Course Syllabus

HLT POL M110/ASIAN AM M161

Ethnic, Cultural, and Gender Issues in America’s Healthcare Systems

Updated Syllabus

Course Information

Class Meetings: Wednesdays, 4:00pm – 6:50 pm

Location: Community Health Sciences Building 73105A

Instructor & TA Information

Course Description

This course will introduce students to issues involving race, ethnicity, gender, and culture as they relate to population health and the healthcare system in the United States. Life course theory will serve as a theoretical foundation to frame inequities in health outcomes and healthcare that emerge from birth through old age, with each week highlighting diverse racial, ethnic, gender, and sexual minority populations from an intersectional perspective. Students will become acquainted with core public health concepts, theories, data tools, and perspectives that help to explain the disparate and unequal health status and access to quality healthcare for various under resourced, minoritized populations. By integrating framework and theory, data, and advocacy, the course will provide an understanding of the public policy process and policy issues confronted by providers in health delivery.

Course Materials

Required Textbook

There is no required textbook for this course.

Course Resources

  1. Use of AskCHIS data lookup tool: askchis.ucla.edu
  2. Fadiman, The Spirit Catches You and You Fall Down
  3. Tweedy, Black Man in a White Coat
  4. Skloot, The Immortal Life of Henrietta Lacks

Learning Outcomes

Course Outcomes

  1. Describe and evaluate how race, ethnicity, culture, and gender are described and conceptualized in health research, practice, and policy.
  2. Identify key health inequities affecting various racial, ethnic, gender, and sexual minority populations.
  3. Apply major theories and employ data tools to appraise evidence in relation to health inequities.
  4. Evaluate and/or generate areas for potential interventions to address gaps in the provision of care, development of intervention or policy, and health research for racial, ethnic, gender, and sexual minority groups.

Course Policies

Late Policies

Please make note of the specific dates and times assignments are due. Late assignments are penalized 5% each day (24-hour period) they are late. If an unforeseen event, or series of events, is affecting your ability to complete assignments in this course, please contact the professor and TA as soon as possible. Things come up- let us know so that we can support you in succeeding in this course.

Grade Calculation

If you would like to calculate your grade, use Canvas' What-If Grades feature.  What are What-If Grades?

Grade Distribution

Letter Grade Scheme
Grade Percentage
A+ 100% to 97%
A 96.99% to 93%
A-  92.99% to 90%
B+ 89.99% to 87%
B 86.99% to 83%
B- 82.99% to 80%
C+ 79.99% to 77%
C 76.99% to 73%
C- 72.99% to 70%
D+ 69.99% to 67%
D 66.99% to 60%
F 59.99% to 0%
P-NP Grading
P 100% to 73%
NP < 73% to 0%

 

University Policies

Academic Integrity

UCLA is a community of scholars. In this community, all members including faculty, staff and students alike are responsible for maintaining standards of academic honesty. As a student and member of the University community, you are here to get an education and are, therefore, expected to demonstrate integrity in your academic endeavors. You are evaluated on your own merits. Cheating, plagiarism, collaborative work, multiple submissions without the permission of the professor, or other kinds of academic dishonesty are considered unacceptable behavior and will result in formal disciplinary proceedings usually resulting in suspension or dismissal. See the Dean of Students website for more information.

[source: Dean of Students syllabus statement (syllabus)] 

Accommodations for Students with Disabilities:

If you are already registered with the Center for Accessible Education (CAE), please request your Letter of Accommodation in the Student Portal. If you are seeking registration with the CAE, please submit your request for accommodations via the CAE website. Students with disabilities requiring academic accommodations should submit their request for accommodations as soon as possible, as it may take up to two weeks to review the request. For more information, please visit the CAE website, visit the CAE at A255 Murphy Hall, or contact us by phone at (310) 825-1501.

[source: Center for Accessible Education (Faculty Questions)]

Resources for Students

UCLA provides resources if you are feeling overwhelmed and need personal and/or academic assistance.

Please see the Red Folder REV2020 web for more information.

Title IX

Advocacy and Confidential Services

Please note that Title IX prohibits gender discrimination, including sexual harassment, domestic and dating violence, sexual assault, and stalking.  If you have experienced sexual harassment or sexual violence, you can receive confidential support and advocacy at the CARE Advocacy Office for Sexual and Gender-Based Violence, 205 Covel Commons, Los Angeles, CA, 90095, care@careprogram.ucla.edu, (310) 206-246 5.  Counseling and Psychological Services (CAPS) provides confidential counseling to all students and can be reached 24/7 at (310) 825-0768.  

