Hi all – somewhat long email ahead but please read!
I am so sorry I didn’t have a chance to go through
everything in my slides yesterday, but it was a great discussion and I really appreciate
everyone’s engagement. I first just wanted to reemphasize what I said at the
end around the fact that we are going to be revisiting how to think about the concepts
I discussed throughout the course. Over the next four weeks specifically we are
going to dissect the socioecological model, taking social determinants first,
then behavior, then biology, and finally health care.
From today, I want to make sure you think about the following take away points:
1. There is theory implicit in the work that we do, and chronic disease epidemiology is implicitly and explicitly focused on individual risks without attention to context and interconnections across risks.
a. There are upstream theories that only address context, such as the Fundamental Cause theory
b. There are also theories that acknowledge multilevel impacts, including both contextual and proximate risk factors. The socioecological model is one that is commonly used in clinical and translational research
2. Acknowledging the importance of a socioecological framework is not inconsistent with targeting proximal influences on health, but requires that we do so in a contextualized way that acknowledges multilevel influences on health outcomes and disparities
3. Overall, you can do quality human research by 1) making sure you appropriately measure sociodemographic characteristics, 2) recruiting and retaining diverse populations, and 3) incorporating a socioecological perspective into what questions you as, how you ask the questions, and how you interpret the results.
a. We focused on the first two today, with more detail about the 1) coming next week.
b. In two weeks, I will come back to reviewing specifics of how incorporating a socioecological perspectives in measurement, analysis, and interpretation of your results will improve both the quality and impact of clinical and translational research. This is slides 88 in the slide set that I will get posted today on the CLE if you want to take an advanced look. This will also be infused throughout the course.
With respect to ancestry and race specifically, I wanted to summarize this discussion by restating that there are times when ancestry can be useful for discovery science generally. In addition, ancestry has been proposed as an approach to address disparities specifically, e.g. in the case of asthma. The way in which this would address disparities is that since ancestry is correlated, although imperfectly, with the social category of race, identifying genetic targets using ancestry for diseases that disproportionately impact communities of color may allow identification of genetic exposures that could be targeted to benefit these communities. I will get a paper by Esteban Burchard uploaded to the CLE as optional reading that provides an example of this. As you will see if you look at this paper, however, there remains issues of confounding with life experiences associated with ancestry. In addition, ancestry itself does not identify therapeutic targets, so this is merely a starting place. Importantly, Dr. Burchard also focuses on gene-environment interactions, so is not merely limited to genetic explanations (which is consistent with the socioecological model). Even given these potentially positive uses of ancestry, as we discussed, there are concerns with the use of ancestry and the way in which this can be interpreted as implying a genetic model of the social construct of race. Therefore, much caution needs to be taken in how we measure, analyze, and interpret results related to race in clinical and translational research.
Please let me know if you have any questions, and I am looking forward to the quarter!