Health Systems 2013 page 1

Welcome to the 2013 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 taught by Dr. Hal Strelnick.  Beginning in 2011, Dan O'Connell and Matt Anderson became the course directors.  This is our third year teaching the course and incorporates a good deal of new content focusing on physician activism.  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 Supreme Court decision upholding 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 see a broad variety of physicians (and some non-physicians) engaged in different forms of advocacy.   We will meet people who work within the government to promote public health (Drs. Bedell and Farley). Other physicians engage in political advocacy outside of government but hope to change government policies (this is the focus of lobby day).  Others have joined unions (Dr. Lewis). Some have attempted to create alternative visions of health care (Dr. Patel). Physicians have also partnered with communities (Drs. Smith and Ramirez). Yet others have attempted to use the academic setting to promote social justice (Dr. Wang, session on the RPSM).  

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 perspective.

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.

Here are the broad outlines of the course:

1) Health Care in our clinics, our city (NYC) and states (weeks 1 and 2): 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.  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.

2) The National Health Care System (weeks 1 and 2): 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. Residents will be examining specific public health advocacy campaigns to see what has worked and what has not.

3) International Health (weeks 3 and 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 Friday, May 17th we will be getting an abbreviated version of PNHP's speaker's workshop. This will prepare us for a trip to Albany on May 21st 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 21tst 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 9 and Thursday, May 16 DFSM Grand Rounds will be broadcast in the 3rd floor conference room and so our first session will begin at 9:00 AM.

Unfortunately, IM's last day with the course is on May 30th. They will miss the last two days of the course - May 31 and June 3.  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)


 Christina Cruz
 Hima Ekanadham
 Ullanda Fyffe
 Rafael Garabis
 Judy Griffin
 Ernesto Guevara erguevar
 Conair Guilliams
 Maudina Gumbs
 Bhavik Kumar
 Norah Li
 Alisha Liggett
 Roona Ray
 Stella Safo
 Manisha Sharma
 Michelle St. Fleur
 Lucy Torres-Deas
 Chloe Turner
 Lauren Zajac


We will be conducting evaluations at the end of each week and a summative evaluation on June 3rd, following the final session of the course.  This course is pass fail for all students.