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.
The focus of my research over the last few years has been on liver health, specifically viral hepatitis, particularly hepatitis B. The social determinants. that have been most relevant to this area of research has been race/ethnicity, education, income, nativity, healthcare access, and health literacy. We have also touched on factors related to stigma and stress. The factors that we have researched have been informed by the Health Behavior Framework (Maxwell et al.), which looks at 1) individual variables, 2) provider and health care system factors, as well as 3) individual/system/societal barriers and supports on the impact of particular health behaviors. After reading the Braveman article, it makes me more critically think about the way in which we ask questions regarding SES (income, education, etc), and that we need to be more thoughtful in the way in approach these questions and tailor measurements to our study population (and not make assumptions about various socioeconomic measures to be interchangeable when they are likely not to be). Because hepatitis B can be transmitted vertically (from mother to child), these factors likely function over the lifecourse as well as intergenerationally. My more recent projects have been more focused on a broader topic of cancer care and looking at neighborhoods, as well as built and social environments and on the impact of cancer care delivery, survivorship quality of life, and cancer outcomes. As the Braveman article discusses, there are many factors that impact health that can’t be accounted for with individual-level SES alone; increasing research is showing that neighborhood factors (including material resources, or lack thereof, community engagement, walkability and access to grocery stores, housing, and crime levels) also can largely impact an individual’s health.
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?
In the realm of hepatitis B research, a lot of the focus previously has been on the individual persona and individual risk factors. More and more, research has been focused on the community-level and highlighting the importance of community-engagement, such as using lay health workers to improve rates of hepatitis B screening among certain immigrant populations. Public policy has also played a role, with organizations such as the Institute of Medicine calling for interventions to reduce the burden of disease from hepatitis B. Yet even so, screening and treatment rates for hepatitis B are low among certain Asian ethnicities, African Americans, and Hispanics and more needs to be done to address these disparities.