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.
I am currently evaluating the effects of English language proficiency on sedation practices in the ICU for mechanically ventilated patients. The social determinants most relevant to my area of research include language and poverty level (based on ZIP code) and insurance status, and race/ethnicity. Language proficiency is the basis of my question and has integral to how interact. Poverty level has its own effects on health status in addition to influences on language proficiency, and may have some contribution to phenotype on which providers may act in the ICU. As described in the WHO reading, socioeconomic position or class may have more of an influence on resources available to a patient – and a much larger effect over a lifecourse and generation than some of the more changeable determinants listed above – this is not well-defined in the literature, and is a much more difficult measure to obtain. Language proficiency can change over one’s life and within a generation depending on available resources, and while poverty level has some degree of fixedness depending on the sociopolitical climate and potential mobility of individuals and communities, there is the possibility of change over a lifetime for this determinant as well.
Although race/ethnicity are controversial, there may be cultural influences affecting communication that would in turn affect drug administration. Although education may have a significant contribution, this is omitted for now due to data collection limitations.
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?
Historically critical care research has had less emphasis on socioecological frameworks, but the field is well due for the application of this lens. There are such rich contributions from sociopolitical, socioeconomic, and structural contexts not currently employed that make up the person and their health upon arrival in the unit. Stress, for example, being difficult to measure, is not at all considered when thinking of a patient’s past history, and there are known hormonal and inflammatory effects associated with this psychological state. How we interview patients needs to change dramatically, however, for this change to occur.