公共卫生

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国立成功大学公共卫生研究所九十八学年度第一学期课程表(初稿)

课程名称:高等公共卫生学

开课老师:全体老师(负责老师:陈美霞,mschen@mail.ncku.edu.tw)

课程助教:

时间地点:星期一下午3:10~6:00,医学院203D教室.

选课要件

这是博士班课程,但是修过"公共卫生理论,历史与实践"课程的硕士班同学,而且希望再进一步追求对公共卫生议题更深刻的分析与理解,以便有助将来或现在投入公共卫生相关事业的同学,都可以修此门课.

课程内容

我们检测设来修这门课的同学都已经有了对公共卫生领域的基础知识,而这门课目标是对公共卫生议题做更深入的分析与探讨.因为公共卫生议题十分广泛,而本所每一位老师都学有专长,任何一位老师都不太可能可以对所有公共卫生议题都能提供深刻的分析,所以,本课程采用协同教学的方式.也就是说,本所数位老师将在这门课中,以平均两堂课的时间,将他/她过去常年累积的研究成果,或近年新开发的研究议题,系统的与修课的同学"倾囊相授",所以这门课也是本所老师研究与教学精华的集结.

协同教学的可能问题是:课堂之间的连续性可能比较弱.本课程克服这个可能问题的根本方法是:"如何可以更深入的分析与探讨不同的公共卫生议题"是连结每一位老师讲课的主轴.因此,即使是不同的老师,他们讲课的目标都是:分享他们"如何更深入的分析与探讨他们长年关怀,专注的公共卫生议题".在技术层面,我们用两个方法增进课堂之间的连结性:1)负责本课程的陈美霞老师每一堂都会积极参与,而且事先会与讲课的老师协调讨论课程内容,并且在上课时协同参与提问与讨论,2)老师讲课时必须以这样的提纲进行:1.议题内容,2.此议题在公共卫生领域的位置,意义,及角色,以及为何该老师对该议题的研究,分析方法在公共卫生领域是相对深刻的,3.此议题在讲课的老师特殊领域(如流病组吕宗学老师的社会流行病学,卫政组许甘霖老师的医疗社会学)的位置,意义,与角色,以及为何该老师对该议题的研究,分析方法在该老师的特殊领域是相对深刻的,4.本研究或本议题与本所宗旨与特色的有机关联,5.提问与讨论.

博士班课程当然比硕士班课程应该更深刻,我们也因此期待修本课程的同学对科学哲学的基本概念有个理解,所以,我们在课程导论之後的三堂课请《科学月刊》创办人,宏光科技大学特聘教授,林孝信老师来为我们讲科学哲学基本概念及综述.但是,这两堂课只能讲授最最基本的科学哲学概念,我们强烈建议,博士班同学应该修习成大(或其他大学)开授的整个学期的科学哲学的课.

课程大纲

3/1课程导论(负责老师:陈美霞)

提纲:

什麽议题是最热门的

什麽是主流非主流

什麽议题是最严重的

什麽是新议题旧议题

什麽议题是最根本的

参考资料:

AnnualReviewofPublicHealth,tablesofcontents,2000年至今

台湾卫志,目录,2000年至今

AmericanJournalofPublicHealth,tablesofcontents,2000年至今

BeagleholeRobertandBonita,Ruth,Publichealthatthecrossroads:achievementsandprospects,Cambridge,UK,NewYork:CambridgeUniversityPress,2004.(我们理解,这本书不少同学都读过,也是"公共卫生理论,历史与实践"课程的必读课本,但是我们在此,会以另外一个角度来重新检视这本书,探讨公共卫生领域上述问题,也让已经阅读过这本书的同学再度系统回顾公共卫生领域相关议题)

Milio,Nancy,Publichealthinthemarket:facingmanagedcare,leangovernment,andhealthdisparities,AnnArbor:UniversityofMichiganPress,2000.(NancyMilio是美国公共卫生界的老将,以"Isa"healthyprofit"patiblewithahealthypopulation"这样一个大哉问做为她几十年关怀,投入美国全民健康的促进与维护事业的反思的起点,在本书中,以一个体制内,体制外的融合观点,展现美国公共卫生界理论与实践的辩证及struggle.本书书评如下)

胡幼慧,新医疗社会学:批判与另类的视角,台北:心理出版社,2001.(胡幼慧老师也是台湾公共卫生界的老将,过去是阳明卫生福利研究所的老师,这本书是她近20年对她在公共卫生领域理论与实践辩证经验的反思,比较是体制外观点,但是本书为本门课提供比较全面的公共卫生议题的回顾.)

