SYLLABUS SUBJECT TO CHANGE

Societies of the World 25 (SW25) Case Studies in Global Health: Biosocial Perspectives Fall 2011 Tuesdays and Thursdays, 10-11:30 am Northwest Labs B-103
COURSE DESCRIPTION: This interdisciplinary course is designed to introduce students to the field of global health. One among a number of courses discussing global health, it aims to frame global health's collection of problems and actions with a particular biosocial perspective. It first develops a toolkit of analytical approaches and then uses them to examine historical and contemporary global health initiatives with careful attention to a critical sociology of knowledge. The teaching team, made up of four practitioner-anthropologists, draws on experiences working in Asia, Africa, Eastern Europe, and the Americas, as well as an interdisciplinary body of literature, to investigate what the field of global health may include, how global health problems are defined and constructed, and how global health interventions play out in expected and unexpected ways. Aligned with the pedagogical goals of the Program in General Education, the course seeks to inspire and teach the following principles: Global awareness. This course aims to present a view of societies that enables students to recognize the role of distinctive traditions, governments, and histories in shaping health and well being. In addition, rather than framing a faceless mass of poor populations as the subject of global health initiatives, the course uses ethnographies and case studies to situate global health problems in relation to the lives of individuals, families, and communities. Grounding in social and historical analysis. The course demonstrates the value of social theory and historical analysis in understanding health and illness at individual and societal levels, as well as in identifying problems and devising solutions. Ethical engagement. Throughout the course, students will be asked to critically evaluate the ethical frameworks that have underpinned historical and contemporary engagement in global health. Students will be pushed to consider the moral questions of inequality and suffering as well as to critically evaluate various ethical frameworks that motivate and structure attempts to redress these inequities. A sense of inspiration and possibility. While the overwhelming challenges of global health could all too easily engender cynicism, passivity, and helplessness, in examining what has made particular leaders and interventions successful (and others less so), students learn that no matter how complex the field of global health and no matter how steep the challenges, it is possible to design, implement, and foster programs and policies that make enormous positive change in the lives of the worlds poorest and suffering people.

FACULTY: Dr. Paul Farmer Department of Global Health and Social Medicine, Harvard Medical School Contact: paul_farmer@hms.harvard.edu Dr. Arthur Kleinman Department of Anthropology, Faculty of Arts and Sciences Contact: kleinman@wjh.harvard.edu Dr. Salmaan Keshavjee Department of Global Health and Social Medicine, Harvard Medical School Contact: salmaan_keshavjee@hms.harvard.edu Dr. Anne Becker Department of Global Health and Social Medicine, Harvard Medical School Contact: anne_becker@hms.harvard.edu

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COURSE OBJECTIVES: This course strives to address the following questions: 1. What is global health? 2. What is the history of the field of global health? 3. How is global health studied? 4. How is global health practiced? 5. Who works in global health, and what do those people do? 6. In what direction is the field of global health moving, and how can I get involved? 7. How does social theory practically contribute to understanding specific global health and health delivery problems, and thereby lead to specific interventions? Together the teaching team and course participants will use a biosocial approach to critically examine global health, drawing on the ideas of clinical medicine, anthropology, history, public health, economics, and delivery science. Students will be encouraged to examine their own positions, perspectives, and roles in relation to work in global health. COURSE STAFF: Head of SW25 Student Advising: Nancy Dorsinville, Nancy_Dorsinville@hms.harvard.edu Head TF: Emily Harrison, SW25.htf@gmail.com Deputy Head TF: Sae Takada, SW25.htf@gmail.com Distance and Continuing Education (SSCI E-125) Head TF: Mike Westerhaus, Michael_Westerhaus@yahoo.com Teaching Fellows (SW25): Marty Alexander lalexand@fas.harvard.edu Felicity Aulino aulino@fas.harvard.edu Hsuan-Ying Huang wozzeck.huang@gmail.com Elissa Klinger eklinger6@gmail.com Tej Nuthulaganti tnuthul@gmail.com April Opoliner april.opoliner@gmail.com Pamela Scorza pscorza@hsph.harvard.edu Kim Sue kimberly.sue@gmail.com Teaching Fellows (SSCI E-125): Raj Panjabi panjabi.raj@gmail.com Jessica Perkins jperkins@fas.harvard.edu Sonya Soni ssoni@mail.harvard.edu COURSE LOGISTICS: Lectures Tuesdays and Thursdays, 10:00-11:30 am Northwest Labs B-103 N.B. Lecture slides and video recordings will be posted on the course website one to two days after the live lecture. Sections Sections are semi-structured spaces for students to clarify and question concepts presented in lectures and in readings. Sections will meet once weekly, beginning September 6, and be offered on Tuesdays and Wednesdays. Please submit section preferences by September 9 at 5pm. Sections will be assigned during the period between September 9 and September 11. No section changes will be allowed after September 12 at 5pm. In the week before sections are assigned please attend one of two special evening sections that will be offered on September 9 and September 10, with time and location TBD. In these sections we will go over course policies and review the material of Week 1 and Week 2. Students in the past have found review of these particular lectures extremely helpful.
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If five or more graduate students enroll in the course, a separate graduate student section will be held with Professor Kleinman. These sections will be held on the following Wednesdays from 3-4pm in the Asia Center, 1739 Cambridge Street, CGIS South, Room S114: September 14 and 28; October 19 and 26; November 2, 16, and 30 If fewer than five graduate students enroll in the course, graduate students will be integrated into the regular sections. Section policies are further described in the Course Policies section of this syllabus. Office Hours All students are welcome to attend and share their questions/comments with the faculty in a small group setting. In addition, all TFs are available and excited to meet with students. While your own TF is often your strongest resource given that he/she knows you and your work best, you are very welcome and encouraged to arrange to meet with any member of the teaching team. Professor Becker: Location TBD 11:30-12:30 on 10/11, 10/25, 11/1, 11/8 Professor Farmer: Location TBD 11:30-12:30 on 9/27, 11/8, 11/15 Professor Kleinman: CGIS South Room 114 (Asia Center) 11:30am-12:30pm on 9/6, 9/8. Location TBD 9/13, 11/15, 12/1. Additional Office Hours on Tuesdays 1:30 3pm at WJH 330. Please schedule via Michele Albanese albanese@fas.harvard.edu and Marilyn Goodrich goodrich@wjh.harvard.edu. Professor Keshavjee: Location TBD 11:30-12:30 on 10/4, 10/18, 11/29; Eliot House JCR 12-1:30 on 10/12 Head TF Emily Harrison: By appointment Deputy Head TF Sae Takada: By appointment. CGIS South Rm S330 Marty Alexander: Wednesday 3-4pm. Gen Ed Office, 4th Flr. Holyoke Center Felicity Aulino: Wednesday 12 or 2pm. WJH Hsuan-Ying Huang: Wednesdy 4-5pm. WJH 343 Elissa Klinger: Monday 8:30-9:30pm, or by appointment. CGIS Cafe Tej Nuthulaganti: Tuesday 2:30-3:30, or by appointment. Dudley House Cafe. April Opoliner: Tuesday 3-4. Gen Ed Office, 4th Flr. Holyoke Center Pamela Scorza: Tuesday 4-5pm, or by appointment. CGIS Cafe Kim Sue: Monday 11am-12pm, WJH 343 Evening Speakers There will be evening speakers over the course of the semester and students are strongly encouraged to attend. The evening speakers will include: Global Health Equity Residents Panel: Hilary Marston, Duncan Maru, Ruma Rajbhandari Raj Panjabi Bill Rodriguez Anjali Sastry Undergraduate Student Assignments There will be two reading assignments per week, one in preparation for each of the two lectures. The following written assignments will also be required over the course of the semester: Three Short Papers: 3-5 page essays responding specifically to given prompts will be due at the end of the first three blocks of the course. Paper 1: Due September 20 at 5pm Paper 2: Due October 6 at 5pm Paper 3: Due October 18 at 5pm Midterm Exam: proctored, closed-book, closed-note, in-class, 1.5 hr in-class exam on October 27 based on lectures, section discussions, and required readings Final Assignment (including proposal, TF meeting, and paper): Due Date TBD - A 15-page writing assignment prompting students to review and reconsolidate materials learned in the course and practice acquired critical thinking skills. Graduate Student Assignments There will be two reading assignments per week, one in preparation for each of the two lectures (see below for details).
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The following written assignments will also be required over the course of the semester: Final Paper Proposal: Final Paper Proposal and Annotated Bibliography: 1,000-word proposal including topic, research question, and timeline for completion; ALSO annotated bibliography laying out sources for final paper (detailed instructions will be given at a later date) Final Paper: 8,000- to 9,000-word research paper on topic related course, using course readings and outside research Reading Assignments: The reading assignment for each lecture is divided into three sections to help students manage their time. For each lecture there will be readings listed as Required, Course Text, and Recommended. Descriptions of each of the reading types are below: Required: All Required readings must be completed before attending section. It will help you to have them read before that day's lecture. Recommended: Recommended readings complement the other assigned readings. Students should use these readings to deepen and broaden their exploration of topics that interest them. Course Text: Course Text readings have been written by course faculty in direct coordination with the lectures presented in this course, and may help students review and understand the ideas presented in class. They are still under active revision, so please do not distribute. Your feedback and responses are also eagerly welcomed by the authors! Please email Matt Basilico at matt.basilico@gmail.com with any suggestions for the text. Books Recommended for Purchase: 1. Farmer, Paul. Haiti After the Earthquake. 2011. New York: Public Affairs. 2. Farmer, Paul. AIDS and Accusation. Berkeley: University of California Press. 3. Kleinman, Arthur. The Illness Narratives: Suffering, Healing, and the Human Condition. 1988. New York: Basic Books. 4. Kleinman, Arthur. What Really Matters: Living a Moral Life Amidst Uncertainty and Danger. 2006. New York: Oxford University Press. 5. Sourcebook 2011. Societies of the World 25, Case Studies in Global Health: Biosocial Perspectives. 6. Course Text: Volume I and Volume II. How to find reading assignments: All reading assignments are marked on the syllabus as purchased book, sourcebook, course text, on reserve, or online, indicating where you can find the material. Instructions on how to access the various types of reading assignments are below: Purchased book: The teaching team recommends that students purchase four books (see below). All are available at the COOP but are also easy to purchase through online sellers such as Amazon.com. Of course, it is not required to purchase these books; all three are on reserve at Lamont and Tozzer libraries. Sourcebook: Available for purchase at the COOP and on reserve at Lamont and Tozzer libraries. Course Text: Available at Gnomon Copy, in two volumes. Volume I will be ready at the beginning of the course. Volume II will be ready a few weeks into the semester. On reserve: Readings labeled on reserve (as well as the four books recommended for purchase and the sourcebook) are on reserve at Lamont and Tozzer libraries. Online: All online materials not posted on the website can be accessed through your Harvard account. There are many ways to access the assigned readings. The best first step is to download the software LiBX, which enables fast access to articles through Harvard: Use the following link: http://lib.harvard.edu/tools/libx.html. Go to the library E-Resources page at lib.harvard.edu. Using the citation information in the syllabus, find the article by going to E-Journals and searching for the relevant article, using the citation locator, or looking a database such as JSTOR, Anthrosource, or Pubmed. Learning how to use the E-Resources page will serve you well when it comes time to research papers for this class and for other classes, as well. Of note, you can also find most articles by using Google Scholar at http://scholar.google.com.ezp1.harvard.edu, logging in with your Harvard ID and PIN, and searching for the first several
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words of the title in quotes or part of the title and the authors name. Learn to love Google Scholar it will be enormously helpful for research papers and finding/accessing Harvards resources. Student Support Harvard College Writing Center: The Harvard College Writing Center is an incredible resource for students as they work to adapt their writing styles to master the assignments in this course (and other courses, as well). The Writing Center offers both scheduled appointments and drop-in hours, as per their website: http://isites.harvard.edu/icb/icb.do?keyword=k33202. In addition, they can be reached via email at wricntr@fas.harvard.edu. Lamont Library: Lamont Library offers individual consultations for students doing research projects. Such consultations may be helpful for students learning how to find resources and use citations appropriately in this course. More information about such consultations is available at http://hcl.harvard.edu/research/contacts/. Harvard librarians are eager to help you with your research, and they have a vast knowledge of resources that can greatly expand your research and learning both in this course and throughout your academic career. Bureau of Study Counsel: The Harvard Bureau of Study Counsel (BSC) offers diverse resources to students attempting to meet the demands of this course and others. Their services include peer tutoring, individual consultation, a reading/study strategies course, ESL support (practice with verbal language skills), LD/ADHD support, and study skills workshops. Information about their services and how to contact them is available at http://www.bsc.harvard.edu/. Harvard Global Health Institute (HGHI): HGHI is an all-inclusive hub for global health resources at Harvard. Information about study abroad/internship opportunities, global health-related resources and events, and research at Harvard is available at http://www.globalhealth.harvard.edu/icb/icb.do. ESL support: Many students may need support with English language skills. The Bureau of Study Counsel offers support for mastering spoken English, and the Writing Center offers support for mastering written English. Students are strongly encouraged to take advantage of both resources. Course Evaluations The course faculty and staff request that students thoughtfully complete the anonymous end-of-semester course evaluations. All of the faculty and staff take student comments very seriously and consider their feedback vital to improving the course, both within the course of this semester and for the future. Students' grades will not be released until end-of-semester course evaluations have been completed.

