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 current research is focused on dementia, specifically the monitoring of disease
progression and identifying the connection between early biomarkers of disease
and disease progression. I would suggest that race/ethnicity, education, occupation,
childhood conditions, and midlife stress, are some of the most relevant social
determinants to my research. Because dementia is a disease that typically
develops at an advanced age, it makes sense that several of the most relevant
social determinants function over the lifecourse, such as race/ethnicity and education.
I selected both of these because they have been independently shown to have a
significant effect on the lifetime risk of developing dementia. Other determinants
that apply to specific portions of life are childhood conditions and midlife stress.
These are measuring different component causes of dementia, as childhood
conditions reflect an intergenerational transfer of socioeconomic conditions
and midlife stress is more reflective of an individual’s personally developed
socioeconomic status. Occupation has a complex interplay with each of the previously mentioned determinants. In my research, I am using a mobile device
application to track lifestyle factors and cognitive changes, and we collect brain
scans as well as samples of blood and CSF to examine biomarkers of disease progression.
Recruitment into studies of dementia is difficult because participants must be
followed for long periods of time, often must travel long distances to research
clinics, and realistically must have sufficient understanding that their participation
in this exploratory phase of dementia research is unlikely to benefit their
health despite yielding a social benefit of improved knowledge. Regrettably, these
factors have often historically limited the access to some social groups of
participants. The use of a mobile device in my studies is expected to reduce
the participant burden, but it will still limit participants to those with enough means to own a
mobile device.
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?
My impression is that a socioecological framework has been applied to the study
and understanding of dementia more or less depending on the time period. Before
the prion theory of dementia had been initiated, there were clearly some cases
which ran in families, but explanations for sporadic cases were frequently
searched for within a socioeconomic realm. After the prion theory was started,
a molecular basis of disease has been the primary focus of most studies.
However, the socioecological framework is increasingly applied to dementia
research because socioeconomic factors do appear to play a significant role,
even amongst individuals with high genetic risk for dementia. I’m very excited
to see if part of the future management of preventive care will be applied at
the socioeconomic level in conjunction with drug and genetic therapies. Dementia
is certainly a multidimensional disease with many social and individual level systems
at play.