August 11, 2009

professor for MEZCOPH, created the new course with a lot of student input and involvement.  “It’s a course of the students and by the students, essentially,” said Dr. Duncan.

True Health Care Change Requires Legislation

When public health professionals work abroad, they determine what’s wrong with health care in a region, where there are injustices, where the health of citizens is not as it should be, and then they work to determine the best policies that would serve the people in the local government.  However, as foreigners they cannot effectively change the representing government the way a citizen can, so besides having the ability to analyze local health care in a region, those in global public health need to know how to work with local residents and to teach them to develop political change. 

Why work on health care policies?  “Legislation is what changes health care,” said Dr. Duncan, shown in the photo at right.  As an example, he pointed out that 25 years ago only 40% of Arizona children were immunized from deadly diseases that are preventable.  Then state legislators decreed that students would not be allowed to come to school until they received their shots, and the rates increased dramatically. 

Issues To Be Addressed

This course will teach students how to analyze health care in a region and to formulating meaningful policy changes.  To give a taste for the geographic and cultural diversities in global health, it will concentrate on three countries on different continents that are very diverse:  Kenya, Peru, and Indonesia.   As public health professionals in these regions, students will look for answers to:

• What are the habits of people?  What do they believe in? 
• What is the culture of the country?
• How do you generate trust in relationships and the ability to accomplish change?
• How do you effect health policy changes in a foreign country?
• What do you really need to know about a political system and type of government?
• What do you need to know so you don’t make mistakes? 
• What type of health care do citizens receive? What are the problems involved in health care in a region? 

Database Information and Statistics

Are Integral Parts of the Course

To answer the above questions, student researchers must talk to people from the area or workers who have been there, such as those in the Peace Corps, and study that region’s information in the databases that exist.  In the course, Dr. Ernst, right, will teach about epidemiology techniques and teach students to study database information. “In order to convince policy makers that changes are needed and to assist in prioritizing those changes you must present good arguments that are founded on real data.”   she said.  Global health issues to be analyzed in the course using database information include:

• Infant and maternal health
• The mortality of children under five years of age
• Maternal education
• Microcredit and its effects on the poor
• Why the health status of some countries is not what it should be. 

In the course, students will be divided into 3 teams of up to four students each, with each team assigned one of the countries. They’ll be expected to explore databases from several different sources and to learn how to interpret the data, since figures are not always the same from one database to another.  In other words, students will have to figure out a reasonable assumption of the truth. “Cultural practices and taboos, such as the stigma towards HIV/AIDS can influence the accuracy of data reported and knowledge of the culture is critical to consider in the interpretation of data.”  How accurate is the picture that the data is painting? 

Hands-On Legislative Experience

After researching the culture and health care of a country, each of the three student teams will select a problem that they have identified from their analyses and from other dialogues about global health, a topic that they are passionate about changing.  Then the students will research the issue and formulate all the steps involved in making a policy change in that country’s government. “The countries we chose have many problems that impact health both directly and indirectly, prioritization will be a key step in their policy formulation,” said Dr. Duncan.

At the end of the course, students will receive hands-on legislative experience.  The instructors will invite a panel of experts who are familiar with the health and culture of the three countries to serve as legislative representatives.  Each student team will present to legislative representatives from the country that they have studied in a forum similar to a U.S. Senate hearing.  Students will be required to make an opening statement, then the “legislators” will drill them, and students will have to defend their policy change plans.  Legislative representatives will include esteemed individuals such as:

• Phil Lopez, the representative from District 27 in the Arizona State Legislature
• ProfessorJohn Ehiri, PhD, MPH, MSc, the new director of MEZCOPH's Health Promotion Sciences Division and a maternal and child health expert who is originally from Nigeria
• Zelda Harris, J.D. a clinical professor of law at The University of Arizona James E. Rogers College of Law and director of the UA's Domestic Violence Law Clinic. 

“I hope they’re very tough on these students because they have to defend what they want to do,” said Dr. Duncan.  “Hopefully this experience will bring it all together for students:  culture, epidemiology, global health issues, policy and management.  This takes the other 3-4 prerequisite courses in global health and makes some practical sense of them.”

MEZCOPH students interested in taking this course may register through UA's Student Link.  The course number for enrollment is EPID/CPH 606. Eight students are currently enrolled in the seminar-style course as of the date of this article, and there is room for four more students (twelve total). 

If you have questions about this course and your program of study, please contact your faculty advisor.