Community Partners

 OASIS -Mike Nees

Atlanticcare Pride Division -Kirby Delgado (Liason)

POC maternity Health - Toshira Moldanado

Sister Jeans -Paige Washington

Who will you interview?

1. patients or potential underserved patients
2. health care providers
3. community advocates
4. case workers
5. navigators 
6. social workers
7. organizational staff
8. researchers
9. public health officials
10. other stake holders

Take-Aways From Our Presentations:

• Barriers to Access
• Historical Factors that continue to impede access
• Distrust of the system
• The impact of Stigma
• Fear of retribution/punishment
• No transportation or other resources
• poverty
• poor education
• immigration status
• others???

• Four Teams:

Unequal Access: Healthcare in the United States

 

Health and Illness in the Richest Country in the World

• Unlike all high income and most middle income countries, the United States have never made universal healthcare a social right.
• Instead, healthcare is offered through a complex mix of public and private coverage that affords no consistency
• Market-based, for profit industry dominated by insurance giants and drug companies
• This has resulted in the highest healthcare spending per capita in the world and mediocore health outcomes.
• The US has lower life expectancy and positive health outcomes than any other developed nation in the world. Scores much lower on managing chronic disease
• The US has the lowest access to primary care of any developed (and some developing) nations
• Lack of access to health insurance coverge (universal coverage) is the main cause
• exacerbates illness
• shortens lives
• increases suffering

ACA as a response to restricted access

• Increase access by expanding access to medicaid (non-group coverage)
• Creating insurance exchanges to sell affordable healthcare
• Using federal monies to finance programs rather than a hodgepodge of state formulas which left most care un- or under-funded.
• Prohibited
• denying coverage because of preexisting conditions
• charging higher prices for women (gender range)
• canceling coverage after it was issued (excision)
• not including a comprehensive packege of basic services (minimum coverage)
• Protected Insurance Companies
• Risk pooling (risk adjustment, risk corridors, reinsurance
• Provided subsidies and tax credits to keep market affordable
• Problem with Implementation
• 2012 supreme court decision made medicare expansion optional for states
• less than 100% below poverty was now ineligible for financial assistance
• left a new group of poor and uninsured
• "coverege gap" for which people blamed obamacare rather than the states that didn't expand medicare by their own choice- even though the government would have paid 100% of it (for the first two years)
• remains politically contentious which is responsible for its partial and tentative rollout and its lack of acceptance.

The Anthropological Approach to Healthcare Access

• concerned with individual phenomonology as opposed to generalization
• qualitative rather than quantitative data
• shows how differently situated individuals have radically different experiences and these are all valid.
• responsive to multiple points of view
• Three theoretical concerns when understanding access post-ACA
• stratified citizenship- the uneven ways in which people experienced the law
• factors: immigration, race, age, income, gender, state of residence
• health citizenship: social inclusion and marginalization are often produced through unequal access to healthcare, structural barriers to health, and provider attitudes.
• differential notions of "deservedness"
• risk-class membership, sense of vulnerability, social resources
• how it is experienced and navigated in health care
• perceived health risks shape coverage behaviors
• people are also "risks" -subject to subprime rates for healthcare with incomplete coverage and high deductibles (average $3000).
• responsibility- ACA provided new responsibilities for individuals and new opportunities for companies to make money
• healthcare now an individual responsibility rather than an employment perk or universal right- individual mandate
• part of the larger history of welfare reform
• put more responsibility on states for healthcare delivery
• unequally distributed increase in responsibility for healthcare and improved health outcomes falls on the most vulnerable and those in the coverage gap.

Syllabus WPH Spring 24: Underserved Communities

                          ANTH 2136: World Perspectives on Health

An Exploration of Medical Anthropology

Spring 2024

9:55-11:10 M/W

AC Room 312

Professor Laurie Greene

Office Hours: m/w 8-9:30, 12:45-1:30

                       or any day by appointment

Office: AC224g or on Zoom

Cell Phone: text in emergency (609) 214-6596

Email: laurie.greene@stockton.edu (please put "Anth 2136" in subject line)

This semester we will be exploring the burgeoning field of medical anthropology. Medical anthropology is an applied discipline which starts with two insights; 

• first, that cultural premises which are often unconscious or difficult to recognize shape the way that we understand health and healing practices (illness and health are an “imposition of human meanings on naturally occurring processes”), 
• and second, that disease patterns, social norms, and socio-economic arrangements are intrinsically related (social factors determine disease patterns). 

