The case describes the challenges facing Shlomit Schaal, MD, PhD, the newly appointed Chair of UMass Memorial Health Care’s Department of Ophthalmology. Dr. Schaal had come to UMass in Worcester, Massachusetts, in the summer of 2016 from the University of Louisville (KY) where she had a thriving clinical practice and active research lab, and was Director of the Retina Service. Before applying for the Chair position at UMass she had some initial concerns about the position but became fascinated by the opportunities it offered to grow a service that had historically been among the smallest and weakest programs in the UMass system and had experienced a rapid turnover in Chairs over the past few years. She also was excited to become one of a very small number of female Chairs of ophthalmology programs in the country. 

Dr. Schaal began her new position with ambitious plans and her usual high level of energy, but immediately ran into resistance from the faculty and staff of the department.  The case explores the steps she took, including implementing a LEAN approach in the department, and the leadership approaches she used to overcome that resistance and build support for the changes needed to grow and improve ophthalmology services at the medical center. 

This case describes efforts to promote racial equity in healthcare financing from the perspective of one public health organization, Community Care Cooperative (C3). C3 is a Medicaid Accountable Care Organization–i.e., an organization set up to manage payment from Medicaid, a public health insurance option for low-income people. The case describes C3’s approach to addressing racial equity from two vantage points: first, its programmatic efforts to channel financing into community health centers that serve large proportions of Black, Indigenous, People of Color (BIPOC), and second, its efforts to address racial equity within its own internal operations (e.g., through altering hiring and promotion processes). The case can be used to help students understand structural issues pertaining to race in healthcare delivery and financing, to introduce students to the basics of payment systems in healthcare, and/or to highlight how organizations can work internally to address racial equity.

The Palestinian Bedouin of the Negev desert are a minority community within Israel, one that has experienced limits on its rights to land use and health access. The Bedouin claim of ownership of their ancestral lands is disputed by the state of Israel, which has attempted to condition access to state services, like health clinics, on the relinquishing of land claims. After the passage of universal healthcare in Israel in 1995, the Bedouin and their representatives developed a legal strategy to secure a right to health on their ancestral lands. This case explores this legal fight, the historical and health contexts of Bedouin citizens of Israel, the limitations of the law in pursuit of justice, and the role of community organizing in the struggle for fundamental rights to health. It highlights the concept of settler colonialism and the relevance of historical context when striving to secure health. Finally, it also emphasizes the distinction between public narratives about vulnerable populations from actors with power such as the State and the narratives of the vulnerable community populations themselves.

In Guatemala, rural and indigenous women face disparities in access to prevention and treatment of cervical cancer. This case analyzes barriers faced by Mayra, an indigenous woman from a rural community in Guatemala who was diagnosed with cervical cancer.  Even though all Guatemalans are entitled to free health care provided by the public health system, economic, geographic, linguistic, and cultural barriers prevent women from obtaining specialized healthcare for complex conditions such as malignancy.  Accompaniment and care navigation are potential solutions to overcome these impediments, helping marginalized patients receive treatment and reducing health disparities for indigenous peoples.

Gender-based analysis in public health is a systematic examination of the differences and similarities in the lives of women and men, as shaped by systems of gender relations, and the causes and consequences of these differences and similarities with respect to population health, policies and laws, programs and services, research priorities, and public discourse. As the Harvard School of Public Health Interdisciplinary Concentration on Women, Gender, and Health (WGH) states: 

"Addressing issues of women, gender, and health requires the study of the health of women and girls—and men and boys—throughout the lifecourse, with gender, gender inequality, and biology understood as important and interacting determinants of well-being and disease. 

"Also included are the study of gender and gender inequality in relation to individuals’ treatment by and participation in health and medical care systems, the physical, economic, and social conditions in which they live, and their ability to promote the health of their families, their communities, and themselves.

"Inherent in this definition is recognition of diversity and inequality among women—and men—in relation to race/ethnicity, nationality, class, sexuality, gender identity and age, and that protection of human rights is fundamental to health."

The WGH 207 teaching example assignment provides students with the opportunity to create brief teaching examples to expose students in non-WGH courses to gender-based analysis. Students work in pairs to create teaching examples based on the substantive material presented by guest speakers throughout the term (e.g., reproductive technologies). Teaching examples focus on cultivating a key technical skill within public health (e.g., Directed Acylic Graphs) through the exploration of a central issue in gender-based analysis (e.g., challenging simplistic conflations of gender and sex). Beyond building the pedagogical skills of WGH 207 students, the assignment has yielded—and continues to yield—teaching examples that can introduce the concept of gender-based analysis into core courses across all departments at HSPH. 

This assignment was originally developed by course instructors Jerel P. Calzo, PhD, and Sabra L. Katz-Wise, PhD.

This teaching case study examines psychological trauma in a community context and the relevance, both positive and negative, of social determinants of health. Healthy People 2020 views people residing in communities with large-scale psychological trauma as an emerging issue in mental health and mental health disorders (Healthy People, 2016). The case study, which focuses on Newark, New Jersey, addresses three of the five key determinants of health: social and community context, health and health care, and neighborhood and built environment. The three key determinants are addressed using psychological trauma as an exemplar in the context of trauma-informed systems. The social and community context is addressed using concepts of social cohesion, civic participation, and discrimination. Access to health and health care are addressed with discussion of access to mental health and primary care services, health literacy, and the medical home model. Neighborhood and built environment are viewed through the lens of available government and NGO programs and resources to improve the physical environment with a focus on quality of housing, crime and violence, and environmental conditions. Upstream interventions designed to improve mental health and well-being that support trauma-informed systems are analyzed. The use of Newark as the case study setting allows a real-life exploration of each of these three key determinants of health.

This case study has four sections – introduction, case study, side bar, and vignettes. Learners should work through the case, access appropriate resources, and work in a team for successful completion.

Elizabeth, a middle-aged African American woman living in Minnesota, develops chest pain and eventually presents to a local emergency room, where she is diagnosed with stress-related pain and given Vicodin. Members of a non-profit wellness center where she is also seen reflect on the connection between her acute chest pain and underlying stress related to her socioeconomic status. On a larger level, how much of her health is created or controlled by the healthcare system? What non-medical policy decisions impacted Elizabeth such that she is being treated with Vicodin for stress?