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Translating Research into Health Policy

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					                                University of Pennsylvania
                             Graduate Program in Public Health
                                  MPH Degree Program
                               Course Syllabus – Spring 2011

Title: PUBH 537 – Achieving Evidence-Based Health Policy

Course Units: 1. 0 c.u., Contact Hours: 42 hours

Course Description: Achieving Evidence-Based Health Policy examines how research can
influence health policy. Individual sessions will be devoted to topics such as the Nurse-Family
Partnership program, health insurance, smoking, and early childhood mental health. Sessions
will examine: how selection of research methods may influence results; the dialectical
relationship between research and policy; and the role of various stakeholders (the media,
foundations, government, advocates) in both research and policy debates. Didactic topical
research presentations will be followed by interactive discussions examining how research
findings translate (or, as the case may be, do not translate) into policy. Guest speakers will
include research and policy experts from the public and private sectors. Prerequisites are
Fundamentals of Health Policy (offered through the Master‟s of Science in Health Policy);
PUBH 505 Public Health Administration and Policy: An Introduction; or permission of
instructor. Enrollment limited to 12.

Placement / Room Assignment:
      TBD

Course Directors:      Marsha Gerdes, Ph.D.
                       gerdes@email.chop.edu
                       CHOP North, 15th Floor
                       3535 Market Street (corner of 36th & Market)
                       Philadelphia, PA 19104
                       215-590-2165
                       Office Hours: By Appointment

                       Sarah Zlotnik, MSPH, MSW
                       zlotniks@email.chop.edu
                       CHOP North, 15th Floor, Room 1541
                       3535 Market Street (corner of 36th & Market)
                       Philadelphia, PA 19104
                       267-426-9340
                       Office Hours: By Appointment

Pre-requisites: None.

Course Objectives: This course is an advanced seminar on health research and policy. The goal
is to give students an opportunity to consider the complex relationship between evidence and
public policy. Policy decisions, by definition, involve choices. Policymakers may be influenced



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by factors other than - or even contrary to - research. Good research can lead to better policy.
But, as experience with cigarettes and stem cells suggests, research alone may not carry the day.
        Conversely, we know that sometimes research can produce (or be the product of)
unacceptable policy goals. The infamous experiments of Nazi scientists and Tuskegee were all
undertaken in attempts to promote particular policy goals. We may not support those goals today,
but we cannot deny the role that research played in advancing them at the time.
    Our hope is to engage students in thoughtful discussions about how research can influence
policy, and policy impacts research. By the end of the seminar, students should be able to:
    1. Consider the strengths and weaknesses of selected research methods in light of policy
        goals and the extent to which research choices are policy choices;
    2. Draft a policy brief with an understanding of evidence, audience and context;
    3. Understand how policy decisions are made, including the role of key stakeholders in
        policy contests;
    4. Frame research questions with a deeper understanding of the policy environment that
        research seeks to influence.

Evaluation Methods:           30%     Class participation
                              10%     Policy brief
                              15%     Midterm presentation
                              35%     Final presentation
                              10%     Discussant role

Course grades reflect the extent to which each student has incorporated the requisite knowledge
and skills in her/his assignments. The final course grade is based on a composite of the student‟s
performance in class and the student‟s presentations (policy brief, midterm, final, and discussant
role). The final grade is based on the following weighting:

Course Requirements:
     Class Participation: Students are expected to attend all classes, be prepared to discuss
      assigned readings, and participate fully in class exercises. Because the class is a small
      seminar, discussion is an important part of the class. We have attempted to assign a very
      modest amount of reading per session so that everyone can read what is assigned and be
      able to participate fully in classes. Students should let an instructor know in advance of
      anticipated absences.
              Additionally, for each class, two students will be responsible for helping guide the
      discussion. For that session, students will email the instructors a few guide questions by
      Monday at 2pm, the day before class.
     Policy Brief: Students will complete an exercise in drafting a policy brief related to a
      health policy area of interest. This brief must follow the guidelines provided in class. This
      exercise will be an opportunity to get feedback on written policy communications from
      the instructors. Policy briefs should be no longer than one page.
     Midterm: The midterm will be an opportunity for students to experience a real world
      scenario often required of those in the policy field. Students will serve as a “staffer” to a
      legislative committee seeking a policy analysis on a topic in which the staffer has limited
      prior knowledge. The staffer will have no more than 72 hours to become fluent in that
      topic, developing a short 5-10 minute oral briefing on the topic for the legislative