Reporting and Non-confidential Services

Your professor is required under the UC Policy on Sexual Violence and Sexual Harassment to inform the Title IX Coordinator should he become aware that you or any other student has experienced sexual violence or sexual harassment. In addition, you can also report sexual violence or sexual harassment directly to the University’s Title IX Coordinator, 2255 Murphy Hall, titleix@equity.ucla.edu, (310) 206-3417. Reports to law enforcement can be made to UCPD at (310) 825-1491. 

Modules & Course Assignments

Course content is divided into modules, with instructions and due dates provided for each individual assignment in the Assignments tab. As a reminder, there will be a discussion post due each week. Unless specified, the initial post will be due before class on Tuesday at 11:59pm PDT, and a response to a classmate will be due after class on Thursday at 11:59am PDT. There will be no discussion post due Week 9 to give you extra time to finish up your group project.

A summary of the other course deliverables is provided below with corresponding due dates. Any changes made will be shared in class and reflected in this table below. 

Course Deliverable Schedule

Week

Due Date

Assignment

2

04/12/2024 by 11:59pm PDT

Healthcare Reflection

4

4/25/2024 by 11:59pm PDT

Quiz #1

7

5/17/2024 by 11:59pm PDT

Topic Proposal

8

5/17/2024 by 11:59pm PDT

Quiz #2

9

5/29/2024 by 3pm PDT

5/31/2024 by 11:59pm PDT

Group Slides

Final Brief

10

6/12/2024 by 11:59pm PDT

Final Exam

 

Current Course Schedule

Week

Topics/Readings

Assignments

UNIT I: CONCEPTS AND FRAMEWORKS FOR UNDERSTANDING RACE, ETHNICITY, GENDER, AND CULTURE IN AMERICAN HEALTHCARE

1

Introduction to Race, Ethnicity, Gender, and Culture in American Healthcare

Required Readings:

  1. Lett, E., Asabor, E., Beltrán, S., Cannon, A. M., & Arah, O. A. (2022). Conceptualizing, Contextualizing, and Operationalizing Race in Quantitative Health Sciences Research. Annals of Family Medicine, 20(2), 157–163. https://doi.org/10.1370/afm.2792
  2. Bowleg, L. (2012). The problem with the phrase women and minorities: Intersectionality – an important theoretical framework for public health. American Journal of Public Health, 102, (7), 1267-73. https://ajph.aphapublications.org/doi/10.2105/AJPH.2012.300750
  3. Jones, N. L., Gilman, S. E., Cheng, T. L., Drury, S. S., Hill, C. V., & Geronimus, A. T. (2019). Life Course Approaches to the Causes of Health Disparities. American Journal of Public Health (1971), 109(S1), S48–S55. https://doi.org/10.2105/AJPH.2018.304738  
  4. Office of Minority Health Population Profiles:  https://minorityhealth.hhs.gov/minority-population-profiles 

Data and Policy Resources & Recommended Readings:

  1. National Institute on Minority Health and Health Disparities (2017). NIMHD Research Framework. https://www.nimhd.nih.gov/about/overview/research-framework/nimhd-framework.html
  2. The 2022 National Healthcare Quality and Disparities Report: We Still Have Much Work to Do. Content last reviewed November 2022. Agency for Healthcare Research and Quality, Rockville, MD. https://www.ahrq.gov/news/blog/ahrqviews/2022-national-healthcare-disparities-report.html
  3. Institute of Medicine (US) Committee on Understanding and Eliminating Racial and Ethnic Disparities in Health Care. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Smedley BD, Stith AY, Nelson AR, editors. Washington (DC): National Academies Press (US); 2003. PMID: 25032386.  https://pubmed.ncbi.nlm.nih.gov/25032386/

W1 Discussion Post

2

Social Drivers of Health & the Culture of American Healthcare

Required Readings:

  1. Braveman, P., & Gottlieb, L. (2014). The Social Determinants of Health: It’s Time to Consider the Causes of the Causes. Public Health Reports, 129(1_suppl2), 19–31.
  2. Islam. (2019). Social Determinants of Health and Related Inequalities: Confusion and Implications. Frontiers in Public Health, 7, 11–11. https://doi.org/10.3389/fpubh.2019.00011   
  3. Baum, Fran E., Begin, Monique, Houweling, Tanja A.J., & Taylor, Sebastian. (2009). Changes not for the fainthearted: Reorienting health care systems toward health equity through action on the social determinants of health. American Journal of Public Health, 99(11), 1967-74.
  4. Watch Sir Michael Marmot on SDOH:  https://www.youtube.com/watch?v=BHYBHKma3x8

