1. Write a paragraph describing the extent to which an socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework? Consider drawing a DAG or a socioecological model (like the one shown in class for obesity) to illustrate your point (you can take a picture to post on the forum).
Socioecological frameworks are often applied in the evaluation of the health and outcomes of transgender people. Unfortunately, as is the case with queer health studies, these applications have been in studies focused primarily on sexual health. This narrow focus has been attributed to 1) access to federal HIV/AIDS research monies specifically focused on transgender health and, 2) failure of health researchers to adequately measure or account for sex and gender identity. Specific to transgender health, a contemporary surge in interest in gender transition related medical and surgical care has also incorporated these frameworks. The lack of research on the overall well-being and health needs of transgender people is an area of needed research that would benefit from a socioecological framing.
2. In the WHO reading, the authors describe structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances. Pick 3 of these factors (at least one structural and one intermediary). Explain why you chose the factors (might use Braveman article to provide justification) and describe how each could be an important determinant of a health outcome of your choosing. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally..
The WHO reading provides an example of contemporary medical theory of sex and gender (section 5.5.5 Gender). The simplistic dichotomization of 'sex=genetics' and 'gender=social norm' is a problematic simplification that undermines our ability to elucidate the social significance and function of these complex and intertwined concepts. Regarding sex, a simplistic binary explanation related to genetics has been complicated by decades of biology and sociology research (See, Fausto-Sterling, Sexing the Body, 2000, for a summary). I will offer my abbreviated synthesis of an alternate understanding. Sex and gender, like social class and race/ethnicity, are social constructs used by the dominant group to control and divide. Medicine, in concert with other knowledge-producing and culture-shaping institutions, participates in the production and adjudication of sex and gender norms. Complex strategies of moralizing and pathologizing sex/gender deviation ritualize and justify the maintenance of these norms. The differential policing of sex/gender norms can be understood, intersectionally, as one tactic in a strategy to support racist, misogynist and colonialist agendas. A commonly accepted consequence of this simplistic understanding of sex and gender in medical research is the systemic lack of sexual orientation and gender identity (SOGI) data.
Race/ethnicity is a particularly important stratifier when considering the well-being of transgender people. A well-documented strategy of colonial control is the implementation of highly rigid binary sex/gender norms. This legacy carries forward to highly racialized and selective application of gendered norms. The racial and/or ethnic identities of an individual may inform that person's agency to self-identify their gender and mediate the consequences of failing at gender.
An important determinant in the health of gay and lesbian people is a supportive and accepting family. Less is known regarding transgender people but it is widely assumed this support is also predictive in this population. This is interesting when considering questions of wealth and class. We know that transgender people experience a disproportionate burden of family ostracization and measures of SES are frequently used to stratify health outcomes among trans and queer people with significant disparities. Assessing social class and wealth may add important information however the appropriateness of using parental occupation/income/education as surrogates for class of trans and queer people would need to be investigated.