Harvard School of Public Health

Health and Society

PH201x

Instructors

Faculty Lead: Ichiro Kawachi, MD, PhD

Professor of Social Epidemiology
Chair, Department of Social and Behavioral Sciences
Harvard School of Public Health

Faculty co-instructor: Monica Wang, ScD, MS

Instructor, Department of Social and Behavioral Sciences
Harvard School of Public Health
Research Fellow, Division of Preventive & Behavioral Medicine
University of Massachusetts Medical School

Teaching Assistants

Kafui Adjaye-Gbewonyo, MS
Department of Social and Behavioral Sciences
Harvard School of Public Health

Felicia Browne, MPH

Department of Social and Behavioral Sciences
Harvard School of Public Health

Readings

Required course readings are from the textbook Social

Epidemiology (Lisa F. Berkman and I. Kawachi, eds). New York:
Oxford University Press, 2000. To purchase a complete version of the
text, go to: http://global.oup.com/academic/product/social-
epidemiology-9780195083316?q=social epidemiology&lang=en&cc=us

Students will have free access to an electronic version of the assigned

textbook chapters for the duration of the course. Lecture slides will be
made available each week. Also included will be notes to direct you to
other supplemental readings that are available online.
Course Learning Objectives

The purpose of this course is to introduce students to the major social

variables -- social class, race, gender, poverty, income distribution,
social networks/support, community cohesion, the work and
neighborhood environment, and residential segregation -- that affect
population health. The course covers the theoretical underpinnings of
each construct (e.g., "race" as a social category), and surveys the
empirical research linking each to population health status. Methods
are introduced to operationalize each construct for the purposes of
empirical application in epidemiologic research.

Graded Assignments

Students will be assessed with multiple choice or short answer

questions at the end of each segment (each lecture is divided into
several segments). Students must score overall at or above 80%
in order to pass the course.

Course Schedule

Course content will be discussed on a weekly basis with the following

schedule:

November 18-24: Week 1: Introduction to the Social Determinants

of Health

December 2-8: Week 2: Socio-economic status (SES) and Health

December 9-15: Week 3: Income inequality and health

December 16-22: Week 4: Racial and ethnic disparities in health

January 6-12: Week 5: Social networks, social support, and health

January 13-19: Week 6: Neighborhood influences on health

January 20-26: Week 7: Social capital, social cohesion, and health

 January 27-February 2: Week 8: Psychosocial work environment

Questions

Questions about weekly content should be posed on the appropriate

week’s discussion thread. All technical questions should be made on
the course FAQ Discussion Thread. Given the enrollment in the class,
emails sent directly to the course teaching staff will not be answered.

SESSION DETAILS BY WEEK

Welcome and EdX Introduction

Administration
Meet the
Instructors

1. Introduction to
Week Reading: Objectives - by the end of the
Health and
1: Introduction sequence of lectures, you will be
to the Social Society Berkman LF, able to:
Determinants of Kawachi I.
Health 2. Life Expectancy: Chapter 1. A 1. Enumerate the major determinants
A Tale of Two Historical
of population health status.
Countries Framework
for Social 2. Define the term “social determinant

3. Upstream vs. Epidemiology of health”.

. In:
Downstream 3. Explain the distinction between
Berkman LF
Approaches and Kawachi “upstream” and “downstream”
I approaches to disease prevention.
4. The Immigration (eds). Social 4. Define Geoffrey Rose’s concept of
Effect & The Epidemiology
the “prevention paradox”.
Strategy of . New York:
Oxford 5. Explain the distinction between “high
Prevention
University risk” and “population” strategies of
5. Case History Press (2000), prevention.
pp. 3-12.
6. Describe the trade-offs (benefits and
6. The Prevention
drawbacks) of the two strategies of
Paradox
prevention.
7. Normality vs. 7. Apply the concepts of the twin
strategies of prevention to analyze
 Abnormality alternative approaches to deal with
public health problems (e.g. obesity
prevention).

8.

1. SES and
Week 2: Socio- Reading: Objectives - by the end of the
mortality: A case
economic status sequence of lectures, you will be
(SES) and health study of the Lynch J and able to:
titanic Kaplan G.
Chapter 2, 1. Define the term “SES gradient
2. SES gradient in Socioeconomi
in health”, and discuss
health today c Position.
In: Berkman alternative explanations for it.
3. Reverse causation LF and 2. Describe the mechanisms and
Kawachi I pathways through which
4. Confounding (eds). Social
Epidemiology income and education affect
5. Schooling . New York: health outcomes.
interventions & Oxford 3. Evaluate the threats to causal
University
importance of inference (reverse causation,
Press (2000),
early childhood pp. 13-35. confounding) in observational
education studies linking
income/education to health.
6. Quasi-
experiments and
SES

Explanations for
the association
between
schooling and
health

Absolute income
Week 3: Income Kawachi Objectives - by the end of the
effect
inequality and I. Chapter sequence of lectures, you will be
health Social 4, Income able to:
Inequality
comparisons and
and Health.
relative In: Berkman 1. Define the “Gini coefficient
deprivation LF and and describe how it is derived.
Kawachi I 2. Distinguish between the
Contextual effect (eds). Social concepts of income inequality,
of income Epidemiology absolute deprivation, relative
. New York: deprivation, and relative rank.
inequality Oxford 3. Discuss the empirical evidence
Relative rank   University linking income inequality to
Press, 2000; population health, and the
pp. 76-94. debates/controversies in the
field.

