1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
One of the projects I want to do in the next year is to evaluate if the disparities which patients with pulmonary hypertension face as they are awaiting transplantation are still present. Pulmonary hypertension is a disease which leads to elevations in the pulmonary artery pressure and it is more common in women than men. Donor organ allocation occurs through something called the lung allocation score (LAS), where allocation is based on urgency. In the past, this system was developed to minimize waiting list mortality while maximizing post-transplant survival. Unfortunately, the system was not fair for patients with pulmonary hypertension, and they are less likely to survive to transplantation than other diagnostic groups. Efforts have been undertaken to improve this and give exceptions to patients with pulmonary hypertension, however, no analysis has been done to see if the disparities are still present in the new system. Thus, the analysis would be a first/second generation project. If the disparities are still presents, it could be used to model a new system which would be more equitable, essentially becoming more equitable.
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Gottleib article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level.
The issue I described above would not be amenable to one of these interventions directly because there is a systematic issue that patients with pulmonary hypertension face by the organ allocation system. This being said, there is a mechanism by which patients with pulmonary hypertension can get an exception to get a higher score. Perhaps an intervention could be done at the transplant-center education level. Each potential patient undergoes a transplant evaluation and gets education. Perhaps an educational objective could be done at that time where patients with pulmonary hypertension are taught about the process and the potential for exceptions. This way they could advocate for an exception when necessary. Another potential intervention to engage this population could be through advocacy groups and education of the issues that this population faces. If politicians knew that this was happening perhaps they could use the political system to enact change.