Health Disparities Forum

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).

 There is a paucity of literature on socioecological factors that influence delirium suggesting that there is ample opportunity to improve our understanding of social determinants and health disparities in this disease. Based on my review, there is one paper exploring the relationship between socioeconomic inequality and delirium and another one on the relationship between African American race and delirium. These are insufficient in understanding the overall socioecological framework of delirium because they do not simultaneously consider many factors such as economic and social opportunities and resources, living and working conditions, and how these may interact with genetic and biological factors. This may be due to the dominance of a physiological model for delirium where medications, illness severity, nutrition, and hospital environment are thought to be direct causes of delirium. However, one could argue that all of these factors exist within a social, racial, economic, and environmental context that should be considered in order to illustrate the etiology of delirium. For example, those with lower SES may have reduced access to healthcare, only visiting hospitals during cases of extreme illness. This lack of familiarity with the hospital environment may increase one’s risk for delirium, along with poorer nutrition and potential substance abuse, which may also be associated with lower SES.

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..

Outcome: Anxiety disorders

I chose the following variables because, based on my primitive understanding, these may be the most important factors that determine the development of an anxiety disorder. The Braveman article suggests that we think about plausible explanatory pathways, collect as much SES data as possible, and systematically consider how unmeasured SES variables may affect these conclusions. As such, if I were to conduct a comprehensive review and study on the causes of anxiety, I would also include education, race/ethnicity, and social-environmental or psychosocial circumstances.

Social class (structural): Anxiety may be induced by greater expectations imposed on an individual in “higher” social classes. Social class carries certain expectations with regards to education, income, health, and behavior, which individuals may experience burden from. Conversely, those in “lower” social classes may have fewer of these responsibilities and expectations but may experience higher anxiety due to economic pressure. These individuals may have fewer resources to contend with their anxieties or choose less constructive forms of therapy such as alcohol or drug abuse, which may exacerbate these effects.

Gender (structural): Based on our current understanding, women suffer from anxiety more than men. This may be due to the traditional roles that women and men fill in society. Women may be indirectly taught that they are in some ways inferior to men and socialized to be more pleasing and obsequious. This perceived differential in power and ability may cause anxiety. Alternatively, women may be more susceptible to anxiety due to unknown biological mechanisms. The effects of gender may also vary as a result of other socioecological factors. For example, perhaps women with lower education are more affected by anxiety.

Behavioral and biological factors (intermediary): These were alluded to in the social class and gender sections. Anxiety may have several behavioral causes with regards to how one responds to stress. Healthy coping mechanisms may include exercise, socializing, and journaling while drinking, substance abuse, and an unhealthy diet can be destructive. However, which coping mechanisms one chooses and are at one’s disposal is likely to be dependent on other structural factors such as education, income, and social class. Gender may introduce biological differences but are also likely to be affected by social and cultural norms.