Data and Policy Resources & Recommended Readings:

  1. Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. https://health.gov/healthypeople/priority-areas/social-determinants-health   
  2. WHO SDOH Framework. https://www.who.int/publications-detail-redirect/9789241500852   

W2 Discussion Post

Healthcare Reflection

UNIT II: HEALTH INEQUITIES OVER THE LIFESPAN

3

Conception Through Birth

Required Readings:

  1. Ciciolla, L., Armans, M., Addante, S., Huffer, A. (2019). Racial Disparities in Pregnancy and Birth Outcomes. In: Fitzgerald, H., Johnson, D., Qin, D., Villarruel, F., Norder, J. (eds) Handbook of Children and Prejudice. Springer, Cham. https://doi.org/10.1007/978-3-030-12228-7_4
  2. Fishman. (2020). An extended evaluation of the weathering hypothesis for birthweight. Demographic Research, 43, 929–968. https://doi.org/10.4054/DemRes.2020.43.31
  3. Watch Dr. Michael Lu: https://www.youtube.com/watch?v=k8fuzh4d544

Data and Policy Resources & Recommended Readings:

  1. Hill, L., Artiga S., Ranji, U., (2022) Racial Disparities in Maternal and Infant Health: Current Status and Efforts to Address Them.  Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/racial-disparities-in-maternal-and-infant-health-current-status-and-efforts-to-address-them/ 
  2. Artiga, S., Hill L., Ranji, U., Gomez Y. (2022) What are the Implications of the Overturning of Roe v. Wade for Racial Disparities?   Kaiser Family Foundation. https://www.kff.org/racial-equity-and-health-policy/issue-brief/what-are-the-implications-of-the-overturning-of-roe-v-wade-for-racial-disparities/

W3 Discussion Post

4

Youth and Adolescence

Required Readings:

  1. Garney, W., Wilson, K., Ajayi, K.V., Panjwani, S., Love, S.M., Flores, S., Garcia, K., Esquivel, C.. Social-Ecological Barriers to Access to Healthcare for Adolescents: A Scoping Review. Int J Environ Res Public Health. 2021 Apr 14;18(8):4138. doi: 10.3390/ijerph18084138. PMID: 33919813; PMCID: PMC8070789.  https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8070789/
  2. Bosse. (2019). Sexual and Gender Identity Development in Young Adults and Implications for Healthcare. Current Sexual Health Reports, 11(4), 274–286. https://doi.org/10.1007/s11930-019-00215-w
  3. Kattari, S. K., Atteberry-Ash, B., Kinney, M. K., Walls, N. E., & Kattari, L. (2019). One size does not fit all: Differential transgender health experiences. Social Work in Health Care, 58(9), 899–917

Data and Policy Resources & Recommended Readings:

  1. Wilson, B.D.M, Choi, S.K., Herman, J.L., Becker, T., Conron, K.J. 2017. Characteristics and Mental Health of Gender Nonconforming Adolescents in California: Findings from the 2015-2016 California Health Interview Survey. Los Angeles, CA: The Williams Institute and UCLA Center for Health Policy Research. https://williamsinstitute.law.ucla.edu/wp-content/uploads/GNC-Youth-CA-Dec-2017.pdf

W4 Discussion Post

Quiz #1

5

Adolescence/Young Adulthood (CANCELLED CLASS)

Required Readings:

  1. Liu, Stevens, C., Wong, S. H. M., Yasui, M., & Chen, J. A. (2019). The prevalence and predictors of mental health diagnoses and suicide among U.S. college students: Implications for addressing disparities in service use. Depression and Anxiety, 36(1), 8–17. https://doi.org/10.1002/da.22830
  2. Yang, K. G., Rodgers, C. R. R., Lee, E., & Lê Cook, B. (2020). Disparities in Mental Health Care Utilization and Perceived Need Among Asian Americans: 2012–2016. Psychiatric Services, 71(1), 21–27. https://doi.org/10.1176/appi.ps.201900126
  3. Cha, B. S., Enriquez, L. E., & Ro, A. (2019). Beyond access: Psychosocial barriers to undocumented students’ use of mental health services. Social Science & Medicine (1982), 233, 193–200. https://doi.org/10.1016/j.socscimed.2019.06.003

