Global Health: Problems and Paradigms

Sherryl Broverman, Professor of the Practice in Biology and Global Health

When people encounter racial differences in health outcomes, they either incorrectly attribute them to genetic differences between socially constructed racial groups or focus on the powerful role played by the social determinants of health. However, this dichotomy is missing an understanding that the experience of racism itself causes physiological and molecular changes that increase health inequity. There is a robust literature on how the stress of experiencing racism is codified in biological systems in a multitude of ways including increased inflammation; changes in gene expression; alterations in immune function; placental functioning; telomere shortening leading premature aging and general physiological ‘weathering’; and possible changes in life history.  This can be addressed from many different perspectives including evolutionary theory on responses to stress. This course will examine the biological impact of the experience of racism and stigma on Black, Indigenous, Asian, and Latinx people as well as newly acculturating immigrants.  We will also examine the research on building resiliency and managing stress.

Manoj Mohanan, Associate Professor of Public Policy

Imagine driving a car, blindfolded, with instructions from the backseat on what to do and they are rarely in agreement. How do you decide what to do, which instructions to rely on?  The COVID pandemic of the last year demonstrated the acute need for better data for policy making, and better practices for engaging with and communicating such data. This seminar will lead students through the basics of how data is generated and circulated (or not), how such information feeds into the policy cycle (or not) and the implications for the overall policy response. The course will draw on concepts from public policy, economics, statistics, as well as public health. We will examine where data for policy comes from, how data becomes controversial, and if there is ‘truth’. We will also look at how data from clinical vs population settings is used differently. And finally, why doesn’t data inform policy more often? How can future leaders do better?

Nicole Barnes, Associate Professor of History

Medicine has long been a global undertaking, and knowing its history prepares us to address emerging health crises. This Focus course begins with the coronavirus pandemic and the first major infectious disease epidemics that emerged from increased trade and warfare: plague and smallpox. Critical analysis of colonial medicine reveals reasons for ongoing inequalities in global health today. We analyze smallpox, cholera and schistosomiasis eradication programs and consider the importance of basic hygiene and safe childbirth. The core text examines the role of stigma in global health today. Your work will include an individual research paper on a topic you choose.

Dr. Alvan Ukachukwu, Research Scholar, Duke Global Neurosurgery and Neurology 

Health systems worldwide all have the same goal: produce health in their population that is equitably distributed. When examining how different countries and regions of the world set up their health system, a multitude of different mechanisms meant to accomplish the same goal are discovered. Given this diversity of approaches, the answer to the question of "What are the core elements of an equitable healthcare system AND how do you implement those elements?" can be elusive. 

Students in this course will explore how health systems are structured globally by examining the core elements of each health system in depth. We will accomplish the goals of this course through a series of country-specific case studies. In addition, experts in health system development and representatives from the countries will join our discussions, speak to the students, and answer questions. Throughout the course, we will explore the different approaches to health system development, discuss the advantages and disadvantages of different choices, and dive deep into current discussions in health system strengthening. Students will engage in discussions on: What does universal healthcare coverage mean, and how can it be implemented successfully? What is the role of providing universal access to surgical care in a health system? What are the benefits and detrimental impacts of international funding on countries trying to build/rebuild their healthcare system?

Students in the course will have the opportunity to expand their understanding of a health system and learn the current approaches to health system development and strengthening. No previous background in health, global health, or health systems is required. Students will only need to bring a passion for learning about how we can genuinely provide the best healthcare to all people no matter where in the world those people live.