按:1.开学第一天因为负责本课程的陈美霞老师无法及时返台,不上课,将此课程顺延,往下推,因此期末考周会上课.

2.上面这些参考读物也会是最後一堂总结课的参考资料.

3.本堂课规划在医学院图书馆上课.

3/8,3/15,3/22科学哲学基本概念及综述(负责老师:林孝信)

提纲:

内容

规律,定律,相关性,因果关系,可预测性问题

科学理论与外在世界的关系:什麽是真理真理可认识吗

Interpretation,description,explanation

科学方法介绍及分析:归纳,演绎,质性,量性研究

社会科学与自然科学的比较

(社会科学哲学:从孔德到昆兹)

派别

经验主义,理性主义,实证主义

後现代主义

诠释学,现象学

参考资料:

3/29,4/12流行病学在社区的理念与实践(待确定)(负责老师:汪忠川)

提纲:

参考资料:

4/19,4/26死因研究:公共卫生问题的照妖镜(待确定)(负责老师:吕宗学)

提纲:

参考资料:

5/3期中回顾(负责老师:陈美霞)

5/10,5/17社区健康营造,健康城市,与公共卫生(待确定)(负责老师:胡淑贞)

提纲:

参考资料:

5/24,5/31意识形态与公共卫生:政治经济学的视角(负责老师:陈美霞)

提纲:

什麽是意识形态

意识形态如何影响个人的健康信念,态度,与行为

意识形态如何影响卫生政策制定

意识形态与医疗制度改革

参考资料:

Eagleton,Terry,Ideology:AnIntroduction,London,NewYork:Verso,2007.

Crawford,R.Youaredangeroustoyourhealth:theideologyandpoliticsofvictimblaming,inNancyKrieger,EmbodyingInequality:EpidemiologicPerspectives,N.Y.:BaywoodPublishingCompany,Inc,2005.

Minkler,Meredith,Blamingtheagedvictim:thepoliticsofscapegoatingintimesoffiscalconservati,InternationalJournalofHealthServices,Vol.13,no.1,1983

Fierlbeck,Katherine,Policyandideology:thepoliticsofpost-reformhealthpolicyinUniterdKingdom,InternationalJournalofHealthServices,Vol26,no3,1996.

Narro,Vicente,Theargumentsagainstanationalhealthprogram:scienceorideologyIntervnationalJournalofHealthServices,Volume18,Number2/1988.

Waitzkin,Howard,Theoreticalapproachestomedicalencounters,chapter2inThePoliticsofMedicalEncounters,NewHenandLondon:YaleUniversityPress,1991.

Narro,Vicente,NeoliberaliasaClassIdeology,or,thePoliticalCausesoftheGrowthofInequalities,InternationalJournalofHealthServices,Volume37,Number1/2007

6/7,6/14,6/21同学报告及自由规划(负责同学:林进嘉)

6/28总结与回顾(负责老师:陈美霞)

参考资料:如第一节课的参考资料

评分标准(需要修改)

出席与参与10%,

隔周(除了学期最後两周)学习心得书面报告(1页A4)20%,

课堂习作20%:任选本课程谈论的议题做进一步的分析,论文最多五页

访谈台湾一位公卫老将:他/她的投入,struggle,对台湾公共卫生的分析,你的critique.25%

期末考(take-home)25%

BookReview(Milio,Nancy,Publichealthinthemarket:facingmanagedcare,leangovernment,andhealthdisparities,AnnArbor:UniversityofMichiganPress,2000)

ThisisareviewthatwaswrittenbyDr.DonaldLightinthejournalSocialScienceandMedicine,volume55(2002)2073-2079.