Data and Policy Resources & Recommended Readings:

  1. Watch Dr. Margarita Alegría on Behavioral Health Disparities: https://www.youtube.com/watch?v=t5xucJyshWQ

W5 Discussion Post

6

Young Adulthood/Middle Adulthood (REMOTE CLASS)

Required Readings:

  1. Subica AM, Link BG. Cultural trauma as a fundamental cause of health disparities. Soc Sci Med. 2022 Jan; 292:114574. doi: 10.1016/j.socscimed.2021.114574. Epub 2021 Nov 17. PMID: 34808396; PMCID: PMC9006767. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9006767/
  2. Hartmann, W. E., Wendt, D. C., Burrage, R. L., Pomerville, A., & Gone, J. P. (2019). American Indian Historical Trauma: Anti-Colonial Prescriptions for Healing, Resilience, and Survivance. The American Psychologist, 74(1), 6–19.
  3. Watch PBS NewsHour: ACEs and Their Effects | Student Mental Health Matters:  https://ca.pbslearningmedia.org/resource/mht-aces-and-their-effects-video/student-mental-health-matters/

Data and Policy Resources & Recommended Readings:

  1. Mersky, J. P., Topitzes, J., & Reynolds, A. J. (2013). Impacts of adverse childhood experiences on health, mental health, and substance use in early adulthood: A cohort study of an urban, minority sample in the U.S. Child Abuse & Neglect, 37(11), 917–925. https://doi.org/10.1016/j.chiabu.2013.07.011
  2. Sangalang, C. C., Becerra, D., Mitchell, F. M., Lechuga-Peña, S., Lopez, K., & Kim, I. (2019). Trauma, Post-Migration Stress, and Mental Health: A Comparative Analysis of Refugees and Immigrants in the United States. Journal of Immigrant and Minority Health, 21(5), 909–919. https://doi.org/10.1007/s10903-018-0826-2
  3. Missing and murdered Indigenous Women. https://www.bia.gov/service/mmu/missing-and-murdered-indigenous-people-crisis

 

 

7

Middle Adulthood/Older Adulthood/Long Term Services and Supports

Guest Lecturer: Dr. Kathryn Kietzman


Required Readings:

  1. Mitra, M., Long-Bellil, L., Moura, I., Miles, A., & Kaye, H. S. (2022). Advancing Health Equity and Reducing Health Disparities for People with Disabilities in the United States. Health Affairs, 41(10), 1379-1386. https://www.healthaffairs.org/doi/pdf/10.1377/hlthaff.2022.00499
  2. Kaye, H. S. (2019). Disability-related disparities in access to health care before (2008–2010) and after (2015–2017) the Affordable Care Act. American Journal of Public Health, 109(7), 1015-1021. https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.2019.305056
  3. Shippee, T. P., Duan, Y., Olsen Baker, M., & Angert, J. (2020). Racial/ethnic disparities in self-rated health and sense of control for older adults receiving publicly funded home-and community-based services. Journal of Aging and Health, 32(10), 1376-1386. https://journals.sagepub.com/doi/pdf/10.1177/0898264320929560

Data and Policy Resources & Recommended Readings:

  1. Christ, A. & Dickman, H. (2022). An Equity Framework for Evaluating California’s Medi-Cal Home and Community-Based Services for Older Adults & People with Disabilities. https://justiceinaging.org/wp-content/uploads/2022/12/An-Equity-Framework-for-Evaluating-CAs-HCBS-System.pdf
  2. Unmet Needs For Help At Home: How Older Adults and Adults With Disabilities Are Faring In California: https://healthpolicy.ucla.edu/our-work/publications/unmet-needs-help-home-how-older-adults-and-adults-disabilities-are-faring-california
  3. California’s Master Plan for Aging Data Dashboard on Aging: https://mpa.aging.ca.gov/DashBoard/

Topic Proposal

 

UNIT III: ELIMINATING HEALTH INEQUITIES ACROSS THE LIFESPAN

8

Making Health Systems Work

Required Readings:

