Questions Related to Week 4 Readings:
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.
I do not think it’s fair to use this GxE theory as a blanket solution to the root of all health disparities. There are specific areas where I agree with the concept of the complex relationship between environment and genes contributing to health disparity outcomes. Gestational diabetes is an example of a disorder that can have genetic disposition which is significantly affected by nutritional environment. However, we should always resist assuming genetics are the primary factor. For instance, black women die of pregnancy related cause at a rate 3x higher than their white counterparts in America1. Historically many have argued that this is related to genetics, however a growing body of research suggests that structural racism (environment) is much more likely to explain mortality disparities2. Hertzmann and Boyce do discuss the concept of gene expression emerging from stressful social structures. We should be very careful making assumptions that it is always social structures contributing to genetic change and not the social structure alone.
2. Discuss implications of epigenetic mechanisms of disease for intergenerational effects on health disparities, as well as for interventions designed to address health disparities.
As discussed above, I think focusing fully on epigenetics may discover genes that are somehow associated with disparities, but can dangerously ignore the social structures that actually produce health outcome differences. The Barcelona de Mendoza paper makes me think less that there is a novel epigenetic link between schizophrenia, bipolar disorder, and asthma and perceived discrimination, but rather that people with these disorders are more likely to be discriminated against because of structural causes. By clutching to genetic markers, we may miss the huge elephant in the room – structural racism and classism – which is more likely to be the source of differences. In addition, focusing on epigenetic sources of disparities creates channels for medical communities to place blame on patients for their outcomes, while the true source may be in disparate care.
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 looked at the relationship between SES on a neighborhood level and allostatic load with variables including neighborhood income/safety/cohesion, affective distress, health behaviors, Individual SES and additional covariates. They concluded that low SES leads to chronic stress which then presents as poor health behavior. In the socioecological model that we are using in the course we use layers to understand to guide our understanding of health disparities. Economic and Social opportunities and living and working conditions correlates to relates to Robinette’s level of neighborhood income, safety and cohesion, while their outcome of health behaviors relates to the socio ecological inner core which includes behaviors.
References
1. Vital Signs: Pregnancy-Related Deaths, United States, 2011–2015, and Strategies for Prevention, 13 States, 2013–2017. Weekly / May 10, 2019 / 68(18);423–429. https://www.cdc.gov/mmwr/volumes/68/wr/mm6818e1.htm?s_cid=mm6818e1_w
2. Howell, E. Reducing Disparities in Severe Maternal Morbidity and Mortality. Clin Obstet Gynecol. 2018 Jun; 61(2): 387–399.doi: 10.1097/GRF.0000000000000349