NancyMilioisanAmericanauthorityonmunityhealth,andherfield-basedexperienceesthroughinthepagesofthisarticulatebook.Thoughalwaystactfulandhelpful,shecannothelpbutdescribetheshamblestowhichpublichealthhasbeenreducedbythedecisionofemployersandgovernmenttoturnhealthcareovertofor-protcorporations.Whenstockholdersaretheprimeconstituency,``itcanconfusetheaimsofmunitypreventionwiththoseofpublicrelationsandmarketing,andimpairaccuracyofandaccesstodatathatarevitaltopublichealthassesenty''(p.267).Decisionsonhowgoods,servicesandinformationareallocated``placeAmericans'interestsandopportunitiesasconsumersabovetheirrights,responsibilitiesandactionsascitizens''(p.272).Thesituationissofragmentedandprimitive(thoughshewouldneverbesoblunt)thatshehastoremendthat``publichealthcouncilscouldmoreeffectivelyguidepublichealthagenciesthanthemanyhundredsoftinyboardsofhealth,eachwithitsownlimitedcapacitytocarryoutevenafewoftheessentialpublichealthservices''(p.280),andshehastoremindherAmericanreadersthat``Healthymunitiesarersthealthyplaces''(p.276).HowembarrassingtohereadersinScotland,orCostaRicaorIndialearnhowfarbehindpublichealthanizationisintherichestnationthatisreadytospendbillionsonupgradingitilitary.

PublicHealthintheMarketisdividedintofourpartsandfourteenchapters.Part1providesawell-researchedoverviewofthenewworldwhichmarket-basedpolicieshecreated,inwhichpublicmoniesareprivatized.Part2assessestheconsequentpolicies.Part3laysoutMilio'stemplateforpolicypracticethatinformsthewholebookandherwork,andPart4providestwoin-depthanalyses,basedonoriginalresearch,oftwocontrastingstates,aswellastheconcludingchapters.

Milio'stemplateormodelcentersononeofthosefigureswith15-20factors,binedintogeneralboxes,witharrowsgoinginalldirections,thatcouldbecritiquedifonewantedtogetdowntospecifics.TheacpanyingtextisamixtureofobservationsaboutUSpublichealthpolicysincethe1960sandgeneralobservations.Forexample,eachpolicyissuehasitsownwebofparticipantgroups,knowledgeoftheterritoryisprerequisiteforanyseriousstrategy,changingthebeliefsofpolicymakersisalmostimpossible.Yettheseandothertruisareoftenignoredbythosewhotrytoaffectpublicpolicy.

ThecasestudiesofArizonaandWestVirginiaareeye-openers.Welearnthattherichestfifthearnabout13timeorethanthepoorestfifth,anamazingdegreeofrelativepoverty,andthataboutone-quarterofthechildrenlivebelowthepovertyline,aninesetlowasanemergencyhouseholdbudget.WelearnthatduringWorldWarI,publichealthofficialsinArizonahadtogofromtowntotown,tryingtopersuaderesidentsthattheyneededtopayforsewerconnections.Somerefused.Bythe1960s,Milioreports,theArizonaStateDepartmentofHealthhadreachedabudgetof12centspercapita.Ironically,thecredoofindividualrightsandunfetteredgrowthheresultedinhighratesofviolentcrime,poverty,unemployment,overcrowdedclassroomsandmunitiesthatareunhealthyplaces-afistfulofpublichealthproblemsthatcannotbesolvedwithprivatemedicalcare.Eveninthe1990s,thestatestilllackedtheabilityeven``toestimateits investmentinthetenessentialpublichealthservices''(p.180).Thispairofchaptersiullofplexdetailabouteffortstodeveloppublichealthprogramsinthetwostates.


Milioseesclearlyanddocumentswelltheeffectsofpetitionpolicyandmarketsonpublichealthandhealthcare.Costcontainmentprogramsheactuallyworsenedaccessofvulnerablegroupstohealthcare.Managedcareanizationshenoresponsibilityfororinterestinupstreampublichealthcausesofpatientproblems.Anygivenmunityisdividedintoeachpany'arketshare,thuscarvingupanyresponsibilityforthewhole.Vitalinformationforpublichealthprograms,oncegatheredroutinely,beesproprietary.Theservicesandpatientsthataremoreprofitablegetsiphonedoff,leingpublichealthcentersandprogramsinbudgetarycrisis.Large-scalefraudandbankruptcyarenotunmonandthrowcareintoturmoil,especiallyforthousandswithseriousproblems.

Inanymarket,thereareafewwinnersandmanylosers.Overall,thisbookprovidestellingdetailandtimehonoredinsightsintoatragedyofourtimes,enhancedbyawonderfulcollectionofquotationsthatframetheissuesinhistoricalperspective.Thebookiswelledited,indexedandprintedbythePress.

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