It is part and parcel of medical anthropology that it is applied. Its concerns are not just for an understanding of the concepts and occurrences of health and illness cross culturally, but also in critical efforts that aim to make health and wellbeing available to everyone, not just those who hold power.

Limited Access and Underserved Communities: In order to understand these concepts we will be looking at the field in general with examples focusing on the SOCIAL and CULTURAL NEXUS of ILLNESS and DISEASE, especially as it pertains to the unequal distribution of health and well-beings across the world. This term we will be focusing (as always) on a relevant and timely issue, and a relevant one for the region -- how to get services to underserved populations in our region, and how to get people who are underserved to successfully access these services. 

"Anthropology, Activism and Inequality"--Anthropology in general, and medical anthropology in particular has an activist agenda. Anthropologists have an ethical obligation to those who they study and in medical anthropology this has been translated to "health equity"-the rights of all individuals everywhere to live healthy and fulfilling lives free from violence, be it physical or "structural". The greatest proponent of this position has been the late medical anthropologist/doctor Paul Farmer. In his ground-breaking works (Infectious Inequalities, Pathologies of Power,AIDS and Accusation), Farmer describes illness as a disease of poverty, and implements models for alleviating disease and suffering in the poorest place in the world. We will be reading a biography of Farmer, his work, and his theoretical insights.

The value of listening to human experience, rather than simply relying on statistics---Our anthropological experiences this semester will focus on "infectious inequalities" within our communities by understanding the "cultural underpinnings" of these illnesses as well as finding "local solutions" for them based on ethnographic "fieldwok". This fieldwork will work to collect life histories of individuals from some of our most marginalized community members, and allow their stories to provide potential solutions to limited access to adequate healthcare. To do this we will partner with community organizations that focus on providing access these populations. To help accomplish this we will be meeting as a hybrid. You will be expected to utilize time on Friday in part, to accomplish your community research for class. .

Student Learning Objectives ---This course has three objectives: 

1) to provide you with an overview of the rich anthropological scholarship on health inequity; 

2) to expose you to the variety of anthropological perspectives from which to explore the complex issues of healthcare access; and 

3) to create opportunities for you to think critically about the factors which hinder healthcare access -- cultural, political, economic, and even aesthetic.

Texts:

(1) Mountains Upon Mountains by Tracy Kidder. Profile Books. 2011. 978-1846684319 REQUIRED

(2) Unequal Coverage: the Experience of Healthcare Reform in the United States. NYU Press. 2017 

978-1479848737 REQUIRED

(3) PackBack AI  -Writing tool which you must purchase outside of the bookstore. (see me if this is a problem) - REQUIRED

(4) Chicago Style Guide for Citation and Bibliography

Syllabus and Reading List 

 

Week 1: An Introduction to Medical Anthropology (January 17)

          -course description and requirements, definition of terms 

          Readings: Unequal Coverage, Introduction

Week 2: What's so Cultural About Disease? (January 22-24)

          -Tenets of Medical Anthropology

          -Presentation: Lt. Santiago (2/22)

          -Presentation: Paige Washington/Sister Jeans (2/24)

          -Presentation Kirby DelgadoACMC LGBTQ+ navigator (2/24)

          Readings: Blog Post 

                            

Week 3: Methodology in Medical Anthropology (January 29-31)

         -Phenomenology, Narrative experience, Ethnography, auto ethnography & methodology

         -Presentation: Mike Nees/Oasis (1/29)

         -Presentation: Toshira Maldanado/Maternal Health (1/29)

          Readings: Blog Post 

Week 4:  Illness Narratives, Thick Description & the Experience of Illness (Feb. 5-7) 

