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.
Although research suggests that the risk of developing an eating disorder is not significantly affected by socioeconomic status (income, educational level, employment status, urban geography), socioeconomic status does impact treatment and therefore health outcome. Research on socioeconomic disparities in treatment is not readily available in the literature, but it is common knowledge that youth with Medicaid across the United States do not receive adequate care for eating disorders, and those that do receive generic treatment that is not evidence-based. Therefore, one factor relevant to racial/ethnic disparities in outcome may be insurance status (uninsured, publicly insured, and privately insured), given that access to specialized healthcare with public insurance is limited. Preliminary data from a California Medicaid dataset suggest that eating disorders disproportionately impact Latinos (60% of all eating disorders cases, most of whom are Spanish-speaking). This association requires additional study. Anecdotally, many of the Latino families in San Francisco County with Medi-Cal who present for eating disorders treatment have immigrated to the United States with a period of separation between caregiver(s) and the affected youth. Several factors may negatively impact this group of Latinos, including English proficiency, lack of access to Latino or Spanish-speaking providers, period of parent-child separation, trauma history, including intergenerational trauma, food insecurity, and acculaturation.
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?
Very few social determinants have been examined as predictors of eating disorder symptomatology, and I don’t believe any have been used to examine treatment outcome. A very small body of research has examined race/ethnicity and socioeconomic status (incorporating income, educational level, employment status, urban geography) and food insecurity on eating disorder prevalence and/or symptomatology, but they have not examined the impact of these factors on access to care or health outcomes, and not particularly through any socioecological framework lens.