1. Write a brief paragraph discussing what social determinants are most relevant to your area of research and why. Consider both structural stratifies (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.
My current research is looking at cervical cancer screening in the United States. I think the largest social determinant is race/ethnicity. While cervical cancer deaths are the lowest they have ever been, the major burden of cervical cancer incidence and mortality is in African American, Native American and Latinx populations. This would definitely be a lifecourse and over intergenerationally issue. While the US is making slow progress in addressing racism, patients of different races and ethnic minorities definitely face more opposition, discrimination and marginalization which function as intermediary determinants. Furthermore, these populations are often isolated in areas that have poor material circumstances with sub par housing, poor access to healthy food options, and increased gang violence. I think another important one is actually gender. Transgender patients are less likely to access healthcare and are not screened as often. Transgender patients already have to deal with feelings of being trapped in a body that does not match their gender, but then have to deal with the issues of discrimination, marginalization and bigotry as a transgendered person. Society is slowly moving towards a norm that is accepting, but this is painfully slow and these factors will continue to exert influences over transgender patients that do need cervical cancer screening. Gender identity unfortunately is associated with increased stressful life psychosocial circumstances. I chose these factors because these populations are not being screened enough and are bearing the brunt of the burden of cervical cancer, which should not be the case.
2. Write a brief paragraph describing the extent to which a 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?
In Cervical Cancer screening I think the socioecological framework incorporating social determinats of health is starting to be applied more and more. As cervical cancer’s mortality has fallen with effective and cheap screening, the burden is in the racial ethnic minorities as well as populations with more social determinants of health. Thus, even the USPTF has stated that a gap in their research is in racial/ethnic and diverse populations. I think this means that there is a great opening to further improve our understanding of approaching disparities in cervical cancer screening that will increase screening in populations that are being under screened.