  1. Listen to Dr. Thomas LaVeist in Health in All Podcast (56 seconds):  https://www.facebook.com/umnsph/videos/s2e4-thomas-laveist-quote/678474582840437/
  2. Handtke O, Schilgen B, Mösko M. Culturally competent healthcare - A scoping review of strategies implemented in healthcare organizations and a model of culturally competent healthcare provision. PLoS One. 2019 Jul 30;14(7):e0219971. doi: 10.1371/journal.pone.0219971. PMID: 31361783; PMCID: PMC6667133. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6667133/
  3. Stubbe, D. E. (2020). Practicing Cultural Competence and Cultural Humility in the Care of Diverse Patients. FOCUS, 18(1), 49–51. https://doi.org/10.1176/appi.focus.20190041

Data and Policy Resources & Recommended Readings:

  1. Lu, J. J., D’Angelo, K. A., Kuoch, T., & Scully, M. (2018). Honouring the role of community in community health work with Cambodian Americans. Health & Social Care in the Community, 26(6), 882–890. https://doi.org/10.1111/hsc.12612
  2. Barnett, M. L., Lau, A. S., & Miranda, J. (2018). Lay Health Worker Involvement in Evidence-Based Treatment Delivery: A Conceptual Model to Address Disparities in Care. Annual Review of Clinical Psychology, 14(1), 185–208. https://doi.org/10.1146/annurev-clinpsy-050817-084825
  3. Metzl, J. M., & Hansen, H. (2014). Structural competency: Theorizing a new medical engagement with stigma and inequality. Social Science & Medicine, 103, 126–133. https://doi.org/10.1016/j.socscimed.2013.06.032

W8 Discussion Post

Quiz #2

9

Group Presentations

Required Readings: No readings for this week.

W9 Discussion Post

Quiz #3

Group Slides

Final Group Project

10

Wrap Up and Future Directions (REMOTE CLASS)

Required Readings:

  1. Pérez-Stable EJ, Webb Hooper M. The Pillars of Health Disparities Science—Race, Ethnicity, and Socioeconomic Status. JAMA Health Forum. 2023;4(12):e234463. doi:10.1001/jamahealthforum.2023.4463. https://jamanetwork.com/journals/jama-health-forum/fullarticle/2812750
  2. Himmelstein KEW, Lawrence JA, Jahn JL, et al. Association Between Racial Wealth Inequities and Racial Disparities in Longevity Among US Adults and Role of Reparations Payments, 1992 to 2018. JAMA Netw Open. 2022;5(11):e2240519. doi:10.1001/jamanetworkopen.2022.40519 https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2798135
  3. Ko, M., Sanders, C., de Guia, S., Shimkhada, R., Ponce, N.A. Managing Diversity to Eliminate Disparities: A Framework for Health. Health Aff (Millwood). 2018 Sep;37(9):1383-1393. doi: 10.1377/hlthaff.2018.0438. PubMed PMID: 30179560.  https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2018.0438
  4. Ponce NA, Shimkhada R, Adkins-Jackson PB. Making Communities More Visible: Equity-Centered Data to Achieve Health Equity. Milbank Q. 2023 Apr;101(S1):302-332. doi: 10.1111/1468-0009.12605. PMID: 37096622; PMCID: PMC10126976. https://onlinelibrary.wiley.com/doi/full/10.1111/1468-0009.12605

Data and Policy Resources & Recommended Readings:

  1. LaVeist TA, Pérez-Stable EJ, Richard P, et al. The Economic Burden of Racial, Ethnic, and Educational Health Inequities in the US. JAMA. 2023. DOI: 10.1001/jama.2023.  https://jamanetwork.com/journals/jama/article-abstract/2804818
  2. CMS Framework for Health Equity 2022–2032:  https://www.cms.gov/files/document/cms-framework-health-equity.pdf
  3. Anderson AC, O'Rourke E, Chin MH, Ponce NA, Bernheim SM, Burstin H. Promoting Health Equity And Eliminating Disparities Through Performance Measurement And Payment. Health Aff (Millwood). 2018 Mar;37(3):371-377. doi: 10.1377/hlthaff.2017.1301. PMID: 29505363. https://pubmed.ncbi.nlm.nih.gov/29505363/
  4. Lee, E. W. J., & Viswanath, K. (2020). Big Data in Context: Addressing the Twin Perils of Data Absenteeism and Chauvinism in the Context of Health Disparities Research. Journal of Medical Internet Research, 22(1), e16377. http://www.ncbi.nlm.nih.gov/pmc/articles/pmc6996749/

W10 Discussion Post

Final exam distributed finals week,