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COURSE POLICIES: Course Announcements You are responsible for keeping up-to-date with all emailed course announcements. All course-wide emails are archived for your reference on the eMailbag page of the course website. Course Enrollment This course has open enrollment. There is no cap on enrollment and no lottery. Lecture Attendance Lecture attendance is strongly recommended, as we encourage active participation and questions. Please silence all cell phones and laptops during lecture. Section Attendance Section attendance is absolutely mandatory; your presence and participation figure significantly into your evaluation. If you have an unavoidable conflict, you may request permission from your TF to attend a section other than your own. You must request permission in an email to your TF (even if the request is also made in person), CC-ing the TF for the section that you will be attending as a guest. This make-up section attendance will be allowed only one time with no penalty. If you become too sick to attend section on the same day the section is taking place and cannot make it to section, you must email your TF and the Head TF before the section begins. They will help you make a plan to attend another section. If you are sick for an extended period of time and must miss multiple sections, you must email your TF AND cc the Head TF to help you devise a make-up plan. You may miss one section with no penalty but must follow the protocol above. If you miss more than one section without sufficient reason (as deemed by the Head TF), your section participation grade will be lowered. Short Papers You are each responsible for writing three 3-5 page, double-spaced essays responding to specific prompts over the course of the semester. These papers will be graded by your section TF. Please see the Paper Expectations document on the course website for more detailed instructions. TFs and faculty will review drafts in-person during their office hours; they will not review drafts via email. Citations/References All references must be cited appropriately in all written work with the exception of the midterm exam, as it is a closedbook assignment. One of two citation formats may be used: 1. American Anthropologist/American Ethnologist: http://www.aaanet.org/publications/style_guide.pdf 2. American Psychological Association: http://www.apastyle.org/index.aspx Policy on Late Papers All assignments are due to the TF by 5 pm on the due date in the section-specific dropbox on the course website. If an assignment is turned in within 24 hours after the due date, it will be accepted but will be subject to a penalty. Undergraduate Student Grade Distribution Short Paper 1, 2 and 3: 10% each; at the end of the semester your best grade will be weighted at 15%. Midterm Exam: 25% Final Assignment: 30% (5% Proposal, 5% Meeting with TF, 20% Final Work) Participation: 10% Graduate Student Grade Distribution Final Paper: 70% Participation: 30% Pass/Fail and Audit Options
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Pass/fail enrollment in SW25 is not permitted. Auditors are permitted with permission of the faculty. Please contact Emily Harrison at SW25.HTF@gmail.com if you are interested in auditing the course. Academic Concerns Procedures If a student's performance becomes concerning over the course of the semester, the Head TF may contact the faculty course head, and the two together may contact the student's Resident Dean. Students should be aware that this procedure is designed to help them identify problems and find strategies for success rather than to penalize or punish them. Senior Thesis Writers Seniors currently writing theses (whether working on Fall 2011 or Spring 2012 deadlines) on topics relevant to the course may be eligible to turn in a modified chapter of their theses in lieu of their Final Assignment (like the Final Assignment, the chapter will be worth 25% of that student's grade). Any student in this position who would like to submit a modified thesis chapter in lieu of the Final Assignment must email his/her respective TF and the Head TF no later than Friday November 4, to discuss this possibility and request permission. The email should include the following: 1) concentration, 2) working thesis title, 3) short description of thesis topic, 4) name of thesis advisor, 5) email address for thesis advisor. Senior thesis writers who have Fall 2011 final thesis deadlines may be eligible for other minor accommodations in assignment load. All senior thesis writers working on Fall 2011 deadlines should email both their TFs and the Head TF as soon as possible and no later than Monday October 17. The email should include the following: 1) concentration, 2) thesis title, 3) thesis deadline, 4) name of thesis advisor, 4) email address for thesis advisor. Under FAS regulations, students must obtain written permission from their thesis advisors to turn in any portion of their theses to fulfill the paper requirement for this course (see 'Submission of the Same Work to More Than One Course' in the FAS Student Handbook). Please share this permission with your TF (whether over email or in hard copy) in addition to following the email requirements laid out above. Accessible Education If you have a letter of introduction from the Harvard University Accessible Education Office, please submit the letter to your section leader as soon as possible and no later than Friday September 16. In addition, please send an email to both your TF and the Head TF, with subject line SW25 Accessible Education, to confirm that you have submitted this letter to your TF, also no later than Friday September 16. The course faculty and staff are more than happy to make any necessary accommodations. The Accessible Education Office can also be contacted via its website at http://aeo.fas.harvard.edu/. Academic Integrity and Collaboration The Harvard University policy on collaboration states that collaboration on exams is not allowed unless explicitly permitted and that collaboration on all other assignments is allowed unless explicitly prohibited. Students should pay careful attention to upholding this policy. In addition, as described above, students are responsible for citing all references used in written work prepared out of class (including response papers, prcis, the final paper proposal, the annotated bibliography, the final exam, and the final paper). This is not necessary on the midterm exam, as it is a closed-book assignment. As stated above, one of two citation formats must be used: 1. American Anthropologist/American Ethnologist (AA/AE): http://www.aaanet.org/publications/style_guide.pdf 2. American Psychological Association (APA): http://www.apastyle.org/index.aspx

