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 think overall, I agree with the concept that gene-by-environment interactions can influence major disparities along racial/ethnic, socioeconomic, and geographic dimensions. But I think we can’t forget the impact of genes and environment together and alone, as well as the interaction between the two. The article discusses the influence of low SES and adversity, particularly during critical windows, on the dysregulation of the HPA axis, which can lead to increased cortisol and can have adverse health consequences downstream, such as depression, obesity, heart disease. However, this is not the only part of the story since there are people with low SES who may not ever develop these aforementioned negative health consequences, or people with low SES who have high level of cortisol who don’t develop negative downstream health effects. Every individual’s experience is different and it is difficult to pinpoint the particular factors that can lead to disparities with race/ethnicity, SES, geography. There are many factors that contribute to the development of cirrhosis, it could be patients who have heavy alcohol drinking, history of hepatitis, autoimmune diseases, obesity, diabetes. Literature has demonstrated that patients with lower SES, have higher rates of alcohol drinking. There are individuals who could also be more genetically predisposed to developing fibrosis of the liver even with lower levels of alcohol drinking. In addition, there are structural and institutional as well as health care access factors that can make it easier or harder to get resources for alcohol cessation or cirrhosis care and even liver transplant.
2. Discuss implications of epigenetic mechanisms of disease for intergenerational effects on health disparities, as well as for interventions designed to address health disparities.
I think that it is important to consider genetic and epigenetic mechanisms of disease for intergenerational effects on health disparities, but definitely does not explain all of the factors contributing to health disparities. The examples brought up in the Hertzmann and Boyce article, particularly the ones with the rats who were initially removed for their mothers but then those who were returned to their cages and had licking and grooming, and arch-backed nursing showed a more adaptive response pattern to stress shows that interventions designed to address epigenetic mechanisms of health disparities may help to mitigate some of the poor health outcomes that we are witnessing. However, this doesn’t account for the social determinants of health and environmental factors we have been discussing, which are also important. I think interventions designed to address health disparities need to account for both genetic/epigenetic, environmental, and social determinants of health.
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 socioecologic model we use in this course looks at individual behaviors, medical care, living and working conditions in homes and communities, and economic and social opportunities and resources along with their interaction with genetic and other biologic factors on health. The Robinette paper discusses the role of allostatic load (and greater allostatic load in lower SES neighborhoods) on health. Allostatic load incorporates a variety of physiologic factors as well as biomarker indicators. This is an interesting way to try to capture information on “the interaction with genetic and other biologic factors in health”. In this paper, they try to used multiple measurements to try to capture he “living and working conditions in homes and communities” as well as “economic and social opportunities and resources: neighborhood income, neighborhood safety, neighborhood cohesion, affective distress. They also looked individual factors such as health behaviors and individual SES.