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 area of research focuses on health care delivery and outcomes for patients with substance use disorders. Addiction is highly stigmatized, and different substance use disorders affect different disadvantaged groups. For example, the current opioid epidemic disproportionately affects those of lower socioeconomic status, and overdose deaths are considered a type of ‘death of despair’, a death attributed to groups experiencing disproportionate amounts of socioeconomic disadvantage with no appreciable sense of improvement in the long term. Another example is the ‘War on Drugs’ which have worked to stigmatize drug use and disproportionately incarcerated communities of color for minor drug offenses. This policy is often thought to be an example of structural racism, and on the individual level leads to interactions with the criminal justice system, making it harder to obtain employment after release and thereby keeping communities of color in the lower rungs of SES. The populations most affected across all substance use disorders are those who tend to be from groups with lower income which lead to intermediary determinants such as being either unemployed or with occupations with low economic opportunity for advancement, higher rates of unstable housing or homelessness, and having increased rates of mental health disorders. The downstream consequences of these factors lead to intergenerational trauma and further entrenchment into the structural systems of lower SES, making it even harder for later generations to break through cycles of addiction and poverty.
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?
Historically addiction has been largely considered in the realm of psychiatry with a focus on substance use disorders being a mental health condition. However, more researchers are recognizing the role of psychosocial and socioeconomic factors that lead to addiction and are beginning to study them. Regardless, there are still large gaps in improving our understanding of how racial and economic disparities disproportionately affect different disadvantaged communities.