          -The Uninsured and the Underinsured

           Readings: Blog Post 

Due: Auto-ethnographies Due: 2/9 on PackBack 

Week 5: Defining Health & Illness (February 12-14)

          Readings: Blog Post 

                           Here (Susan Sontag) 

Week 6: Infectious Inequality & The Politics of Illness (February 19-21)

          -economics of structural inequality

          -inequality factors in addiction

           Readings: Blog Post 

                            Mountains Upon Mountains

                           

Week 8: Unequal Access and Stratification (February 26-27)

           -Stratified Healthcare

            Readings: Blog Post 

                            Unequal Coverage, Chapter 1-2

Week 9: Healthcare Inequality and Stratification (March 4)

            -Stratification: immigration and Medicaid

             Readings: Blog Post 

                           Unequal Coverage, Chapters 3-4

                             NO CLASS MARCH 6-17 SPRING BREAK

Midterm - Monday, March 18

Due: Cultural Narratives of Access to Care #1-- Due 3/10 on Packback

Week 10: The Uninsured & Underinsured (March 18-20)

           -The Uninsured and Eligibility

           Readings:Blog Post 

                           Unequal Coverage, Chapters 5-6

Week 11: Social Class & Conservative Politics (March 25-27)

            -Social Class and ACA

           Readings:Blog Post 

                           Unequal Coverage, Chapters 7

Due: Cultural Narratives of Limited Access #2-- Due 3/29 on Packback

      Week 12: Mental Health & Mental Illness (April 1 No Fooling!)

              Readings:Blog Post 

                              Unequal Coverage, Chapters 8-9

  

NO CLASS WEDNESDAY April 3...Preceptorial Advising

      Week 13: Increasing Access -Healthcare Dreams (April 8-10)

          Readings:Blog Post 

                          Unequal Coverage, Chapters 10

Due: Cultural Narratives: Limited Access #3 --Due April 12 on Packback

      Week 14: Presentations (April 15-17)

               Readings:Blog Post 

      Week 13: Presentations (April 22-24)

                Readings:Blog Post 

Due: Cultural Narratives: Limited Access #4 --Due April 26 on Packback

     

 

    ^Grading:
Attendance Policy (required) You are expected to attend all classes, and attendance will be recorded. Phone use is prohibited in class---NO PHONES-- I will note your phone behavior in class. I reserve the right to deduct points from the graded materials below if you miss more than 3 classes or are frequently on your phone.
Midterm Exam (25%) The midterm exam will cover topics from all texts, videos, and lectures from the first half of the semester. 

      Fieldwork Projects (75%) Meeting the Needs of the Underserved: Community Partners

   Getting on PACKBACK

   

    Packback Deep Dives

    Packback Deep Dives will be used to assess independent research skills and improve academic communication through long-form writing assignments such as essays, papers, and case studies. While completing the writing prompts on Deep Dives, you will interact with a Research Assistant that will help you gather your notes and cite your sources, and Digital Writing Assistant for in-the-moment feedback and guidance on your writing.

    How to Register on Packback:

    

      An email invitation will be sent to you from help@packback.co prompting you to finish registration. If you don’t receive an email (be sure to check your spam), you may register by following the instructions below:

1. 1. Create an account by navigating to https://app.packback.co and clicking “Sign up for an Account”

       Note: If you already have an account on Packback you can log in with your credentials.

2. 2. Then enter our class community’s lookup key into the “Looking to join a community you don't see      

        here?” section in Packback at the bottom of the homepage.

        Community Lookup Key: c3409037-939e-4d13-8a08-496683a5c0c4

3. Follow the instructions on your screen to finish your registration.

       Packback requires a paid subscription. Refer to www.packback.co/product/pricing for more information.

 How to Get Help from the Packback Team: 

  If you have any questions or concerns about Packback throughout the semester, please read their FAQ at    help.packback.co. If you need more help, contact their customer support team directly at   help@packback.co. 

      For a brief introduction to Packback Questions and why we are using it in class, watch this video: https://www.youtube.com/watch?v=OV7QmikrD68