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COURSE SCHEDULE: I. So You Think You Have a Plan: Using Social Theory to Imagine the Unexpected in Global Health 09/01 - PAUL FARMER Haiti After the Earthquake: A Critical Sociology of Global Health 09/06 - ARTHUR KLEINMAN Four Social Theories - Biosocial Interactions; Unintended Consequences; Social Construction of Reality; and the Weberian Vision of Modernity 09/08 - ARTHUR KLEINMAN Three More Social Theories - Social Suffering, Biopower, and Local Moral Experience 09/13 - ERICA JAMES An Ethnography of Global Health Organizations in Haiti SHORT PAPER 1 DUE: 9/20 II. The History of Colonial Practices and Good Intentions: Global Health from the Colonial Period to the Present 09/15 - JEREMY GREENE Colonial Medicine and Its Legacies in Global Health 09/20 - JEREMY GREENE The Role of Biomedicine in Global Health 09/22 - EMILY HARRISON Point IV to the Rise of the World Bank: Discourses of Development and Global Health 09/27 - SALMAAN KESHAVJEE Neoliberalism as Development Theology 09/29 - SALMAAN KESHAVJEE Non-Governmental Organizations and the Delivery of Health Care SHORT PAPER 2 DUE: 10/6 III. The Biosocial: A Framework for Case Studies 10/04 - SALMAAN KESHAVJEE Exploring the Biosocial: MDR-TB as a Paradigm for Global Health 10/06 - SALMAAN KESHAVJEE Overcoming Structural Violence: MDR-TB care in Russia SHORT PAPER 3 DUE: 10/18 IV. Acting in a World of Unintended Consequences: Case Studies in Global Health 10/11 - JOE RHATIGAN Polio Vaccination in Uttar Pradesh 10/13 - PAUL FARMER Delivery Struggles in Rwanda 10/18 - MIKE WESTERHAUS Common Sense, Community Health Workers, and Malaria Control in Northern Uganda 10/20 - NAVA ASHRAF BRAC's TB Program: Pioneering DOT Treatment for TB in Rural Bangladesh 10/25 - OPHELIA DAHL From Ethnography to Action in Haiti: Why Ethnography Matters 10/27 - IN-CLASS MIDTERM EXAM V. Cross-Cutting Themes in Global Health 11/1 - ANNE BECKER Global Mental Health: Finding and Closing the Resource Gaps 11/3 - ANNE BECKER Eating Pathology, Suicide Risk and Rapid Social Change in Fiji: Low Visibility and High Vulnerability 11/8 - ALLAN BRANDT with AEB Transnational Capitalism: The Case of Global Tobacco 11/10 - JENNIFER LEANING with PF Humanitarianism and an Anthropological Perspective 11/15 - ARTHUR KLEINMAN Stigma and Mental Health 11/17 - KALPANA JAIN, SAM LOEWENBERG (RICHARD KNOX) Media and Global Health 11/22 - JULIO FRENK with PF and SK Strengthening Health Systems: The Case of Mexico and Its Global Implications 11/29 - GREGG GONSALVES with SK Policy and Advocacy 12/1 - LAST LECTURE with ALL Global Caregiving, and Closing Thoughts FINAL ASSIGNMENT DUE: TBD

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Lecture 1 Date: 9/1/11 Theme: So You Think You Have a Plan: Using Social Theory to Imagine the Unexpected in Global Health Title: Haiti After the Earthquake: A Critical Sociology of Global Health Lecturer: Paul Farmer Guiding Questions: 1. What happens in the aftermath of a catastrophic event, whether classed as natural or unnatural? 2. How do so-called global health interventions influence what happens after a catastrophe in ways both intended and unintended ways? 3. Why is a critical sociology of knowledge around such interventions important? Readings:
Course Text Required Recommended Source Chapter 1. Introduction Farmer, Paul. 2011 Haiti After the Earthquake Petryna, Adriana 2002 Life Exposed: Biological Citizens After Chernobyl. Princeton: Princeton University Press. Which parts? Chapter 1 pp. i-245 (by end of Lecture 4) pp. 9-16, 115143 Where to find it? Purchased Book Purchased Book On reserve

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Lecture 2 Date: 9/6/11 Theme: So You Think You Have a Plan: Using Social Theory to Imagine the Unexpected in Global Health Title: Four Social Theories - Biosocial Interactions; Unintended Consequences; Social Construction of Reality; and the Weberian Vision of Modernity Lecturer: Arthur Kleinman Guiding Questions: 1. Why do we care about social theory when talking about global health? How can social theory influence global health practice, and what are its limitations? 2. Delineate and explain each of Kleinmans social theories for global health. Based on readings and lectures covered thus far, can you think of alternative or complementary theories to those Kleinman suggests? 3. What does social construction of knowledge mean? Without challenging existing biological bases of infectious disease, explain how diseases like epilepsy, leprosy, and HIV/AIDS can be conceptualized as socially constructed. 4. Define biosocial. 5. Define the theory of unintended consequences. Why might it be important to people working against child malnutrition in Swaziland?

Readings:
Course Text Required Source Chapter 2: Unpacking Global Health Kleinman, Arthur 2010 Four Social Theories for Global Health. Lancet 375(9725):1518-9. Merton, Robert K. 1936 The Unanticipated Consequences of Purposive Social Action. American Sociological Review 1:894-904. Weber, Max 1946 On Bureaucracy. In From Max Weber: Essays in Sociology. New York: Oxford University Press. Berger, Peter L. and Thomas Luckmann 1967 The Social Construction of Reality: A Treatise in the Sociology of Knowledge. Garden City: Anchor Books. Kleinman, Arthur 2006 What Really Matters: Living a Moral Life Amidst Uncertainty and Danger. New York: Oxford University Press. Weber, Max 1949 Objectivity in Social Science and Social Policy. In The Methodology of the Social Sciences. Glencoe: Free Press. Berger, Peter L. and Thomas Luckmann 1967 The Social Construction of Reality: A Treatise in the Sociology of Knowledge. Garden City: Anchor Books. Which parts? Chapter 2 All All Where to find it? Purchased Book Online Online

pp. 196-204, 224-44 pp. 52-67

Sourcebook

Sourcebook

Chapter 1 (Introduction) All

Purchased book

Recommended

On reserve

pp. 92-127 (Legitimation)

On reserve

Faculty Office Hours: Arthur Kleinman, 11:30 12:30, CGIS South Room 114 (Asia Center) Special Sections This Week Only Please attend one of the following sections, in which a team of TFs will review theory and course policies: Thursday 9/8/11: Time and Location TBD Friday 9/9/11: Time and Location TBD

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Lecture 3 Date: 9/8/11 Theme: So You Think You Have a Plan: Using Social Theory to Imagine the Unexpected in Global Health Title: Three More Social Theories - Social Suffering, Biopower, and Local Moral Experience Lecturer: Arthur Kleinman Guiding Questions: 1. What is social suffering? 2. Define biopower. How is the concept of biopower relevant to global health? 3. Why is attention to local experience important in global health programs and initiatives? Give examples. 4. Returning to the questions this course began with, why do we care about social theory when talking about global health? How can social theory influence global health practice,and what are its limitations? 5. What does political economy mean? How does it relate to the social construction of knowledge and the other social theories we are examining in this course? Readings:
Required Source Farmer, Paul 2010 Partner to the Poor. Berkeley: University of California Press. Chapter 16: On Suffering and Structural Violence Pfeiffer, James and Mark Nichter 2008 What Can Critical Medical Anthropology Contribute to Global Health?: A Health Systems Perspective. Medical Anthropology Quarterly 22(4):410-5. Kleinman, Arthur, Veena Das, and Margaret Lock, eds. 1997 Social Suffering. Berkeley: University of California Press. Foucault, Michel 1990 The History of Sexuality: An Introduction. London: Penguin. Feierman, Steven, Arthur Kleinman, Kearsley Stewart, Paul Farmer, and Veena Das 2010 Anthropology, Knowledge-Flows, and Global Health. Global Public Health 5(2): 122-8. Lockhart, Chris 2008 The Life and Death of a Street Boy in East Africa: Everyday Violence in the Time of AIDS. Medical Anthropology Quarterly 22:94115. Turshen, Meredith 1989 The Politics of Public Health. New Brunswick, New Jersey: Rutgers University Press. Kim, Jim and Paul Farmer 2008 Chapter 2: Global Issues in Medicine. In Harrisons Principles of th Internal Medicine, 17 Edition. New York: McGraw-Hill. Morgan, D. and I. Wilkinson 2001 The Problem of Social Suffering and the Sociological Task of Theodicy. European Journal of Social Theory 4(2):199-214. Which parts? Chapter 16 Where to find it? Sourcebook

