant to US based pandemic.

    Week 6

    Readings:

    Classic: Daniels N. 1994. Four Unresolved Rationing Problems: A Challenge. Hastings Center Report. 24(4): 27-29.

    Article defines four key problems when considering resource allocation in health care setting.

    Macklin R, Cowan E. 2012.  Given Financial Constraints, It Would Be Unethical To Divert Antiretroviral Drugs From Treatment To Prevention. Health Affairs 31(7):1537-44.

    Application of different perspectives on fair allocation of ARVs to those who are HIV-positive and need them for treatment versus those who are not HIV-infected but at risk of infection.

    Week 7

    Readings:

    Bayer R, Bachynski K. 2013. Banning Smoking in Parks and On Beaches: Science Policy, and the Politics of Denormalization.  Health Affairs 32(7): 1291-1296.

    Critique of promoting policy in absence of evidence of public health benefit.

    Pierce M, Maman S, Groves A, King E, Wyckoff. 2011. Testing Public Health Ethics:  Why the CDC.s HIV Screening Recommendations may Violate the Least Infringement Principle.  Journal of Law, Medicine and Ethics 39(2):263-71.

    Failure of empirical data to support policy change.

    Baicker K, Finkelstein A. 2011. The Effects of Medicaid Coverage – Learning from the Oregon Experiment. NEJM 365(8):683-685.

    Report of study conducted in Oregon that randomly assigned uninsured individuals eligible to receive access to health care or not.

    Recommended:

    Burke W, Laberge AM, Press N. 2010. Debating Clinical Utility. Public Health Genomics 13(4):215-223.

    Article does a great job of describing challenges when considering application of genetic tests to identify individual health traits are considered for use at population based level.  Article may be tough going for those without basic understanding of genetics.

    Week 8

    Readings:

    Classic: Fuchs V, Emanuel E. 2005.  Healthcare reform: Why? What? When? Health Affairs 24(6): 1399-1414.

    Tour de force regarding health care reform options and challenges/barriers in pursuing different options.

    Rulli T, Emanuel E, Wendler D. 2012. The Moral Duty to Buy Insurance. JAMA 308(2): 137-8.

    Concise argument in favor of the moral duty of all citizens to buy insurance.

    Gostin L. 2012. The Supreme Court’s Historic Ruling on the Affordable Care Act: Economic Sustainability and Universal Coverage. JAMA 308(6):571-572.

    Concise summary of Supreme Court decision on ACA.

    Recommended:

    Buchmueller T, Carey C, Levy H. 2013. Will Employers Drop Health Insurance Coverage Because Of The Affordable Care Act? Health Affairs 32(9):1522-1530.

    Review of data to date as to whether employers will opt to send employees to Exchanges for coverage.  Consideration of key factors that will influence employer behavior.

    Reference:

    Powers M, Faden R.  2006. Chapter 5, Medical Care and Insurance Markets. Social Justice: The Moral Foundations of Public Health and Health Policy (New York: Oxford University Press): 100-141.

    Extended and dense ethical analysis of reliance on markets for health care access and delivery from Powers/Faden book on their theory of social justice. 

  • Files from the Online Library
  • Academic Ethics Code

    Students enrolled in the Bloomberg School of Public Health of The Johns Hopkins University assume an obligation to conduct themselves in a manner appropriate to the University's mission as an institution of higher education. A student is obligated to refrain from acts which he or she knows, or under the circumstances has reason to know, impair the academic integrity of the University. Violations of academic integrity include, but are not limited to: cheating; plagiarism; knowingly furnishing false information to any agent of the University for inclusion in the academic record; violation of the rights and welfare of animal or human subjects in research; and misconduct as a member of either School or University committees or recognized groups or organizations.

  • Contact Information
    Faculty
    Holly Taylor
  • Disability Support Services
    If you are a student with a documented disability who requires an academic accommodation, please contact the Office of Student Life Services at 410-955-3034 or via email at dss@jhsph.edu.