1. Racial/ethnic
Week 4: Racial Reading:
disparities in
and ethnic Objectives - by the end of the
disparities in health Krieger N. sequence of lectures, you will be
health Chapter 3, able to:
2. Race, SES, and Discriminatio
health n and Health. 1. Provide an account of the
In: Berkman different ways in which the
3. The construct of LF and variable “race” has been
race Kawachi I used in the medical/public
(eds). Social health literature, i.e. as a
4. Racial Epidemiology biological variable
discrimination . New York: (signifying innate biological
Oxford differences in susceptibility
5. Impact of University to disease) vs. as social
Press (2000) construct?
discrimination 2. Evaluate the genetic
pp. 36-75.
over the contribution to racial
lifecourse and disparities in health.
3. Analyze examples of racial
across domains
discrimination at different
Internalized levels of action
(institutional, interpersonal,
discrimination internalized).
 1. Social networks
Week 5: Social Reading: Objectives - by the end of the
characteristics
networks, social sequence of lectures, you will be
support, and and functions Berkman LF able to:
health and Glass T.
2. Social support Chapter 7, 1. Define and distinguish the
Social concepts of “social
3. Gender integration, networks” and “social
differences in social support”.
social support networks, 2. Distinguish between
social different types of social
4. Gender support and support.
differences in health. In: 3. Enumerate and describe
Berkman LF three mechanisms through
intergenerational and Kawachi which social networks
social support I promote health.
(eds). Social 4. Critically appraise evidence
5. Spread of obesity Epidemiology on the causal relationship
through social . New York: between social ties and
networks Oxford health.
University
Randomized Press, 2000;
pp. 137-173.
controlled trials of
social support
provision

Compositional vs.
Week 6: Reading: Objectives - by the end of the
contextual effects
sequence of lectures, you will be
Neighborhood MacIntyre S able to:
Ecologic fallacy
influences on and Ellaway
health Challenges in A. Chapter 1. Define what is meant by
14, the term “ecological
neighborhood Ecological fallacy”.
research Approaches: 2. Distinguish between
Rediscoverin compositional and
Neighborhood g the Role of contextual effects of
influences on the Physical neighborhoods on health;
 health and Social and describe how multi-
Environment. level study designs help us
Methods to In: Berkman to distinguish between
LF, Kawachi I them.
address
(eds). Social 3. Describe threats to causal
endogeneity Epidemiology inference in studies that
, New York: assess the potential
Oxford influence of neighborhood
University contexts on health.
Press 2000;
pp. 332-348.

Social capital
Week 7: Social Reading: Objectives - by the end of the
definition and
capital, social sequence of lectures, you will be
cohesion, and functions Kawachi I, able to:
health Berkman LF.
Social capital and Chapter 8,
natural disaster: Social 1. Define the term “social
1995 Chicago cohesion, capital”.
social capital, 2. Enumerate three
Heat Wave Part 1 community-level
and
health. In: mechanisms/processes
Social capital &
Berkman LF, through which community
natural disaster: Kawachi I social capital contributes to
1995 Chicago (eds). Social health improvement.
Heat Wave Part 2 Epidemiology 3. Describe the potential
, New York: relevance of community
Social capital & Oxford social capital to disaster
University resilience and recovery.
natural disaster: 4. Discuss what is meant by
Press 2000;
2011 Great pp. 174-190. the “dark side” of social
Eastern Japan capital.
Earthquake

Building social
capital

Ingredients of Job
Week Reading: Objectives - by the end of the
8: Psychosocial Stress sequence of lectures, you will be
work Theorell T. able to:
environment Demands/Control Chapter 5,
Working
Model of Job
conditions 1. Define “job strain”, and
Stress and health. describe the Karasek
In: Berkman demands/control model of
Job-redesign LF and stress.
Kawachi I 2. Describe the concept of “job
Non-standard
(eds). Social re-design” to reduce job
work and job Epidemiology stress.
insecurity . New York: 3. Critically appraise the
Oxford association between job
Causal University insecurity and poor health.
associations Press, (2000) 4. Discuss the role of work/life
pp. 95-117 balance in employee health.
between job
stressors and
health

Work/life balance
and gender
differences in job
strain