All

Online

Introduction Part V: Right of Death and Power over Life All

Sourcebook Sourcebook

Online (posted directly on course website) Online

Recommended

All

Chapters 1, 2, and 3 All (of Chapter 2)

On reserve

Online (via HOLLIS)

All

Online

Faculty Office Hours: Arthur Kleinman, 11:30 12:30, CGIS South Room 114 (Asia Center) Special Sections This Week Only Please attend one of the following sections, in which a team of TFs will review theory and course policies: Thursday 9/8/11: Time and Location TBD Friday 9/9/11: Time and Location TBD
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Lecture 4 Date: 9/13/11 Theme: So You Think You Have a Plan: Using Social Theory to Imagine the Unexpected in Global Health Title: An Ethnography of Global Health Organizations in Haiti Lecturer: Erica James Guiding Questions: 1. How is truth complicated by politics in James' descriptions of aid organizations in Haiti? 2. What social theories does James use to frame and investigate her experience? 3. How would you describe and explain some of the unintended consequences of the purposive actions taken by people participating in the aid industry? How are well-intentioned actions influenced by bureaucratic structures? 4. How are various different stakeholders victims in the aid relationship? How are they agents? Readings:
Course Text Required Source Chapter 9. Values in Global Health: Human Rights and Moral Frameworks James, Erica C. 2010 Democratic Insecurities. Berkeley: University of California Press. Introduction: Democracy, Insecurity, and the Commodification of Suffering James, Erica C. 2010 "Ruptures, Rights and Repair: The Politics of Truth in Haiti," Social Science and Medicine, Special Issue on Conflict, Violence and Health," 70(1): 106-113. James, Erica C. 2008 "Haunting Ghosts: Madness, Gender and Ensekirite in Haiti in the Democratic Era" In Postcolonial Disorders, edited by Mary-Jo DelVecchio Good, Sandra Hyde and Byron Good. University of California Press. pp. 132-156. Which parts? Chapter 9 Introduction Where to find it? Course Text Sourcebook

All

Online

All

Sourcebook

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Lecture 5 Date: 9/15/11 Theme: The History of Colonial Practices and Good Intentions: Global Health from the Colonial Period to the Present Title: Colonial Medicine and Its Legacies in Global Health Lecturer: Jeremy Greene Guiding Questions: 1. Why is it important to study the history of colonial medicine when studying global health? 2. What are some of the consequences of the original preoccupation with tropical diseases for todays global health? 3. How did the medicalization of difference justify the colonial endeavor? 4. How can anthropology and other social theory be limiting? What are the criticisms of culturalist anthropology? Of modernization and development theory? 5. How does Foucaults concept of biopower fit into the story of colonial medicine and its legacies in global health? 6. Compare different disease eradication strategies in light of the critiques made in this weeks readings. Readings:
Course Text Required Source Chapter 3: Colonial Medicine and its Legacies Worboys, Michael 1976 The Emergence of Tropical Medicine. In Perspectives on the Emergence of Scientific Disciplines. London: Routledge. Manson, Patrick 1897 The Necessity for Special Education in Tropical Medicine. Lancet 150(3866):842-5. Greenough, Paul 1995 Intimidation Coercion, and Resistance in the Final Stages of the South Asian Smallpox Eradication Campaign, 1973-1975. Social Science and Medicine 41(5):633-45. Vaughan, Megan 1991 Curing Their Ills: Colonial Power and African Illness. Palo Alto: Stanford University Press. Starn, Orin 1991 Missing the Revolution: Anthropologists and the War in Peru. Cultural Anthropology 6:63-91. Packard, Randall 1997 Malaria Dreams: Postwar Visions of Health and Development in the Third World. Medical Anthropology 17:279-96. Escobar, Arturo 1995 Encountering Development. Princeton: Princeton University Press. Fort, Meredith, Mary Ann Mercer, and Oscar Gish, eds. 2004 Sickness and Wealth. Cambridge, Massachusetts: South End Press. Litsios, Socrates 1997 Malaria Control, the Cold War, and the Postwar Reorganization of International Assistance. Medical Anthropology 17:255-78. Birn, Anne-Emanuelle and Armando Solrzano 1999 Public Health Policy Paradoxes: Science and Politics in the Rockefeller Foundations Hookworm Campaign in Mexico in the 1920s. Social Science and Medicine 49(9):1197-1213. Which parts? Chapter 3 Pp. 75-98 Where to find it? Course Text Sourcebook

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Lecture 6 Date: 9/20/10 Theme: The History of Colonial Practices and Good Intentions: Global Health from the Colonial Period to the Present Title: The Role of Biomedicine in Global Health Lecturer: Jeremy Greene Guiding Questions: 1. How has the impact of modern biomedical therapeutics varied by place, time, socioeconomic status, race, and gender? 2. Looking back over the past two centuries, how do we evaluate the role of biomedicine in comparison to other interventions, such as nutrition, sanitation, economic growth, human rights protections, democratic institutions, and others in reducing mortality and morbidity? 3. What should the role of biomedicine be in improving health today? 4. How might you explain the false-dichotomy between public health and medicine? Readings:
Required Source Greene, Jeremy 2011 Making Medicines Essential: The Emergent Centrality of Pharmaceuticals in Global Health. BioSocieties 6: 10-33. McDermott, Walsh 1980 Pharmaceuticals: Their Role in Developing Countries. Science 209(4453):240-5. 11 July, 1980. Kleinman, Arthur 1995 A Critique of Objectivity in International Health. In Kleinman, Arthur, Writing at the Margins. Berkeley: University of California Press. Brandt, Allan 2000 Antagonism and Accommodation: Interpreting the Relationship Between Public Health and Medicine in the United States During the 20th Century. American Journal of Public Health 90:707-15. Colgrove, James 2002 The McKeown Thesis: A Historical Controversy and Its Enduring Influence. American Journal of Public Health 92(5): 725-729. Greene, Jeremy 2007 Prescribing by Numbers: Drugs and the Definition of Disease. Baltimore: Johns Hopkins University Press. Szreter, Simon 2002 Rethinking McKeown: The Relationship Between Public Health and Social Change. American Journal of Public Health 92(5):722-5. McKinlay, John B. And Sonja M. McKinlay 1977 The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century. In The Milbank Memorial Fund Quarterly. Health and Society 55(3):405-28. Cutler, D., A. Deaton, A. Lleras-Muney. 2006 The Determinants of Mortality. Journal of Economic Perspectives 20(3):197-20. Rosenberg, Charles 1979 The Therapeutic Revolution: Medicine, Meaning, and Social Change in Nineteenth-Century America. In The Therapeutic Revolution, Morris Vogel and Charles Rosenberg, eds. Philadelphia: University of Pennsylvania Press. Pellegrino, Edmund 1979 The Sociocultural Impact of Twentieth-Century Therapeutics. In The Therapeutic Revolution, Morris Vogel and Charles Rosenberg, eds. Philadelphia: University of Pennsylvania Press. Which parts? All Where to find it? Sourcebook

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Lecture 7 Date: 9/22/11 Theme: The History of Colonial Practices and Good Intentions: Global Health from the Colonial Period to the Present Title: Point IV to the Rise of the World Bank: Shifting Discourses of Development and Global Health Lecturer: Emily Harrison Guiding Questions: 1. 2. 3. 4. What brought about Alma-Ata? What were Alma-Atas legacies? Compare and contrast PHC and SPHC. How do the structures of power, status, and decision-making within institutions such as the WHO, IMF and World Bank influence the policies and programs they develop?

Readings:
Course Text Required Source Chapter 4: Bold Visions and Neoliberalism Baumgartner, Leona. 1962 "The Emerging Adventure in World Health." New York: American Public Health Association. READ FULL VERSION AVAILABLE AT LINK:
http://ajph.aphapublications.org.ezp-prod1.hul.harvard.edu/cgi/reprint/53/4/544

Which parts? Chapter 4 All

Where to find it? Purchased Book Online

Recommended

Cueto, Marcos 2004 The Origins of Primary Health Care and Selective Primary Health Care. American Journal of Public Health 94(11):1864-74. Text of Alma Ata Listios, Socrates 2002 The Long and Difficult Road to Alma Ata: A Personal Reflection. International Journal of Health Services 32(4):709-32. Adamson, Peter 2001 The Mad American. In Jim Grant: UNICEF Visionary, Richard Jolly, ed. Florence: UNICEF. Buse, Kent and Gill Walt 2000 Role Conflict? The World Bank and the Worlds Health. Social Science and Medicine 50(2):177-9. Walsh J A & Warren K S 1979 Selective primary health care: an interim strategy for disease control in developing countries. NEJM 301. pp. 967-74. UNICEF 1987 Adjustment with a Human Face. Oxford: Clarendon Press. Jolly, R 1991 Adjustment with a Human Face: A UNICEF Record and Perspective on the 1980s. World Development 19(12):1807-21. Brown, Theodore, Marcos Cueto, and Elizabeth Fee 2006 The World Health Organization and the Transition from International to Global Public Health. American Journal of Public Health 96(1):62-72. Pavignani, Enrico 2000 Can the World Bank Be an Effective Leader in International Health? Social Science and Medicine 50(2):181-2. Ruger, JP 2005 The Changing Role of the World Bank in Global Health. American Journal of Public Health 95:60-70.

