Social and Behavioral Aspects of Public Health

Course Objectives

1. General background: The overall framework for the course is based on the biopsychosocial or ecologic perspective on health. In these models, health is seen as being determined by biologic, behavioural, social, and environmental factors that interact with each other and, to a greater or lesser extent, can be influenced by individuals and groups.
2. Specific aims:
   1. To familiarize students with views on key concepts that form a basis for literacy in the social and behavioural aspects of public health: culture, race/ethnicity, gender, poverty disparities, factors related to behaviour change, community, organizational climate, family.
   2. To familiarize students with the concept of a narrative as a therapeutic, policy, and investigative tool.
   3. To help develop empathy for and a collaborative stance toward populations with whom one will work in the field of public health.
   4. To promote interest in further study of the social and behavioural determinants of health.
3. Teaching philosophy
   1. Less is more - topics are selected to introduce selected issues rather than provide comprehensive review; less reading, attempt to pick articles that are not too technical, hope in that way that busy students can actually complete the reading assignments.
   2. A study that is personally engaging is more likely to be meaningful. The course attempts to be engaging and not an intellectualized view of the topics.
   3. Emphasis on peer discussion and feedback as befitting graduate school and rich, diverse backgrounds of students. Emphasis on the community of learners versus the teacher as an oracle.
4. Skills/knowledge at the end our course
   1. Have the ability to recognize the importance of key biopsychosocial/ecologic concepts when they appear (or fail to appear) in studies of public health problems.
   2. Develop a sense of empathy and partnership with individuals and groups who become involved in public health problems; develop the ability to tell/listen to stories as a mechanism for developing empathy and partnership.
   3. Develop ability to read and write narrative accounts of public health problems.
   4. Develop the ability to work collaboratively to achieve clear communication (often across cultural and language barriers) about public health problems.

Course Requirements

1. Units are comprised of a lecture/discussions or lectures and presentation and discussion of student narratives
   1. For each unit, there is one main article assigned, with other optional background readings. The lecture material serves as a framework for a large-group discussion; we will try to highlight material from the readings and encourage questions related to the readings.
   2. For four of the units (see schedule), students are asked to write a 2-3 page narrative describing either their personal experience with the topic or something vicariously experienced through contact with other individuals or communities. Details about writing narrative are presented in the introductory lecture.
   3. Narrative writing is done in stages:
      1. Initial composition alone
      2. Workshopping with a partner (time allotted in class)
      3. Revision alone
      4. Optional lab time for further revision
      5. Reading aloud to class followed by a discussion
      6. Optional recording in lab time
2. Lab sessions: these sessions are optional. They represent office hours to discuss the course or related material in more depth and in addition:
   1. Opportunities for workshopping materials with the instructors
   2. Training in basic audio editing and recording for narratives
   3. Opportunities to record and edit narratives
3. Reading narrative: students are asked to select a chapter from one book from the course list and use it as an example of narrative and as a source of information about the key topic or topics for which they have the most interest. Other narrative sources can include the narrative sections included in many medical journals. This will be the basis for one of the midterm assignments.
4. Midterm assignments
   1. Students will be asked to turn in their second narrative. The submitted material should include the original narrative and the final workshopped version. Criteria for evaluation include:
      1. Is there a focus? This need not come out immediately with a topic sentence; however, by the end, the reader should feel that there has been a specific point or points made?
      2. Does your voice or the voice of the protagonist really come through? What techniques are used to do this?
      3. Is it detail-rich and multi-layered? Are specific events, people, and situations described?
      4. Does the writing convey feelings?
      5. Is the flow of ideas coherent? Are there discontinuities in voice or topic, are these explained?
      6. Are there insights revealed beyond telling the story? This goes back to (a): is the story a stepping-off point to something deeper or more generalizable?
   2. A brief review of the outside narrative material (described above). The review should be 3-4 pages long and include a summary of the following points. When addressing these points, use specific examples. Give full bibliographic information about the narrative so that others can locate it.
      1. Implications for public health interventions or policies that stem from the experiences of the lead character(s) and his/her/their community
      2. Techniques the author(s) use to help readers understand the social reality of the characters
      3. Techniques the authors(s) use to convey the voice of the subjects and to create a personal connection with the reader
5. Final assignments
   1. A portfolio of the narratives written during the course. Each narrative should be preceded by a 1-2 paragraph definition of the key topic to which it is linked. The definition should include references. The original version of each narrative plus the revised workshopped version should be included. Evaluation of the portfolio will be based on 1) the definition paragraphs, 2) overall completeness of the portfolio, and 3) detailed reading by the instructors of one of the narratives (students should indicate which they would like the instructor to read in detail).
   2. Short answer exam about a short narrative. It involves reading a short narrative and answering some questions about its content, form, and related information from the course.