1. Write a brief paragraph discussing what social determinants are most relevant to your area of research and why. Consider both structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances, as described in the WHO reading. Explain why you chose the factors (might use Braveman article from last week to provide justification. 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.
As a nephrologist and a kidney health researcher, racial and socioeconomic disparities are front and center. The occurrence of kidney disease and end-stage renal disease (which requires dialysis for survival) is highly skewed, leaving Black patients with a significantly higher burden of disease. This disproportion is evident at a glance into almost any dialysis unit, and it is a reality that all nephrology clinicians and researchers must contend with. The reasons for this disparity are complex and certainly not explained entirely by biology. My own research focuses on measuring risk of kidney injury, especially as a result of exposure to common medications. The risks that come with use of the medications are modulated by factors such as health literacy and access to high quality care that affords safe monitoring of nephrotoxic medication use. It is evident that social factors play a huge role in shaping the context that kidney patients live in. Race inflects socioeconomic status through opportunities for occupation and the accordant income and benefits. Access to health insurance facilitates interaction with the healthcare system and makes it more likely that patients will have physicians that can ensure the safe use and monitoring of medications. These disparities that increase risk for acute kidney injury and subsequent chronic kidney disease, which increases risk for other illnesses (e.g. CVD) that may lead to death and disability over the lifecourse.
2. Write a brief 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?
As noted above, acute kidney injury and chronic kidney disease risk are inflected by social determinants. Beginning with the stark disparities in rates of serious kidney disease by race, nephrology must contend with the fact that our understanding of biology is inadequate to explain the epidemiology of illness. There is a vigorous and growing nephrology research enterprise that seeking to define these relationships. Recently, researchers have turned their attention not only to ways that social determinants contribute to risk of chronic kidney disease, but also how they complicate the management of chronic kidney disease. This subfield has spurred some exciting work, such as community-based interventions to deliver chronic disease care (barbershop-based blood pressure management is a prime example). Without a doubt, research in my field must be grounded in a socioecological framework in order to translate to real-world impacts that benefits patients across society.