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Lecture 8 Date: 9/27/11 Theme: The History of Colonial Practices and Good Intentions: Global Health from the Colonial Period to the Present Title: Neoliberalism as Development Theology Lecturer: Salmaan Keshavjee Guiding Questions: 1. What is driving the agenda in international health: health needs or economic models? 2. How do the architects of structural adjustment policies conceptualize the market? How do they conceptualize the state? 3. What is the association between health and poverty? Health and inequality? What are the implications of poverty trap theory for interventions? 4. How best can measures of health, such as the DALY or QALY, be reconciled with local experience? Are there alternative (or preferable) ways to quantify morbidity and mortality? Readings:
Course Text Required Source Reread: Chapter 4. Bold Visions and Neoliberalism Jamison, Dean, et al. 2006 Cost-Effectiveness Analysis. In Priorities in Health. Washington, DC: The World Bank. Anand, Sudhir and Kara Hanson 1997 Disability-Adjusted Life Years: A Critical Review. Journal of Health Economics 16:685-702. Kim, Jim, et al. 2000 Dying for Growth: Global Inequality and the Health of the Poor. Boston: Common Courage Press. Rowden, Rick 2009 The Deadly Ideas of Neoliberalism: How the IMF Has Undermined Public Health and the Fight Against AIDS. New York: Zed Books. Murray, Christopher 1994 Quantifying the Burden of Disease: The Technical Basis for Disability-Adjusted Life Years. Bulletin of the World Health Organization 72:429-45. World Bank 1993 World Development Report. Oxford: Oxford University Press. WHO 2001 Executive Summary of the Report. Macroeconomics and Health: Investing in Health for Economic Development. Rodrik, Dani 2006 Goodbye Washington Consensus, Hello Washington Confusion? Journal of Economic Literature XLIV:973-987. Reread: Kleinman, Arthur 1995 A Critique of Objectivity in International Health. In Kleinman, Arthur, Writing at the Margins. Berkeley: University of California Press. Sen, Amartya 1994 Objectivity and Position: Assessment of Health and Well-being. In Chen, Lincoln, Arthur Kleinman, and Norma Ware, eds. Health and Social Change in an International Perspective. Boston: Harvard University Press. Which parts? Chapter 4 Chapter 3 (pp. 39-57) All Where to find it? Purchased Book Online

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Lecture 9 Date: 9/29/10 Theme: The History of Colonial Practices and Good Intentions: Global Health from the Colonial Period to the Present Title: Non-Governmental Organizations and the Delivery of Health Care Lecturer: Salmaan Keshavjee Guiding Questions:
1. 2. 3. 4. Describe various ways in which NGOs can be connected to the societies in which they work. How do NGOs funding structures influence the policies that they implement and vice versa? Does the neo-liberal agenda affect the function of NGOs? How would you define global civil society? Does it exist? 5. What does public-private partnership mean? Give an example of coordination between public and private entities.

Readings:
Course Text Required Source Chapter 5. AIDS and the New Global Health Paradigm Keshavjee, Salmaan 2004 The Contradictions of a Revolving Drug Fund in Post-Soviet Tajikistan: Selling Medicines to Starving Patients. In Castro, Arachu and Merill Singer, eds. Unhealthy Health Policy: A Critical Anthropological Examination. Walnut Creek, California: Altamira Press. Pp. 91-117. Okuonzi, S.A. and J. Macrae 1995 Whose Policy is it Anyway? International and National Influences on the Health Policy Development in Uganda. Health Policy and Planning 10(2):122-132. Edwards, M. and D. Hulme 1996 Introduction. In M. Edwards and D. Hulme, eds. Beyond the Magic Bullet: NGO Performance and Accountability in the Post-Cold War World. West Hartford, Connecticut:Kumarian. Pp. 1-22. Zaidi, S.A. 1999 NGO Failure and the Need to Bring Back the State. Journal of International Development 11:259-71. Stein, Howard 2008 Transcending Neoliberal Health Policies. In Beyond the Old Bank Agenda: An Institutional Approach to Development. Chicago: University of Chicago Press. Brugha, Ruari and Anthony Zwi 2002 Global Approaches to Private Sector Provision: Where Is the Evidence? In Lee, Kelley, Kent Buse, and Suzanne Fustukian, eds. Health Policy in a Globalizing World. Cambridge: Cambridge University Press: 63-77. Pearce, Jenny 2000 Development, NGOs, and Civil Society: The Debate and Its Future. In Development, NGOs, and Civil Society. Oxfam: 15-43. Odinkalu, Chidi 1999 Why More Africans Dont Use Human Rights Language. Human Rights Dialogue 2(1). Reich, M.R. 2002 Reshaping the State from Above, from Within, from Below: Implications for Public Health. Social Science and Medicine 54(2002):1669-75. Clarke, G. 1998 Non-governmental Organizations (NGOs) and Politics in the Developing World. Political Studies, XLVI:36-52. Keane, John 2003 Unfamiliar Words. In Global Civil Society? Cambridge: University Press. Pp. 1-39. Which parts? Chapter 5 All Where to find it? Purchased Book Sourcebook

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Chapter 8 (pp. 207-248)

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Lecture 10 Date: 10/4/11 Theme: The Biosocial: A Framework for Case Studies Title: Exploring the Biosocial: MDR-TB as a Paradigm for Global Health Lecturer: Salmaan Keshavjee Guiding Questions: 1. How was the global problem around MDR-TB constructed (e.g. on the basis of science, cost, morality, etc.)? What forms of knowledge were treated as valuable (e.g. that of multilateral organizations, physicians, and fieldbased practitioners)? 2. What type of information informs the construction of different models of disease progression? How does this feed into the creation of policy? 3. Do you see biopower working in this case? How? 4. What does this example tell us about the processes of thinking that govern international health? Readings:
Required Source Farmer, Paul 1997 Social Scientists and the New Tuberculosis. Social Science and Medicine 44(3): 347-358. Coker, Richard 2000 Extrapolitis: A Disease More threatening than TB in Russia? European Journal of Public Health 10(2):148-9. Farmer, Paul E. and Jim Yong Kim 2000 Resurgent TB in Russia: Do We Know Enough to Act? European Journal of Public Health 10(2):150-3. Keshavjee S and Farmer PE. Time to put boots on the ground: making universal access to MDR-TB treatment a reality. Int J Tuberc Lung Dis 2010, 14(10):12221225. Keshavjee S and Farmer PE. Picking up the Pace Scale-up of MDR Tuberculosis Treatment Programs. New England Journal of Medicine, November 4, 2010, 369(19):1781-1784. Program in Infectious Disease and Social Change 1999 The Global Impact of Drug-Resistant Tuberculosis. Boston: Harvard Medical School and the Open Society Institute. Cohen T, Sommers B, Murray M 2003 The Effect of Drug Resistance on the Fitness of Mycobacterium tuberculosis. Lancet Infectious Disease 3(1):13-21. Kim, Jim Y., et al. 2005 Limited Good and Limited Vision: Multi-drug Resistance Tuberculosis and Global Health Policy. Social Science and Medicine 61(4):847-59. Reread: Foucault, Michel 1990 The History of Sexuality: An Introduction. London: Penguin. Which parts? All Where to find it? Online

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Lecture 11 Date: 10/6/11 Theme: The Biosocial: A Framework for Case Studies Title: Overcoming Structural Violence: MDR-TB care in Russia Lecturer: Salmaan Keshavjee Guiding Questions: 1. What is structural violence and how does it manifest itself? 2. How can health programs overcome the effects of structural violence? 3. What were the particular factors affecting health in Russia in the post-Soviet period? How are these linked to broader global trends already discussed in the course? Readings:
Required Source Field, Mark G., David M. Kotz, and Gene Bukhman 2000 Neoliberal Economic Policy, State Desertion, and the Russian Health Crisis. In Dying for Growth: Global Inequality and the Health of the Poor. Boston: Common Courage Press. Program in Infectious Disease and Social Change 1999 The Global Impact of Drug-Resistant Tuberculosis. Boston: Harvard Medical School and the Open Society Institute. Keshavjee, S., I. Gelmanova, A. Pasechnikov, S. Mushustin, Y. Andreev, J. Furin, J.S. Mukherjee, M. Rich, E. Nardell, P.E. Farmer, J.Y. Kim, S.S. Shin 2008 Treating Multi-Drug Resistant Tuberculosis in Tomsk, Russia: Developing Programs that Address the Linkage Between Poverty and Disease. Annals of the New York Academy of Sciences 1136:1-11. Gelmanova IY, Taran DV, Mishustin SP, Golubkov AA, Solovyova AV, Keshavjee S. 2011 Sputnik: A programmatic approach for improving TB treatment adherence and outcome among treatment defaulters. International Journal of Tuberculosis and Lung Disease, Forthcoming. Erofeyev, Victor 2002 The Russian God: Vodka Celebrates its Five-Hundredth Anniversary. New Yorker. December 16, 2002. Galtung, J 1969 Violence, Peace, and Peace Research. Journal of Peace Research 6:167-91. Farmer, Paul 2004 An Anthropology of Structural Violence. Current Anthropology 45:305-26. Wacquant, Loic 2004 Response to: Farmer, An Anthropology of Structural Violence. Current Anthropology 45:322. Gidden, Anthony 1972 Emile Durkheim; Selected Writings. London: Cambridge University Press. Lock, Margaret and V.K. Nguyen 2010 An Anthropology of Biomedicine. Wiley-Blackwell. Chapter 4: Local Biologies and Human Difference. 83-108. Which parts? Pp. 155-73 Where to find it? Sourcebook

