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.
My research focuses on organ allocation in liver transplantation. There is established legal framework (“The Final Rule”, 1998) that mandates organs should be allocated based first on medical acuity of the potential transplant recipient and second on waitlist time. The Final Rule prohibits disparity in organ allocation according to geography as follows: “Neither place of residence nor place of listing shall be a major determinant of access to a transplant.” However, two decades of subsequent research have conclusively demonstrated that geography plays an enormous role in access to transplantation. To circumvent this disparity, patients awaiting transplant are permitted to be listed at more than one transplant center, however this practice is highly biased and primarily utilized by patients who have flexible insurance and the financial means to travel, and these patients tend to be white, male, and affluent. As such, the social determinants most relevant to my research include race (as defined by the transplant center), SES measures (education, income, occupation, neighborhood defined by zip code), and their intersectionality.
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?
The persistent, fundamental problem in solid organ transplantation is that the demand for organs substantially outpaces the supply of organs from both living and deceased organ donors. A variety of socioecological frameworks have been applied in transplantation, but these have primarily focused on increasing donation from either living or deceased donors. Two large hurdles on the recipient side of transplantation include access to the waiting list, and progression from the waitlist to transplant. There appear to be opportunities in both of these realms for the development and application of a socioecological framework.