Health Systems 2014

Welcome to the 2014 Health Systems Course.  Click for an overview of the course schedule.

Health Systems is one of the three "core courses" of the Social Medicine Curriculum set up at the RPSM in the early 1980's.  For many years it was designed and taught by Dr. Hal Strelnick.  Beginning in 2011, Dan O'Connell and Matt Anderson became the course directors.  This is our fourth year teaching the course and every year we incorporate a good deal of new content.  One thing that has not changed is our commitment to listen carefully to your feedback.  

Goals of the Course

1. Understand the US health care system(s)

One major change since last year is the ongoing implementation of the Affordable Care Act (ACA). We will spend a good deal of time thinking and debating what the new environment means for health in the US as well as the goal of "health for all."

2. Explore physician activism as a tool for social change

In the course of this month you will meet a broad variety of physicians (and some non-physicians) engaged in different forms of advocacy.   We will meet some physicians who work within the government to promote public health (Dr. Hillary Kunins at the New York City DOH and  Dr. Cristina Laurell in Mexico City), and others engaged in political advocacy outside of government who hope to change government policies (this is the focus of lobby day). Some involved in the course have joined unions (Dr. Toni Lewis) or attempted to create alternative visions of health care (Dr. Neil Patel and Dr. Diana Ramirez). We will hear from physicians who have partnered with communities (Dr. Lanny Smith and Dr. Jack Geiger) and others who have attempted to use the academic setting to promote change (Dr. Andy Racine). Still others have dedicated themselves to single-issue advocacy (Dr. Lin-Fan Wang and Dr. Marji Gold).  

Each of these forms of advocacy has its particular strengths and limitations.  We are offering you a chance to talk with those who are doing the work and learn from their experiences.

Structure of the Course

The organization of health systems is currently an area of intense public debate, not only in the US, but also internationally.  This course is built around the examination of health systems ranging from the local (our clinics and NYC) to the national and international.  Interwoven throughout these specific topics is the theme of activism and advocacy.  Approaching health systems from the perspective of changing them will require us to consider questions of political power and how social change is made.

The course is loosely organized around five general themes:

1) Introductory Week: We will examine the debates over health care reform in the US and the recent history of attempts to change the US health care system. 

2) The ACA: The National Health Care System (week 2)

 Residents will prepare reports on different State health care systems to understand how these have evolved and what insight they can offer for national debates.

We will draw on local resources to understand the health system of the city, the role of the Department of Health and how community groups have impacted the health care system.  

3) Primary Care: 

4) International Health (week 4): We will look at the impact of neoliberal health policies as well as the diversity of health care systems internationally. 

5) Activism: Activism and Advocacy are woven throughout the entire month.  On Saturday, May 3, Laurie Wen of PNHP will be conducting a speaker's workshop. This will prepare us for a trip to Albany on May 6th to participate in PNHP's Lobby Day to support the New York State Single Payer bill. 

Structure of each day

The course will just run in the mornings (8:30-11:45) with the exception of May 6th when we will go to Albany.  Most mornings will be divided into two 90 minute sessions. The first will run from 8:30 to 10:00. The second will run from 10:15 to 11:45. On Thursday May 15th  DFSM Grand Rounds will be broadcast in the 3rd floor conference room at 8:00 AM (Steffie Woolhandler will speak) and our first session will begin immediately afterwards. 

Unfortunately, IM's last day with the course is on May 30th. They will miss the last day of the course - June 2nd.  There was nothing we could do about this.

What we expect from you

 We expect you to come to class and to do the readings. We want you to listen critically and ask questions.

 Each resident will be responsible for preparing two 10 minute presentations during the course of the month:

1.     Week 2: The health system (or health innovation) undertaken at the state level

2.     Week 3: A public health activism campaign that was either successful or not.

3.     Week 4: The health care system of a foreign country (or) the health care system reforms promoted by international organization


Copies of Bodenheimer and Grumbach's Understanding Health Policy, 5th Edition will be available for borrowing. (Here is the Amazon link for those who are interested).  This book is not required reading but may be helpful to you in understanding the diverse systems that make up the US "non-system" as well as recent policy debates.

The Heart of Power by James Morone may also be useful in understanding how our health care system has evolved over the past half century.  Some copies of this book are also available. (Amazon Link)


 Ariel Aguillard
 Joel Bumol
 Will Dewitt
 Masha Gervits
 Shakeilla Howell
Jessica Marrero
 Chris Moore
 Daniel Morris
 Lizzy Reed
 Robin Reister
 Juan Robles
 Hilary Rosenstein
 Angelina Shigeura
 Arunjot Singh
 Raman Singhal


We will be conducting evaluations at the end of each week and a summative evaluation on June 2nd, following the final session of the course.  This course is pass fail for all students.