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Lecture 12 Date: 10/11/11 Theme: Acting in a World of Unintended Consequences: Case Studies and Cross-Cutting Themes in Global Health Title: Polio Vaccination in Uttar Pradesh Lecturer: Joe Rhatigan Guiding Questions: 1. What does it mean for a vaccination campaign to "work"? Can it work technically without working politically? Ethically? Morally? Historically? 2. Who are vaccination campaigns for? How do the various intuitions about the answer to this question shape what actions are acceptable? 3. What social theories can you use to help explain the scenario described in this case? How is polio vaccination a biosocial issue? 4. What issues that come up in polio vaccination campaigns might be similar in other vaccination campaigns, such as HPV? How might the priority issues differ? Readings:
Required Source CASE STUDY Polio elimination in Uttar Pradesh Bhattacharya S. A Tale of Two Global Health Programs: Smallpox Eradication's Lessons for the Antipolio Campaign in India. AJPH 2009 99(7): 1176-1184. Polio Basics: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002375/ Smallpox Basics: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002332/ Measles Basics: http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002536/ Bloom DE, Canning D, Weston M. The Value of Vaccination. World Economics 2005; 6(3):15-40. Kaufmann JR, Feldbaum H. Diplomacy And The Polio Immunization Boycott In Northern Nigeria. Health Affairs 2009;28(4): 1091-1101 Jegede AS. What Led to the Nigerian Boycott of the Polio Vaccination Campaign? PLoS Med 2007; 4(3): e73. Which parts? All All Where to find it? Online Online

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Lecture 13 Date: 10/13/11 Theme: Acting in a World of Unintended Consequences: Case Studies and Cross-Cutting Themes in Global Health Title: Delivery Struggles in Rwanda Lecturer: Paul Farmer Guiding Questions:
1. 2. 3. 4. 5. 6. What are the major challenges facing the Rwandan health care system? How do they differ between urban and rural areas? What is PIH's model of HIV/AIDS care delivery? How does the PIH model of care compare to approaches taken by other NGOs delivering HIV/AIDS care in Rwanda? Do you have enough information to assess this? Why has the PIH program in Rwanda been successful so far? How can the model be improved? Should PIH spread the model to other districts in Rwanda? If yes, how? Start to think about the term structural as we have encountered it in this course. What is the meaning of structural when speaking of structural adjustment? Structural violence? In Rwanda, both structural adjustment and structural violence were at play. Uvin argues that they were connected and that development and humanitarian aid to Rwanda in the years prior to the genocide helped to set the stage for what was to occur. What does he mean?

Readings:
Course Text Required Source Chapter 6: Building an Effective Health Delivery Model in Rural Haiti and Rwanda CASE STUDY HIV Care in Rwanda Farmer, Paul and Bruce Nizeye, Sara Stulac, Salmaan Keshavjee 2010 Partner to the Poor. Berkeley: University of California Press. Chapter 18: Structural Violence and Clinical Medicine
http://www.plosmedicine.org/article/info%3Adoi%2F10.1371%2Fjournal.pmed.003 0449

Which parts? Chapter 6 All All

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Recommended

Uvin, Peter 1998 Aiding Violence. West Hartford, Connecticut: Kumarian Press. Kinzer, Stephen 2008 A Thousand Hills: Rwandas Rebirth and the Man Who Dreamed It. Hoboken: Wiley. Gourevitch, Peter 1999 We Wish to Inform You that Tomorrow We Will Be Killed with Our Families. New York: Farrar, Straus, and Giroux.

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Lecture 14 Date: 10/18/11 Theme: Acting in a World of Unintended Consequences: Case Studies and Cross-Cutting Themes in Global Health Title: Common Sense, Community Health Workers, and Malaria Control in Northern Uganda Lecturer: Mike Westerhaus Guiding Questions: 1. What are the commonsensical responses to malaria in global health? 2. How can a biosocial understanding of malaria in Northern Uganda influence the design of potential responses? 3. What elements of a community health worker model are important to develop a sustainable program? 4. How do commonsensical practices in global health both allow practitioners to act meaningfully in the world yet also constrain them to specific modes of response? Readings:
Required Source CASE STUDY Malaria Control in Northern Uganda Sverker, Finnstrom. 2005. For God and My Life: War and Cosmology in Northern Uganda. Chapter 6 in No Peace, No War: An Anthropology of Contemporary Armed Conflicts, edited by Paul Richards. pp. 98-116. Okuonzi, Sam. 2004. Dying for economic growth? Evidence of a flawed economic policy in Uganda. Lancet 364:1632-37. Schutz, Alfred. 1953. Common-Sense and Scientific Interpretation of Human Action. Philosophy and Phenomenological Research 14(1): 1-38 Reread: Packard, Randall M. 1997. Malaria Dreams: Postwar Visions of Health and Development in the Third World. Medical Anthropology 17:279-296. Geertz, Clifford. 1975. Common Sense as a Cultural System. The Antioch Review 33(1):5-26. Reread: Okuonzi, S.A. and J. Macrae 1995 Whose Policy is it Anyway? International and National Influences on the Health Policy Development in Uganda. Health Policy and Planning 10(2):122-132. Which parts? All All Where to find it? Online Sourcebook

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Lecture 15 Date: 10/20/11 Theme: Acting in a World of Unintended Consequences: Case Studies and Cross-Cutting Themes in Global Health Title: BRAC's TB Program: Pioneering DOT Treatment for TB in Rural Bangladesh Lecturer: Nava Ashraf Guiding Questions:
1. What were the challenges that Bangladesh faced in controlling tuberculosis? 2. How effectively did BRAC collaborate with the Bangladesh Tuberculosis Programme? 3. Was BRACs TB program a success? 4. Could BRACs shebika model work in the context of other countries and/or diseases?

Readings:
Required Source CASE STUDY BRAC's Tuberculosis Program: Pioneering DOT Treatment for TB in Rural Bangladesh CASE STUDY SUPPLEMENT Community Health Workers at the Bangladesh Rural Advancement Committee Raviglione, Mario and Richard OBrien. 2008 Chapter 158: Tuberculosis. In Fauci, Anthony, et al. Harrisons th Principles of Internal Medicine, 17 Edition. New York: McGraw-Hill. Nichter, Mark 2008 Global Health: Why Cultural Perceptions, Social Representations, and Biopolitics Matter. Tuscon: University of Arizona Press. Which parts? All Where to find it? Online

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Lecture 16 Date: 10/25/11 Theme: Acting in a World of Unintended Consequences: Case Studies and Cross-Cutting Themes in Global Health Title: From Ethnography to Action in Haiti: Why Ethnography Matters Lecturer: Ophelia Dahl Guiding Questions: 1. What is the goal of ethnography? 2. How does ethnography contribute to, support, and challenge other forms of data? 3. What is the relationship between the ethnography of Haiti you have read and the way the early founders of Partners in Health approached their clinical practice? 4. Can you identify tensions between scientific inquiry and action? What is the impact of the observer on the scientific inquiry he or she undertakes? 5. How can the past work described in lecture and readings inform the work being done today in Haiti? Readings:
Course Text Source Reread: Chapter 6: Building an Effective Health Delivery Model in Rural Haiti and Rwanda Farmer, Paul AIDS and Accusation. Berkeley: University of California Press. Kleinman, Arthur 1988 The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books. Chapter 15 [Partial]:The MiniEthnography, p. 230-236. Kleinman, Arthur 2006 What Really Matters: Living a Moral Life Among Uncertainty and Danger. New York: Oxford University Press. Chapter 3: 46-79. Farmer, Paul 2010 Partner to the Poor. Berkeley: University of California Press. Introduction to Part III: Structural Violence. p. 293-297. Which parts? Chapter 6 Where to find it? Purchased Book

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Lecture 17 Date: 10/27/11 IN-CLASS MIDTERM EXAM

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Lecture 18 Date: 11/1/11 Theme: Cross-Cutting Themes in Global Health Title: Global Mental Health: Finding and Closing the Resource Gaps Lecturer: Anne Becker
Guiding Questions:

