1. Hertzmann and Boyce argue that “it is not genes or
environment, nor is it genes and environment, but rather it is
gene-by-environment interactions that influence developmental
trajectories.” To what extent do you think that GxE interactions can contribute
to major disparities along racial/ethnic, socioeconomic, or geographic
dimensions? Please consider this both in general and in respect to your
particular area of interest.
Having a rather rudimentary understanding of epigenetics, I am not entirely sure what degree gene-by-environment interactions contribute to major disparities. It is hard to imagine that we have much development that is NOT influenced by the environment in which we are exposed (or nurtured or not), however, one cannot help but think if there are heritable traits that are predetermined and not subject to experiential influences that there are similar such elements related to disparities. I think the degree to which the gene-by-environment effects exist are only just beginning to be studied and understood, my guess is that these bio-developmental states have a greater impact than we realize. We certainly recognize the effect of environment on race/ethnicity, as well as socioeconomic status; as a result of both of these – or in the reverse direction as well – geography also has its own contributions. Thinking about my own interest in disparities in critical care, very little contribution is currently recognized at the bedside about any of these domains (racial/ethnic, socioeconomic, or geographic – the last may get the most attention if one truly had to rank them, but even then the difference is small), and Hertzmann and Boyce’s argument suggests we are missing out majorly on contributors to health. I would certainly be in favor of better collecting this information and surfacing it in understanding someone’s health more holistically. I also recognize, however, that in critical care, the acuity of a situation may be time prohibitive in considering these elements, and immediate action in response to a clinical scenario may trump investigating these origins of their disease.
2. Discuss implications of epigenetic mechanisms of disease for intergenerational effects on health disparities, as well as for interventions designed to address health disparities.
The Barcelona de Mendoza paper suggests that racial discrimination may have an effect on DNA methylation, causing epigenetic changes in gene expressions related to physical and mental health conditions. This implies that oppressive and discriminatory experiences may have significantly longer effects than we realized. Whether personally mediated, internalized, or institutional in origin, the racism encountered is manifesting in health and health outcomes, which in turn have effects on educational attainment, income, and social position.
What can be considered potentially helpful, though, is the changes described are epigenetic, meaning that this change in gene expression has the potential to be altered (as the genetic structure itself is unchanged, presumably). This strengthens the case to study and identify health disparities, and to invest in models that address and reduce these inequities.
3. Discuss how the findings in the Robinette paper relate to socioecological model we are using in this course – e.g. briefly describe how the different levels displayed in this model are related to each other in this paper.
The Robinette paper discusses macrolevel factors (built environment and social context) as well as microlevel (individual perception of neighborhood status and personal-relationship support) that contribute to an individual’s allostatic load with some association specifically with anxious arousal symptoms, fast food consumption, smoking, and exercise. Looking at this in the context of the Robert Wood Johnson foundation framework, there is some sense that economic and social opportunities, as well as the living and working conditions create a much larger effect on behaviors and health care than the RWJ model suggests; there is more interconnectedness than the framework permits. Not only does socioeconomic neighborhood status affect one’s health but the built environment and social context from this has a huge role in the stressors, opportunities, relationships, and behaviors that one has available. Robinette argues that the subsequent allostatic load plays a role in “the cumulative effects of wear-and-tear on physiologic regulatory systems,” demonstrating anxious arousal, fast food, smoking status, and exercise habits contributed to individual health even after adjustment for individual SES; the greater environment dictates much of the other elements in the framework in a significant way.