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Education Abroad Program
Universitat Pompeu Fabra
Global Health Program
Health Systems and Public Health: a focus in Spain and the
U.S
Language of instruction: English.
Coordination: Dr. Jordi Alonso and Dr. Gabriela Barbaglia.
Total workload course: 45 lecture/contact hours and 105 self-study
and group-work hours.
Recommended credits: 3 US credits-6 ECTS credits.
Course prerequisites: Undergraduate students from different areas,
who want to undergo postgraduate studies in health-related sciences.
Language requirements: English and basic Spanish
Course focus and approach: The aim of this course is to provide a
broad perspective of what health systems are with a particular focus
on public health services. Important public health topics will be also
approached.
Course description: This course will approach 5 main public health
topics, with an emphasis on the comparison between Europe and
United States. An up-to-date picture on how population health can
be measured will be introduced in the Global Burden of Disease class.
The objectives and the organization of health systems in general will
be presented with an emphasis in the Spanish and the American
health systems. What is public health along with its different
functions will be presented and discussed. Finally, three specific
public health topics will be approached, cancer screening, vaccines
and inequalities in health, as examples of the transdisciplinary nature
of public health. Two public health institutions (the Public Health
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Global Health Program
Agency of Barcelona - ASPB- and the Catalan Agency for Health
Information, Assessment and Quality - AQuAS) and the
Iberoamerican Cochrane Centre will be visited. Through these visits
the students will have the opportunity to be in contact with different
public health activities.
Course workload: There will be 45 contact hours, including classes,
seminars and the different visits. The student will have to do oral and
written presentations. Most of the work will be done in groups.
Teaching methodology: The course will include lectures, seminars
and on-site practical assignments.
Assessment criteria:
Qualifications will be based on the following criteria:
a- Class participation (10%)
b- Assignments (20%)
c- Three reports (max 500 words) (30%)
d- Mid-term exam (20%)
e- Final exam (20%)
The grades are: 94-100%: A; 93-86%: B; 85-79%: C; 78-70%: D
and 69-0%: F.
Absence policy:
Attending class is mandatory and will be monitored daily by
professors. Missing classes will impact on the student’s final grade as
follows:
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Absences
Penalization
Up to two (2) absences
No penalization
Three (3) absences
1 point subtracted from final
grade (on a 10 point scale)
Four (4) absences
2 points subtracted from
final grade (on a 10 point
scale)
Five (5) absences or more
The student receives an
INCOMPLETE (“NO
PRESENTAT”)
for the course
The PEHE/HESP attendance policy does not distinguish between
justified or unjustified absences. The student is deemed
responsible to manage his/her absences.
Emergency situations (hospitalization, family emergency...) will be
analyzed on a case by case basis by the Academic Director of the
HESP.
Classroom norms:
- No food or drink is permitted in class
- Students will have a ten-minute break after one-hour session.
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Course outline
Session 1: The Global Burden of
15.15-17.15
Disease: Concepts, Data,
Discussions
January 12th - room 40.152
Global Burden of Disease
January 14th - room 13.104
Global Burden of Disease
January 19th - Hosp. Sant Pau
Iberoamerican Cochrane Center visit
January 21st - room 13.104
Oral Presentation
Session 2: An Analytical Model for
Health Systems: Objectives &
Organization
January 26th - Roc Boronat, 81
AQuAs visit (10-12pm)
January 28th - Roc Boronat, 81
AQuAS visit (10-12pm)
February 2nd - room 40.152
Health System
February 4th - room 13.103
Health System
February 9th - room 40.152
Oral presentation
Session 3: Public Health Functions:
An International Perspective
February 11th - room 13.104
Public Health Functions
February 16th - room 40.152
Public Health Functions
February 18th - Lesseps square, 1
ASPB visit
February 23rd - room 40.152
Oral presentation
February 25th: Mid-term exam - room 13.101
Session 4: Public Health Topics
March 1st - room 13.101
Cancer screening
March 3rd - room 13.104
Cancer screening
March 8th - room 40.152
Vaccines
March 10th - room 13.104
Vaccines
March 15th - room 40.152
Inequalities in health
March 17th - room 13.104
Inequalities in health
March 22nd - room 40.201
Oral presentation
March 29th - room 13.104
Consultation hours
March 31st: Final exam -room 13.104
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General course contents and reading assignments
Session 1: Global Burden of Disease: Concepts, Data,
Discussions
A consistent and comparative description of the burden of diseases
and injuries and the risk factors that cause them is an important
input to health decision-making and planning processes. This session
will introduce the students how diseases, injuries and risk factors that
cause premature death, loss of health and disability in different
populations can be compared.
Required readings:
- Murray CJL et al. Disability-adjusted life years (DALYs) for 291
diseases and injuries in 21 regions, 1990–2010: a systematic analysis
for the Global Burden of Disease Study 2010. Lancet 2012; 380:
2197-223.
Additional resources:
Institute for Metric and Evaluation in Health (IMHE), 2013. The Global
Burden of Disease: Generating Evidence, Guiding Policy. Seattle, WA:
IHME.
http://www.healthmetricsandevaluation.org/gbd/research/project/glo
bal-burden-diseases-injuries-and-risk-factors-study-2010
Session 2: An Analytical Model for Health Systems: Objectives
and Organization
This session will introduce the students to health systems by
identifying their major objectives, functions, elements and
organizational issues. It will review international health systems
organization and transformation. The evidence about the contribution
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of health systems to the improvement of population’s health will be
discussed.
Required readings:
Murray CJL, Frenk J. A framework for assessing the performance of
health systems. Bull World Health Organisation 2000; 78 (6):
717-31.