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         committee. The briefing should include the staffer‟s recommendation to the committee
         and should review some potential policy alternatives. Accompanying the presentation, the
         staffer should provide the committee a policy brief (e.g., one page prose or bullets)
         overviewing the staffer‟s recommendation.
        Final Expert Presentation and Discussant Role: Each student is required to give a final
         presentation at the end of the semester that critically examines policy from multiple
         perspectives. Your assignment should be focused on an area of special interest to you.
         Ideally this will be an area in which you plan to work in the future. Also as a component
         of this project, every student will be assigned and graded on their role as “discussant” of
         another student‟s presentation. As a discussant, students will be expected to review their
         colleague‟s presentation in advance of class, and present their reactions in class.

Required Course Materials:
Bardarch E. Practical Guide for Policy Analysis: The Eightfold Path to More Effective Problem
       Solving. Washington, DC: CQ Press; 2009.

Recommended Course Materials:
Gordis L. Epidemiology. 4th ed. Philadelphia: Elsevier/Saunders; 2009.
       (for more information on epidemiology and research design)

Academic Integrity: Students are expected to adhere to the University‟s Code of Academic
Integrity. Care should be taken to avoid academic integrity violations, including: plagiarism,
fabrication of information, and multiple submissions. Students who engage in any of these
actions will be referred to the Office of Academic Integrity, which investigates and decides on
sanctions in cases of academic dishonesty.

See link for more information: http://www.upenn.edu/academicintegrity/index.html

MPH Academic Standing Policy/Academic Probation: According to University policy, a
graduate student must maintain a „B‟ average or better to be considered in good academic
standing. A student who does not meet the University policy of a „B‟ /3.0 average will be
reviewed by the MPH Program Director, the Associate Director and the Academic Progressions
Committee. A student may be put on academic probation for a period of 1 semester to improve
his/her overall average may be put on academic probation for a period of 1 semester to improve
his/her overall average.
        Any course in which the student receives a grade below a B- will not be applied toward
the Master of Public Health degree. The record of any student who receives an unsatisfactory
grade (less than a „B-„) in a course or who does not meet the University policy of a „B‟ /3.0
average will be reviewed by the MPH Program Director, the Associate Director and the
Academic Progressions Committee. A student may be put on academic probation for a period of
1 semester to improve his/her overall average
        Students may continue to take other courses during the probation period and the student
must make arrangements with the course director to remediate any grades lower than a B-. These
arrangements must be approved by the MPH Program Director with input from the Academic
Progressions Committee as needed. Any student who is on academic probation for a period
greater than 1 semester will be referred to the Academic Progressions Committee for review and



Last updated: 9/8/11                                                                              3
recommendation. This committee is authorized to dismiss the student or allow the student to
remain in the program on a probationary basis. A return to good academic standing is contingent
on receiving an acceptable grade (B or higher) in all remaining courses.

The MPH grading policy is at the discretion of the individual course instructors.

Please find below the generally used grading scale for the MPH Program.
    A+ 97-100                 B+ 87-89               C+ 77-79
    A     93-96               B      83-86           C     73-76
    A- 90-92                  B- 80-82               C- 70-72           F           0-69
Please note that an A+ carries the same weight (4.0) as an A.

Incomplete Grade: It is expected that a matriculated Master of Public Health student shall
complete the work of a course during the semester in which that course is taken. A student who
fails to complete a course within the prescribed period shall receive at the instructor‟s discretion
either a grade of I (incomplete) or F (failure). If the incomplete is given, the instructor may
permit an extension of time up to one year for the completion of the course. In such cases, any
course which is still incomplete after one calendar year from its official ending must remain as
incomplete on the student‟s record and shall not be credited toward the MPH degree. Students
who receive two or more incompletes within a semester may not register for the subsequent
semester(s) without the permission of the Department.

For additional information on academic policies, please refer to the corresponding sections in the
Student Handbook.




