Professor Veronika Wirtz provides feedback on a student’s stakeholder map during a GH888 class. Photo: Megan Jones

MPH program

“How Would You Increase Motorcycle Helmet Use in Cambodia?”

Students in Veronika Wirtz’s global health policy seminar tackle this question and others like it in classroom exercises designed to give them hands-on experience in the application of political science research methods to real-world health challenges.

“How would you increase motorcycle helmet use in Cambodia?”

More than just a simple hypothetical, this is the kind of question that students in the School of Public Health’s Seminar on Global Health Policy Issues (GH888) are asked to consider in class. The course, taught by Veronika Wirtz, professor of global health, gives students hands-on experience applying political science research methods to real-world health challenges: translating evidenced-based solutions into policy changes that actually saves lives.

“Many who enter the field of public health express the desire to make change in the world they see,” says Wirtz. “Changing the status quo is almost always a question of changing a policy that will shift the status quo in a desirable direction.”

In public health, knowing what works is often the easy part. The greater challenge—turning evidence into policy and practice—demands the kind of real-world problem solving that Wirtz modeled in her class. As the students discovered, preventing injury and death from motorcycle accidents is not a question of what should be done—wearing a helmet is proven to reduce the risk of brain injury by up to 74%—but the crux of the problem is how to get it done. Despite high awareness of the benefits of helmets, use remains low across Cambodia, a disparity that presented the students with an excellent learning opportunity.

Wirtz asked students to imagine they are global health policy analysts brought in to advise decision-makers in solving a particular problem. Picture a graph with two axes: along the horizontal axis is a spectrum of power or influence and along the vertical axis is position or interest. This is a stakeholder map, formally known as Mendelow’s matrix, and it functions as a visual snapshot of the positions of policy actors according to their capacity to impact a policy and their level of investment in that policy. Drawing on background research gathered through stakeholder analysis, stakeholder mapping places each actor into one of four quadrants: high power and high support, little power and high support, little power and little support, or little power and high support. The students must decide who falls where and why.

The act of generating the map helps the students to better understand the behavior, intentions, and interrelations of various stakeholders, says Wirtz, so they may better identify key decision makers, likely sources of opposition, and candidates for alliances and coalitions to support implementation.

To leverage the passions that first drew her students to public health, Wirtz organizes GH888 around a semester-long policy analysis project in which students research an international policy issue of their choice, propose a new policy or modify an existing one, and plan for its adoption, implementation, and evaluation.

In later sessions, students applied what they learned from mapping stakeholders in the helmet case study to better understand the interests and influence of stakeholders in the control of electronic cigarette and heated tobacco products through age restrictions or bans in Indonesia; the addition of canopy cover and green space to reduce heat-related illness in Mexico; the mandate of mental health screenings as part of HIV/AIDs, tuberculosis (TB), and other priority disease programs in India, and the digitization of patient health records to improve TB management in the Philippines.

Khushbu Sharma, a GH888 student pursuing dual certificates in health policy and law and epidemiology and biostatistics, chose to focus her policy analysis on mental health because, after graduation, she hopes to make breaking down barriers to mental health care as a policy analyst her full-time job.

Prior to enrolling at SPH, Sharma worked as a mental health navigator and behavioral health technician, but she became frustrated with her limited ability to ensure her patients had access to necessary healthcare services and medications. After working with several patients whose insurance denied coverage of necessary care, she decided to pursue an MPH to expand her understanding of healthcare at the systems level so that she might advocate changes to support the health of entire populations.

“Dr. Wirtz has made so many concepts in this class incredibly accessible and has been so proactive in trying to support us in our future career goals and aspirations,” she says. “In many other classes we spend a lot of time understanding theory, which is useful, but I really enjoyed putting it all into practice for our own policy analyses. I would strongly recommend this course to other people who are interested in global health policy.”

Sharma’s classmate Tyler Beerley echoes her recommendation. Beerley is pursuing a certificate in global health program design, monitoring, and evaluation while working full-time as an awards manager at Partners in Health (PIH). His policy analysis focusing on TB management is directly applicable to his current role at PIH where he helps to implement a multi-million-dollar portfolio of international projects, including TB programming in the Philippines.

“If you learn best through hands-on application of theory, then this is the course for you,” says Beerley. “I have learned how to apply policy analysis frameworks to better understand why and how issues climb up—or fall down—the hierarchy of policies policymakers chose to prioritize. Each class is highly interactive and outcome oriented—it is really an interdisciplinary professional development course preparing students to be successful in post-graduate life.”