Aim and Content

The INTH 316 is composed of 4 components:

1. Health systems: concepts and shifting strategies (2 days teaching and 1 day reading literature)
2. Culture and health (5 days ¿ morning sessions and group work)
3. Health Systems Economic Evaluation (5 days ¿ morning sessions and computer exercises)
4. Health education/promotion (5 days ¿ morning sessions ¿ and group work

Component 1

Health Systems

• Extended definitions of health, ¿Health for all strategy¿
• Medicalization: health-ism, the risk society, and the paradox of health.
• Illness/health¿ introducing sectors of health care systems (ref. Klainman); illness behaviour
• Role of Medicine: Shifting visions/ideologies/strategies
• Fundamental objectives of health systems and the relevance to recent policies as expressed in the 2008 world health report
• Introduction to health systems
• Health systems and the politics of global health:

Global actors and changing policies

• Vertical approaches, 1946-77
• Primary health care and selective primary health care 1978-1992
• Health systems reforms and reversal to vertical approaches, 1990 ¿ 2000
• The area of large global health initiatives 2000 ¿
• 30 years after Alma Ata: A revised primary health care strategy 2008 -
• Outcome of the policies
• Policy options for improving the health care for poor populations

• Defining and applying the terms: Quality, Equity and Trust
• Different approaches in priority setting ¿ with focus on limited resource settings
• Major challenges of hospitals in low-income settings

Component 2

Culture and health

This module is an introduction to medical anthropology, where the emphasis is on how culture impacts upon people¿s health and illness in terms of how people in varying cultural contexts talk about, understand the body, how they relate to health and ill health, and to types of treatment when they get sick.

Like all systems of healing, biomedicine is a cultural product, which has arisen from a `Western¿ context. Although biomedicine is culturally embedded, the practice of biomedicine has shown little cognizance in the multiplicity of cultural factors and practices related to ill health and health seeking behaviour. Biomedical concepts of health and disease and its related practices are often transported from one part of the world to the other in relatively fixed ¿packages of truths¿. Notwithstanding great results, biomedicine has at times proven to be ineffective and even detrimental to the receiving group of people. Central to this challenge is failure on the part of biomedicine to take into account culture¿s influence on people¿s attitudes, belief systems, conceptions of health, illness and disease, disease etiology, and health seeking behaviour. Diverse theoretical approaches to human suffering in medical anthropology and health psychology will be the focus in this module.

The following areas of topics will be addressed during the course

• What is `culture¿ (in the context of medical anthropology)?
• The concepts of disease, illness and sickness
• Culture in relation to the body, health, illness and disease
• Culture in relation to food and drugs
• Individual and ethnic factors in health
• Culture, caring and curing
• Culture and patient healer - doctor interactions

Component 3

Health promotion-disease prevention

• Basic concepts in health promotion / disease prevention
• Health behaviour and health behaviour theory
• Strategies and methods of health promotion

Component 4

Health Systems Economic Evaluation

• The structure of economic evaluation
• Measuring and valuing resource use
• Measuring and valuing consequences
• Presenting and interpreting the evidence
• Appraising the quality and usefulness of evidence

Learning Outcomes

Component 1

Health Systems

1. Be familiar with historical shifts in ideologies and strategies relevant to current discussions on objectives, functions and challenges of health systems
2. Discuss major roles of health systems related to global health initiatives
3. Discuss priority setting strategies and challenges related to equity, quality and trust

Component 2

Culture and health

1. Define and operationalize the concept ´culture´ (and other central concepts in medical anthropology) in order to show an understanding of the variation related to how people in different cultures and social groups explain health and ill health and how they treat illness. This implies gaining an understanding of the cultural embeddedness of health, illness and disease.
2. Discuss how cultural beliefs and practices relate to transitions in biological, psychological and social aspects of human life.
3. Discuss how environmental, cultural, social and individual factors interact to produce, sustain and alleviate health problems.

Component 3

Health promotion-disease prevention

• Present an overall structure for the planning, implementation and evaluation of health promotion programs
• Be able to discuss advantages /disadvantages with various strategies of health promotion
• Be able to discuss a socio-cognitive approach to the explanation of health behavior

Component 4

Health Systems Economic Evaluation

• Know how different types of economic evaluations and modelling techniques can help address policy questions in health care
• Be able to describe and discuss issues on measuring and valuing resource use in health and non-health service costs
• Be able to describe and discuss issues on measuring and valuing health consequences
• Know the basic requirments for presenting output from economic evaluations, be able to correctly interpret results and discuss how results should be applied in priority setting
• To be able to appraise the quality and usefulness of economic evaluations in low-income settings.

Course offered (semester)

Autumn

Course Unit Level

Master and PhD

Access to the Course Unit

Open to all registered students at Master and/or PhD level at the University of Bergen

Pre-requirements

Minimum a Bachelor or equivalent, according to the requirements for the Master programme.

Teaching Methods

The course will involve formal lectures, interactive group discussions, seminars, computer exercises; oral presentations; literature reading and essay writing. Videos will also be shown.

Assessment methods

Essay/multiple choice

Reading List

Modul 1

Health Systems

1. Hardon A et al. Applied health research manual. Anthropology of health and health care. Het Spinhuis Pblishers, Amsterdam, Netherlands. Revised edition 2001. Foreslått tekst: Modul 2: Health and illness; and Module 4 Health systems.
2. Task Force on Health systems Research. Informed choices for attaining Millennium Development Goals: towards an international cooperative agenda for health-systems research. Lancet 2004, 364, 997-1003.
3. Plos Medicine Editors. Reform should make health the first item of busines. Plos Medicine 2008, 5e208.
4. World Health Report 2008: http://www.who.int/whr/2008/en/index.html
5. Global Health. An introductory textbook: Chapter 11 and 12
   

Modul 2

Culture and health

Cecil G. Helman (2001). Culture, health and illness. (4th edition). London: Arnold

Modul 3

Health promotion-disease prevention

1. Compendium in health promotion - selected papers/chapers*
2. Watt RG. Strategies and approaches in oral disease prevention and health promotion. Bulletin of the World Health Organization 2005;83:711-718
3. Molla M et al. Applicability of the theory of planned behaviour to intended and self-reported condom use in a rural Ethiopian population. AIDS Care 2007; 19: 425-31

* on MY Space

Modul 4

Health Systems Economic Evaluation

1. Julia Fox-Rushby and John Cairns (2005). Economic Evaluation. Open University Press. McGraw-Hill Education.
2. Exercises and group work materials provided during lectures

Place of Teaching

Centre for International Health, University of Bergen

Course Unit Evaluation

Students evaluate the teaching according to the quality assessment requirements of the University of Bergen. The evaluation method is through an online questionnaire (My Space).