Thanks to you all for your thoughtful responses to the Week 2 assignment on social and structural factors. I have responded to some of you directly, and have some general comments below. If you want particular feedback on any homework assignment directly to you, please let me know and I will prioritize getting you an individualized response. But please know I am reading and enjoying all of the responses!
Every week I will also point out and ask you each to read 1-2 answers that I think did a particularly good job of addressing the issues presented that week or are particularly interesting. For this week, I want to highlight Nicolas Arger’s and Rebecca Kim’s responses, regarding sarcoidosis and chronic liver disease respectively. I encourage you all to read them!
For my general comments:
- It is clear there are lots of areas in health and health care (e.g. peripheral artery disease, interstitial lung disease) that are understudied with respect to the impact of social and structural factors. And even in areas where more work has been done (maternal mortality, kidney disease) there is a still a lot of work to be done.
- Many of you identified structural and social stratifiers of potential relevance to your work. However, what was less clear in some cases was what mechanisms you thought connected these factors and your outcomes. For example, why would income impact outcomes following hospital discharge? Is it because of being able to access home-based health services? Because of social networks? Other things?
- I would encourage you all to think more about the impact of neighborhood – and neighborhood segregation – on health outcomes
- Many of you indicated the challenges of limited access to data on social and structural factors – e.g. working with EHRs that don’t collect the data, secondary analysis of survey data etc. I would encourage you all to work to use whatever data on social factors is available, to be thoughtful about your own data collection when you are doing it yourself, and acknowledge in discussion of your results what the limitations are with respect to what data you had access to.
- I would encourage you all to think about the biological impact of the chronic experience of racism in society as an influence on health – e.g. as a driver of disparities in chronic kidney disease, vascular disease, etc.
- In terms of thinking about things over the life course, I would encourage you to consider whether the social factors you are considering may act differently at different points in the life course. For example, for outcomes of ICU admissions, could socioeconomic position/language proficiency affect people differently if they are hospitalized as children vs. as adults? Similarly, are disparities in access to organ transplant due to language and socioeconomic factors different at different points in the life course?
Thanks all!