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Course Outline / Assignments:
    **[Please note: Speakers & Case Study Topics are subject to updated for the semester]**
        Dat
Class          Class Topics             Readings
          e
  1     1/19 WHAT IS POLICY AND           Oberlander J. Learning from failure in health care
               THE POLICY                  reform. N Engl J Med. 2007;357:1677-9.
               CHALLENGE                  Brandt AM. The cigarette, risk, and American
                                           culture. Daedalus. 1990;119:155-76.
                                          Bardach E. A Practical Guide for Policy Analysis:
                                           The Eightfold Path to More Effective Problem
                                           Solving. Washington, DC: CQ Press; 2009: 1-64.
                                          Kolata G. Panel urges mammograms at 50, not 40.
                                           The New York Times. November 17, 2009.
                                           (Available at:
                                           http://www.nytimes.com/2009/11/17/health/17can
                                           cer.html)
  2     1/26 RESEARCH DESIGN AND  Gambrill E. Evidence-based practice and policy:
               THE CHALLENGE OF            Choices ahead. Research on Social Work Practice.
               “EVIDENCE-BASED”            2006;16:338-57.
               POLICY                     Chalmers I. Trying to do more good than harm in
                                           policy and practice: The role of rigorous,
               GUEST SPEAKER:              transparent, up-to-date evaluations. The ANNALS
               Susmita Pati, MD MPH        of the American Academy of Political and Social
               (Assistant Professor of     Science. 2003;589:22-40.
               Pediatrics, UPenn          Robinson TN, Sirard JR. Preventing childhood
               School of Medicine, and     obesity: A solution-oriented research paradigm.
               from PolicyLab at the       Am J Prev Med. Feb 2005;28(2 Suppl 2):194-201.
               Children‟s Hospital of     US Government Accountability Office. A variety
               Philadelphia)               of rigorous methods can help identify effective
                                           interventions. 2009: Publication No. GAO-10-30.
                                           [Read pages 1-8 and 20-32, skim the rest]
  3      2/2 CREATING A POLICY            Bardach E. A practical guide for policy analysis:
               BRIEF                       the eightfold path to more effective problem
                                           solving. Washington, DC: CQ Press; 2009:
               POLICY BRIEF                    Appendix A:111-25.
               ANALYSIS: Review four  Sorian R, Baugh T. Power of information: Closing
               briefs from the class       the gap between research and policy. Health
               folder                      Affairs. 2002;21:264-73.
               [How do they use           Brownson RC, Royer C, Ewing R, McBride TD.
               evidence? What is the       Researchers and policymakers: travelers in parallel
               quality of the research?    universes. Am J Prev Med. 2006;30(2):164-172.
               Do they effectively        POLICY BRIEF EXERCISE: Based on the guidelines
               present their argument?     reviewed in this class, draft a policy brief (no more
               ]                           than one page) on a health topic of your choice to
                                           be submitted in class, February 16th (Week 5).
  4      2/9 ENGAGING                     Barber M. Instruction to Deliver: Tony Blair, the