1. What resource gaps characterize mental health care delivery in low-income settings? 2. What are key challenges to diagnostic assessment for mental illness across socially and culturally diverse populations and how do these impact access to care? 3. How can metrics-as-usual fail in assessing social and behavioral risk factors for mental illness? 4. What strategies have been used to close the mental health care delivery gap?
Readings:
Source Chapter 8: Odd Cases Mental Health and TB Prince M., P. Patel, S. Saxena, M. Maj, J. Maselko, M.R. Phillips, A. Rahman 2007 No Health Without Mental Health. Lancet 370:859-77. Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007; 370: 878889. Kleinman, Arthur 2009 Global Mental Health: A Failure of Humanity. Lancet 374:603-4. Patel V, Collins P, Copeland J, Kakuma R, Katontoka S, Lamichhane J, Naik S, Skeen S. The Movement for Global Mental Health. The British Journal of Psychiatry. 2011;198: 88-90. Raviola G, Becker AE, Farmer PE. A global scope for global health: Mental health in the ensemble. The Lancet; in press. Patel V and Sumathipala A. International representation in psychiatric literature. Brit J Psychiatry 2001; 178:406-409. Becker AE, Perloe A, Eddy K. Clarifying criteria for cognitive signs and symptoms for eating disorders in DSM-V. International Journal of Eating Disorders 2009; 42:611-8. Lee S, Ng KL, Kwok K, Fung C. The changing profile of eating disorders at a tertiary psychiatric clinic in Hong Kong. Int J Eat Disord 2009. Nasser, Latif. The Great Divide, or How An Obscure Diagnosis from Colonial Africa ended up in Playboy Magazine American Psychiatric Association. Appendix I: Outline for Cultural Formulation and Glossary of Culture-Bound Syndromes Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision. Swartz S, Carpenter KM. The right answer for the wrong question: Consequences for Type III error for public health research. Am J Public Health 1999; 89; 1175-980. Kleinman A. Anthropology and psychiatry. The role of culture in crosscultural research. The British Journal of Psychiatry 1987. 151: 447-54. Becker AE, Thomas JJ, Pike K. Should Non-Fat-Phobic Anorexia Nervosa Be Included in DSM-V? International Journal of Eating Disorders 2009; 42:620-35. Nichter M. Idioms of distress: Alternatives in the expression of psychosocial distress: A case study from South India. Culture, Medicine and Psychiatry 1981; 5:379-408. Thomas JJ, Crosby RD, Wonderlich SA, Striegel-Moore RH, Becker AE. A latent profile analysis of the typology of bulimic symptoms in an indigenous Pacific population: Evidence of cross-cultural variation in phenomenology. Psychological Medicine 2011; 41:195-206 Which parts? Chapter 8 All All All All Where to find it? Purchased Book Online Online Online Online

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Lecture 19 Date: 11/3/11 Theme: Cross-Cutting Themes in Global Health Title: Eating Pathology, Suicide Risk and Rapid Social Change in Fiji: Low Visibility and High Vulnerability Lecturer: Anne Becker Guiding Questions: 1. What evidence is there that eating pathology and suicide risk are related to vulnerabilities ensuing from rapid social and economic change in Fiji? 2. What factors contributed to low visibility of mental health needs for Fijian youth? 3. What strategies for meeting youth mental health needs could work in Fiji and resonate with proposed global mental health care delivery strategies? Readings:
Required Source Becker, A.E., R.A. Burwell, S.E. Gilman, D.B. Herzog, P. Hamburg. 2002 Eating Behaviours and Attitudes Following Prolonged Television Exposure Among Ethnic Fijian Adolescent Girls. The British Journal of Psychiatry 180:509-14. Becker AE. 2004 Television, Disordered Eating, and Young Women in Fiji: Negotiating Body Image and Identity During Rapid Social Change. Culture, Medicine and Psychiatry. 28:533-59. Becker AE, Fay K, Agnew-Blais, Khan A, Striegel-Moore RH, Gilman SE. 2011 Social network media exposure and adolescent eating pathology in Fiji. The British Journal of Psychiatry; 198: 43-50. Bhavsar V and Bhugra D. 2008 Globalization: Mental health and social economic factors. Global Social Policy. 8:378-396. Lowe, E.D. 2003 Identity, Activity, and the Well-being of Adolescents and Youths: Lessons from Young People in a Micronesian Society. Culture, Medicine, and Psychiatry 27:187-219. Patel V. 2009 The future of psychiatry in low- and middle-income countries. Psychological Medicine. 39: 1759-62. Schrecker, T., R. Labonte, R. De Vogli 2008 Globalisation and Health: The Need for a Global Vision. Lancet 372:1670-6. Patel V, Simon G, Chowdhary N, Kaaya S, Araya R. 2009 Packages of care for depression in low- and middle-income countries. PLoS Med. 6(10):e1000159. Farmer, Paul 2010 Partner to the Poor. Berkeley: University of California Press. Which parts? All Where to find it? Online

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Chapter 15

On Reserve

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Lecture 20 Date: 11/8/11 Theme: Cross-Cutting Themes in Global Health Title: Transnational Corporations and Global Health: The Case of Global Tobacco Panel: Allan Brandt, Peter Benson, Anne Becker Guiding Questions: 1. What is a transnational corporation? 2. Explain how a disease or an epidemic might be conceptualized as a product of a corporation. 3. How could you draw on a Weberian vision of modernity to explain corporate strategic engagement with state regulatory bodies, such as the FDA? 4. What are corporate oxymorons? To whom are these linguistic tools appealing? 5. What does it mean to transfer risk from a corporation to individuals? Can you relate this to ideas about structural violence and "blaming the victim"? Readings:
Required Source Brandt, Allan 2007 The Cigarette Century New York: Basic Books. Chapter 13. Exporting an Epidemic: 447-491. http://quod.lib.umich.edu.ezp-prod1.hul.harvard.edu/cgi/t/text/textidx?c=acls;idno=heb06648 Reread: Becker AE, Fay K, Agnew-Blais J, Khan AN, Striegel-Moore RH, Gilman SE. Social network media exposure and adolescent eating pathology in Fiji. The British Journal of Psychiatry 2011; 198: 43-50. Benson, Peter 2010 Safe Cigarettes. Dialectical Anthropology 34(1): 49-56. Benson, Peter 2010 Corporate Oxymorons. Dialectical Anthropology 34(1): 45-48. Benson, Peter 2010 Capitalism and the Politics of Resignation. Current Anthropology 51(4): 459-486. Ferguson, James 2005 Seeing Like an Oil Company: Space, Security and Global Capital in Neoliberal Africa. American Anthropologist 107(3): 377-382 Glynn, Thomas and John R. Seffrin, Otis W. Brawley, Nathan Grey, and Hana Ross st 2010 The Globalization of Tobacco Use: 21 Challenges for the 21 Century. CA Cancer J Clin 60:50-61. Which parts? All Where to find it? Online

Online

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Faculty Office Hours: Anne Becker and Paul Farmer, 11:30 - 12:30, location TBD
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Lecture 21 Date: 11/10/11 Theme: Cross-Cutting Themes in Global Health Title: Humanitarianism and an Anthropologial Perspective Panel: Jennifer Leaning, Arthur Kleinman, Paul Farmer Guiding Questions: 1. What are the characteristics that define a humanitarian emergency? 2. How do we define population vulnerability, particularly in war and disaster, and what factors can be used to quantify hyper-vulnerable sub-groups? 3. What are the guiding principles of relief organizations in the context of the Humanitarian Charter? 4. What are the respective roles of NGOs, UN agencies, and other actors and how are these activities different from longer-term developmental strategies? Readings:
Required Source Gourevitch, Philip 2010 "Alms Dealers," The New Yorker. October 11, 2010. Polman, Linda 2010 Crisis Caravan. New York: Metropolitan Books. Chapters 1 and 3. Leaning, J, P Spiegel and J Crisp 2011 Public Health Equity in Refugee Settings. Conflict and Health 5(6). Leaning, J 2008 Disasters and Humanitarian Crises: A Joint Future for Responders? Prehospital and Disaster Medicine 23(4): 291-294. Lautze, S, J Leaning, A Raven-Roberts, R Kent and D Mazurana 2004 Assistance, Protection, and Governance Networks in Complex Emergencies. Lancet 364: 2134-2141. Sphere Handbook. Humanitarian Charter and Minimal Standards 2004: Chapter 1 The Humanitarian Charter. Salama P, Speigel P, Talley L, Waldman R 2004 Lessons Learned From Complex Emergencies Over Past Decade. Lancet 364: 180113. Katz I, Wright A 2004 Collateral Damage Mdecins sans Frontires Leaves Afghanistan and Iraq. New England Journal of Medicine 351: 25. Obermeyer, Z, Murray CJ, Gakidou E 2008 Fifty Years of Violent War Deaths from Vietnam to Bosnia: Analysis of Data from the World Health Survey Programme. British Medical Journal:1-9. Which parts? All Chapters 1 and 3 All All Where to find it? Online Sourcebook Online Online

