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.
The development of disease is a complex problem that is affected both by genetic and environmental factors. Genetic predispositions appear to be modified by socioeconomic factors, as evidenced by research which shows a higher prevalence for a wide variety of conditions including heart disease and developmental delay among disadvantaged communities. GxE interactions are likely a major factor in health disparities among sociodemographic dimensions. Among adolescent patients with renal transplantation, the worst outcomes are seen among those with low SES and minority groups.
2. Discuss implications of epigenetic mechanisms of disease for intergenerational effects on health disparities, as well as for interventions designed to address health disparities.
Epigenetic changes have huge implications for the effect on environmental factors on health outcomes and their propagation through generations. Epigenetic changes induced by environmental stressors (for example, childhood poverty) are passed down to future generations and affect their risks to the development of disease. This contributes to a cycle of poverty and poor outcomes, in which those with the least access to resources are also at the highest risk of adverse health outcomes. Effective interventions must address these environmental factors in order to be truly effective. If, for example, we provide families with better access to preventative care, the positive effect of the intervention will be tempered by environmental factors such as stressful home environments. The most effective interventions would address environmental disparities which contribute to epigenetic changes.
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 that we focus on in this course looks at individual behaviors, access to medical care, and environmental factors and access to resources and how these factors interact with biologic factors to effect health outcomes. The Robinette factors examines allostatic load and how this effects health. Allostatic load uses physiologic factors and biomarkers to build a model on interactions between genetic and other biologic factors on health. Allostatic load is found to be higher in lower SES neighborhoods and in participants with higher levels of anxious arousal. This uses a specific biologic model to examine the same factors that we focus on in the socioecolgic model we use in this class.