Additional reading and resources:
Aday LA. Establishment of a conceptual base for health services
research. J Health Serv Res Policy 2001; 6: 183-4.
OECD Health Data 2011:
http://www.oecd.org/document/16/0,3746,en_2649_37407_2085200
_1_1_1_37407,00.html
World Health Organization (WHO). Health in Transition Series (HiTS):
http://www.euro.who.int/observatory/Hits/TopPage
Session 3: Public Health Functions: an International
Perspective
Public Health is the science and profession of protecting and
improving the health of societies through policies, interventions,
education, promotion of healthy life conditions and lifestyles, and
research. This session will provide an introduction to public health.
Definitions, approaches and essential functions of public health will be
discussed. A central questions for discussion will be: Can we assess
better the individual and collective positive effects of public health
policies?
Required readings:
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Porta M (Ed.). A dictionary of epidemiology. 6th. edition. New York,
Oxford University Press, 2014. Read (and reflect on) definitions of
terms that catch your interest, including if possible, Public health;
global health; epidemiology; prevention; common good; integration,
creativity; effectiveness; metaphor; risk factor; causal
inference; causes in public health sciences; dysregulation; Health in
All Policies; healthy public policies, costs of inaction; external
effects;political epidemiology; EVIDENCE-BASED MEDICINE;
EVIDENCE-BASED PUBLIC HEALTH;
strategy, “population”; strategy, “high-risk” significance;
relevance; medicalization; iatrogenesis; values.
Porta M. Ver lo que nos sale a cuenta. Diario El País, 10 de junio de
2010: 31
Additional reading:
Goldsteen RL, Goldsteen K, Graham DG. Introduction to Public
Health. Springer Publishing Company, 2010. (Chapter 1)
Turnock BJ. Public Health. What it is and how it works. Fifth Edition.
Jones and Bartlett Publishers, 2012. (Chapter 5)
http://www.whatispublichealth.org/what/
Session 4: Public Health Topics: I. Cancer screening
Cancer screening involves testing apparently healthy people for signs
of the disease. We know that cancer screening saves thousands of
lives each year. It can detect cancers at an early stage and in some
cases and even prevent cancers from developing in the first place.
But screening is not perfect: the tests can miss cancers, and have
other risks too. This session will address the basic aspects on cancer
screening overall and specifically in Spain, it benefits and harms, and
will include practical exercises intended to understand how cancer
screening programmes are run and evaluated.
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Required readings:
Cancer Research UK. Understanding cancer screening. Available at:
http://www.cancerresearchuk.org/about-cancer/screening/understandingcancer-screening
Easy read about the meaning and facts of screening and which cancer
screenings are available. The UK cancer screening programmes are quite
similar to the ones in Spain.
Recommended bibliography:
Ascunce N, et al. Cancer screening in Spain. Ann Oncol. 2010 May;21
Suppl 3:iii43-51
This article explains the different cancer screening programmes we have in
Spain. However, keep in mind that, in the last 5 years colorectal cancer
screening programmes have been implemented in many other regions.
Burón A, et al. Colorectal Cancer Early Screening Program of
Barcelona, Spain: Indicators of the first round of a program with
participation of community pharmacies. Med Clin (Barc). 2015 Aug
21;145(4):141-6. [article in Spanish]
For those capable of reading in Spanish, this article is worth Reading
because ti explains the details of the colorectal cancer screening programme
of Barcelona, the one we will be talking about and eventually visit.
Public Health Topics: II. Vaccines
After clean water, vaccines represent the most effective and costsaving public health intervention. This session will provide an
introduction to vaccines. It will review the history of vaccine
development, the types of vaccines and the impact of vaccination in
the United States and worldwide. In addition, the risks of vaccines,
both real and perceived will be discussed, with a focus on the
Papilloma Virus Vaccine.
Required readings:
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Centers for Disease Control and Prevention. Epidemiology and
Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A,
Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation,
2015. (Chapter 1 - Principles of Vaccination). Available at:
http://www.cdc.gov/vaccines/pubs/pinkbook/index.html
Recommended bibliography and additional resources:
Centers for Disease Control and Prevention. Epidemiology and
Prevention of Vaccine-Preventable Diseases. Hamborsky J, Kroger A,
Wolfe S, eds. 13th ed. Washington D.C. Public Health Foundation,
2015.
World Health Organization (WHO). Immunization, Vaccines and
Biologicals:
http://www.who.int/immunization/en/
Centers for Disease Control and Prevention (CDC). Vaccines:
http://www.cdc.gov/vaccines/
Public Health Topics: III. Inequalities in Health
Most health problems are attributable to the conditions of life and
work. These conditions include social determinants such as poor
housing and overcrowding, inadequate working conditions and social
exclusion. However health policies remain dominated by diseasefocused solutions that ignore the social and physical environment.
This session will provide knowledge on the definition and assessment
of social inequalities in health. It will address the major axes of
inequality which are social class, gender, ethnicity or country of origin
Required readings:
Marmot M, Commission on Social Determinants of Health. Achieving
health equity: from root causes to fair outcomes. Lancet . 2007 Sep
29 , 370 (9593) :1153-63 .
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Artazcoz L, Borrell C, Benach J. Gender inequalities in health among
workers: the relation with family demands. J Epidemiol Community
Health. 2001 Sep;55(9):639-47.
Recommended bibliography:
Commission on Social Determinants of Health. Closing the gap in a
generation: Health equity through action on the social determinants
of health. WHO, 2008.
http://www.who.int/social_determinants/thecommission/finalreport/e
n/
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