Last updated: 9/8/11                                                                           5
                   CONSTITUENCIES AND            Public Services and the Challenge of Achieving
                   THE IMPLEMENTATION            Targets. London: Politico's Publishing; 2007:
                   CHALLENGE                     Chapter 2, 45-69; Chapter 3, 70-79, 87-97.
                                                Atkins D, Siegel J, Slutsky J. Making policy when
                   GUEST SPEAKER:                the evidence is in dispute. Health Affairs.
                   Feather Houstoun              2005;24(1):102-113.
                   (President, William          Landman A, Glantz SA. Tobacco industry efforts
                   Penn Foundation, and          to undermine policy-relevant research. Am J
                   former Secretary,             Public Health. 2009;99:45-58.
                   Pennsylvania                 Lantz PM, Lichtenstein R, Pollack HA. Health
                   Department of Public          policy approaches to population health: The limits
                   Welfare)                      of medicalization. Health Affairs.
                                                 2007;26(5):1253-1257.
                   CONSTITUENCY
                   EXERCISE: Each student
                   will be assigned one to
                   two constituency groups
                   to examine health care
                   reform.
  5       2/16     NURSE FAMILY                 Olds DL. The nurse-family partnership: An
                   PARTNERSHIPS                  evidence-based preventive intervention. Infant
                                                 Mental Health Journal. 2006;27:5-25.
                   (SUBMIT POLICY BRIEF)        Mercy J, Saul J. Creating a healthier future through
                                                 early interventions for children. JAMA.
                   GUEST SPEAKER: David          2009;301:2262-4.
                   Rubin, MD MSCE               Council on Community Pediatrics. The role of
                   (Associate Professor of       preschool home-visiting programs in improving
                   Pediatrics, UPenn             children's developmental and health outcomes.
                   School of Medicine, and       Pediatrics. 2009;123:598-603.
                   Senior Co-Director,          Pew Center on the States. Federal Health Care
                   PolicyLab at The              Reform Legislation Home Visiting Summary.
                   Children‟s Hospital of       State Home Visiting Legislation. Prepared by
                   Philadelphia) and Tara        Prevent Child Abuse America for the Home Visit
                   Dechert (Public/Private       Forum. 2002. [just skim to see the range of
                   Ventures)                     funding providers]
                                                Fixsen, D. L., & Blase, KA. Implementation: The
                                                 missing link between research and practice. NIRN
                                                 Implementation Brief #1. 2009, January. Chapel
                                                 Hill: The University of North Carolina, FPG,
                                                 NIRN.
                                                Fixsen DL, Naoom SF, Blase KA, Friedman RM,
                                                 Wallace F. Implementation Research: A Synthesis
                                                 of the Literature. Chapter 1: Introduction. Tampa,
                                                 FL: University of South Florida, Louis de la Parte
                                                 Florida Mental Health Institute, The National
                                                 Implementation Research Network, 2005 (FMHI



Last updated: 9/8/11                                                                               6
                                               Publication #231).
  6       2/23     AUTISM AND THE             Bouder JN, Spielman S, Mandell DS. Brief report:
                   INSURANCE INDUSTRY          Quantifying the impact of autism coverage on
                                               private insurance premiums. J Autism Dev Disord.
                   GUEST SPEAKER: David        2009 Jun;39(6):953-7. Epub 2009 Feb 13.
                   Mandell, ScD (Assistant  Shattuck PT, Grosse SD. Issues related to the
                   Professor of Psychiatry     diagnosis and treatment of autism spectrum
                   and Pediatrics, UPenn       disorders. Mental Retardation and Developmental
                   School of Medicine and      Disabilities Research Reviews. 2007;13(2):129-
                   Associate Director          135.
                   Center for Autism          Shattuck PT, Parish SL. Financial burden in
                   Research, The               families of children with special health care needs:
                   Children‟s Hospital of      Variability among states. Pediatrics.
                   Philadelphia)               2008;122(1):13-18.
                                              Coffman JM, Hong MK, Aubry WM, et al.
                                               Translating medical effectiveness research into
                                               policy: Lessons from the California Health
                                               Benefits Review Program. Milbank Quarterly.
                                               2009;87(4):863-902.
  7        3/2     CONDITIONAL CASH           Lagarde M, Haines A, Palmer N. Conditional cash
                   TRANSFERS                   transfers for improving uptake of health
                                               interventions in low- and middle-income countries:
                   GUEST SPEAKER: Kevin        a systematic review. JAMA. 2007;298:1900-10.
                   Volpp, MD PhD              Volpp KG, Troxel AB, Pauly MV, et al. A
                   (Professor, Wharton         randomized, controlled trial of financial incentives
                   School and UPenn            for smoking cessation. N Engl J Med.
                   School of Medicine)         2009;360:699-709.
                                              Volpp KG, John LK, Troxel AB, Norton L,
                                               Fassbender J, Loewenstein G. Financial incentive-
                                               based approaches for weight loss: A randomized
                                               trial. JAMA. 2008;300:2631-7.
                                              Fernald LC, Gertler PJ, Neufeld LM. Role of cash
                                               in conditional cash transfer programmes for child
                                               health, growth, and development: an analysis of
                                               Mexico's Oportunidades. Lancet. 2008;371:828-
                                               37.
                                              Mayor Bloomberg and major philanthropic
                                               foundations unveil size, scope, and schedule of
                                               Opportunity NYC, the nation‟s first-ever
                                               conditional cash transfer program [press release,
                                               no. 93]. The City of New York; March 29, 2007.
                                               (Available at:
                                               http://www.rockfound.org/about_us/press_releases
                                               /2007/032907cct_nyc.pdf)
                                           Spring Break
  8       3/16     GLOBAL HEALTH              Denny CC, Emanuel EJ. US health aid beyond