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Lecture 22 Date: 11/15/11 Theme: Cross-Cutting Themes in Global Health Title: Mental Health and Stigma Lecture: Arthur Kleinman Guiding Questions: 1. How can we best coneeptualize stigma in order to apply it to health conditions globally? 2. Has the concept of stigma led to a euphemization of severe discrimination and social death among patients with AIDS, severe mental illness, and other highly stigmatized conditions? 3. Do anti-stigma campaigns work? 4. How best can health systems and communities respond to stigma so as to lessen its negative effects on individuals and the process of caregiving? Readings:
Required Source Reread: Kleinman, Arthur 2009 Global Mental Health: A Failure of Humanity. The Lancet, Vol. 374, pp 1-2. Yang, Lawrence Hsin and Arthur Kleinman, Bruce Link, Jo Phelan, Sing Lee and Byron Good. 2007 Culture and Stigma: Adding Moral Experience to Stigma Theory. Social Science and Medicine Vol. 64, pp. 1524-1535. Yang, Lawrence Hsin and Arthur Kleinman. 2008 'Face' and the Embodiment of Stigma in China: The Cases of Schizophrenia and AIDS. Social Science and Medicine Vol. 67, pp. 398408. Jinhua, Guo and Arthur Kleinman 2011 Stigma: HIV/AIDS, Mental Illness, and China's Nonpersons. Ch. 7 in Deep China: The Moral Life of the Person, by Arthur Kleinman, Yungxiang Yan, Jing Jun, Sing Lee and Everett Zhang. Berkeley: University of California Press, 2011. pp. 237-262. Kleinman, Arthur What Really Matters: Living a Moral Life Among Uncertainty and Danger. New York: Oxford University Press. Chapter 8: 196-216. Which parts? All Where to find it? Online

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Recommended

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Faculty Office Hours: Arthur Kleinman and Paul Farmer, 11:30 - 12:30, location TBD
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Lecture 23 Date: 11/17/11 Theme: Cross-Cutting Themes in Global Health Title: Media and Global Health Panel: Kalpana Jain, Sam Loewenberg, Richard Knox Guiding Questions: 1. For whom is global health journalism written and produced? Whom and what is it serving? 2. How do journalists participate in the global health project? 3. What are some of the particular challenges of employing biosocial persepctives in modern journalistic media? 4. Do current funding mechanisms for global health journalism permit ethical reporting and analysis? 5. How can journalism be compared with ethnography? 6. Is global health journalism a moral experience? Readings:
Required Source Nellie Bristol and John Donnelly. 2011. Taking the Temperature: The Future of Global Health Journalism. A Report for the Kaiser Family Foundation Polman, Linda 2010 Crisis Caravan. New York: Metropolitan Books. Chapter 2. Society of Professional Journalists 1996 - Present SPJ Code of Ethics http://www.spj.org/ethicscode.asp Which parts? All Where to find it? Course Website

All All

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Lecture 24 Date: 11/22/11 Theme: Cross-Cutting Themes in Global Health Title: Building Health Systems: The Case of Mexico and Its Global Health Implications Panel: Julio Frenk, Paul Farmer, Salmaan Keshavjee Guiding Questions:
1. 2. 3. 4. How can vertical programs be used to strengthen the entire health system in a country? What are the barriers to the integration of vertical programs with the general health care system? What is the relationship between delivery science, GHIs and health systems strengthening? What would a critical sociological analysis of knowledge on health sector reform highlight?

Readings:
Course Text Required Source Chapter 7: Redefining Global Health Delivery Frenk, Julio Bridging the Divide: Global Lessons from Evidence-Based Health Policy in Mexico. The Lancet 368: 954-961. Roberts, Mark, William Hsaio, Peter Berman and Michael Reich 2004 Getting Health Reform Right. New York: Oxford University Press. Ch 1 (pp 3-20) Frenk, Julio 2010 The Global Health System: Strengthening National Health Systems as the Next Step for Global Health. PLoS Medicine 7(1). Frenk, Julio 2010 The World Health Report 2000: Expanding the Horizon of Health System Performance. Health Policy and Planning 25: 343-345. World Health Organization 2009. An Assessment of Interactions between Global Health Initiatives and Country Health Systems. The Lancet 393: 2137-2169. Kim, Jim Yong, Joseph Rhatigan, Sachin H. Jain, Rebecca Weintraub, and Michael E. Porter 2010 From a Declaration of Values to the Creation of Value in Global Health: A Report from Harvard Universitys Global Health Delivery Project. Global Public Health 5(2):181-8. Sanders, David and Andy Haines 2006 Implementation Research is Needed to Achieve International Health Goals. PLoS Medicine 3(e186):1-4. Murray, CJ and J Frenk 2008 Health Metrics and Evaluation: Strengthening the Science. Lancet 371(9619): 1191-9. Frenk, Julio and Octavio Gomez-Dantes 2010 Global Lessons of the Mexican Health Reform: Empowerment Through the Use of Evidence. Rev Peru Med Exp Salud Publica 27(3): 412-18. Which parts? Chapter 7 All Where to find it? Purchased Book Online

Chapter 1

Online

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Lecture 25 Date: 11/29/11 Theme: Cross-Cutting Themes in Global Health Title: Policy and Advocacy: The Case of HIV and Its Applicability to Other Global Health Challenges Panel: Gregg Gonsalves, Mark Harrington, Salmaan Keshavjee Guiding Questions:
1. How does the critical self-reflection emphasized in this course translate to action, scale, and rights? 2. What are the sources of human crisis? What are obstacles to human assistance? 3. How can vertical interventions be used to strengthen national health systems? What are the limitations of vertical programs? 4. Can a US American advocacy movement work in other settings? What are the limitations of scaling up or transporting social movements?

Readings:
Required Source Making Services Work for Poor People. 2004. World Development Report. Chapters 3,4,5,6,8. El-Sadr, W.M., Gregg Gonsalves and Peter Mugyenyi 2011 No Need for Apologies. JAIDS, 57(Suppl 2): S68-S71. Keshavjee, S., K. Seung, H. Satti, J. Furin, P. Farmer, JY Kim, M. Becerra. 2008 Building Capacity for Multidrug-Resistant Tuberculosis Treatment: Health Systems Strengthening in Lesotho. Innovations 2(4):87-106. El-Sadr W.M. and E.J. Abrams. 2007 Scale-up of HIV Care and Treatment: Can it Transform Healthcare Services in Resource-Limited Settings? AIDS 21(Suppl 5):S65-70. Boggio, A., et al. 2009 Limitations on Human Rights: Are They Justifiable to Reduce the Burden of TB in the Era of MDR- and XDR-TB? Health and Human Rights. Amon, J., F. Girard, and S. Keshavjee 2009 Limitations on Human Rights in the Context of Drug-Resistant Tuberculosis: A Reply to Boggio et al. Health and Human Rights. Which parts? Chapters 3, 4, 5, 6, 8. All All Where to find it? Online Online Online

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Faculty Office Hours: Salmaan Keshavjee, 11:30 - 12:30, location TBD

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Lecture 26 Date: 12/1/10 Theme: Cross-Cutting Themes in Global Health Title: Global Caregiving and Closing Thoughts Lecturer: Arthur Kleinman, Anne Becker, Paul Farmer, Salmaan Keshavjee Guiding Questions: 1. 2. 3. 4. Is caregiving a moral experience? If so how? What constitutes lay or family caregiving? What is the place of caregiving in professional medicine? What place should caregiving have in biomedical care? What is the role of caregiving in global health? What are the barriers to caregiving in global health, and how can they be overcome?

Readings:
Course Text Required Source Re-Read: Chapter 9. Values in Global Health: Human Rights & Moral Frameworks Schiller, N.G. 1993 The Invisible Women: Caregiving and the Construction of AIDS Health Services. Culture, Medicine, and Psychiatry 17:487-512. Kleinman, Arthur 2006 What Really Matters: Living a Moral Life Amidst Uncertainty and Danger. New York: Oxford University Press. Kleinman, Arthur 1988 The Illness Narratives: Suffering, Healing, and the Human Condition. New York: Basic Books. Kleinman, Arthur 2008 Catastrophe and Caregiving: The Failure of Medicine as an Art. Lancet 371(9606):22-3. Kleinman, Arthur 2009 Caregiving: The Odyssey of Becoming More Human. Lancet 373(9660):292-3. Farmer, Paul 1999 Infections and Inequalities. Berkeley: University of California Press. Levinas, Emmanuel 1988 The Provocations of Levinas: Rethinking the Other. New York: Routledge. Farmer, Paul Partner to the Poor. Berkeley: University of California Press. Which parts? Chapter 9 All Where to find it? Purchased book Online

Chapters 3, 8 and 9 Chapters 1, 2, 14, 15, and 16 All

Purchased book

Purchased book

Online

All

Online

Chapter 1

Sourcebook

Chapter 10

On reserve

Chapter 23 and Conclusion

Sourcebook

Faculty Office Hours: Arthur Kleinman, 11:30 - 12:30, location TBD

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