Last updated: 9/8/11                                                                             7
                   INTERVENTION &                PEPFAR: The Mother & Child Campaign. JAMA.
                   FUNDING PRIORITIES –          2008;300(17):2048-2051.
                   HIV/AIDS CASE                Mayer KH, Hamilton CD. Distributing US health
                   STUDY                         aid. JAMA. 2009; 301(13) 1339-40.
                                                Dugger CW. As donors focus on AIDS, child
                   GUEST SPEAKER: Carol          illnesses languish. The New York Times. October
                   McLaughlin, MD MPH            29, 2009. (Available at:
                   (University of                http://www.nytimes.com/2009/10/30/world/30chil
                   Pennsylvania‟s Center         d.html)
                   for High Impact              Smith AD. Experts want African aid funds
                   Philanthropy)                 channeled away from HIV. The Observer
                                                 (Guardian UK). October 25, 2009. (Available at:
                                                 http://www.guardian.co.uk/world/2009/oct/25/aids
                                                 -hiv-africa-aid-scientists)
                                                McNeil DG. Obama is criticized on AIDS
                                                 Program. The New York Times. December 8, 2009.
                                                 (Available at:
                                                 http://www.nytimes.com/2009/12/09/health/policy
                                                 /09aids.html)
                                                Disease Control Priorities Project. Using cost-
                                                 effectiveness analysis for setting health priorities.
                                                 March 2008. (Available at:
                                                 http://www.dcp2.org/file/150/DCPP-
                                                 CostEffectiveness.pdf)
                                                Kaiser Family Foundation. The US Global Health
                                                 Initiative: Overview and budget analysis. Policy
                                                 Brief. December 2009. (Available at:
                                                 http://www.kff.org/globalhealth/upload/8009.pdf)
  9       3/23     MIDTERM
                   PRESENTATIONS

                   GUEST EXPERT: Joined
                   by Peter Grollman,
                   MGA (federal and state
                   lobbyist with The
                   Children‟s Hospital of
                   Philadelphia,
                   Government Affairs)
  10      3/30     HEALTH INSURANCE             Sparer M. Medicaid and the US path to national
                                                 health insurance. N Engl J Med. Jan
                   GUEST SPEAKER:                2009;360(4):323-5.
                   Susmita Pati, MD MPH         Gruber J. Universal health insurance coverage or
                   (Assistant Professor of       economic relief – a false choice. N Engl J Med. Jan
                   Pediatrics, UPenn             2009;360(5):437-9.
                   School of Medicine, and      Lee TH, Mongan JJ, Oberlander J, Rosenthal MB.
                   from PolicyLab at the         Perspective roundtable: Health care and the



Last updated: 9/8/11                                                                                 8
                   Children‟s Hospital of      recession. N Engl J Med. Jan 2009;360(4):e5.
                   Philadelphia)              Fuchs V. Health care reform – why so much talk
                                               and so little action? N Engl J Med. Jan
                                               2009;360(3):208-9.
                                              Gais T, Dadayan L. The new retrenchment: Social
                                               welfare spending, 1977-2006. Nelson Rockefeller
                                               Institute on New Government. September 15, 2008.
                                              Pati P, Keren R, Allessandrini E, Schwarz D.
                                               Generational differences in US public spending,
                                               1980-2000. Health Affairs. 2004;23(5):131-41.
                                              Davis K. Investing in health care reform. N Engl J
                                               Med. Feb 2009;360(9)852-5.
  11       4/6     PERFORMANCE                Utah Department of Human Services. Qualitative
                   MANAGEMENT                  Case Review Protocol. Human Systems &
                                               Outcomes, Inc. August 2007. (Available at:
                                               http://www.hsosr.utah.gov/pdf/qcr-protocol-
                                               fy08.pdf)
                                              Additional readings to be announced
  12      4/13     COURSE WRAP UP           Readings to be determined
  13      4/20     STUDENT                  Readings selected by student presenters
                   PRESENTATIONS
  14      4/27     STUDENT                  Readings selected by student presenters
                   PRESENTATIONS




Last updated: 9/8/11                                                                           9

				
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