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.
It makes sense to me that gene-by-environment interactions influence developmental trajectories. Some specific examples come to mind. For inflammatory bowel disease, we know there is genetic predisposition for development of IBD. But then there is also evidence and anecdotal experience showing initial onset and flares may be related to stressors - including medications, infections, etc. However, this also includes life stressors anything from stressors at work, financial difficulty, loss of family/friend, really anything. Someone with a genetic predisposition for IBD who may be at higher risk for life stressors due to racial/ethnic, socioeconomic and/or geographic dimensions, may experience more severe disease, more frequent flares, and therefore overall poorer outcomes.
2. Discuss implications of epigenetic mechanisms of disease for intergenerational effects on health disparities, as well as for interventions designed to address health disparities.
In my specific area of interest, differences in outcomes of chronic liver disease for patients with different social determinants of health, there has been a gene identified with studies showing an association with worse outcomes for patients with non alcoholic fatty liver disease if the gene is present. This gene also happens to be more prevalent in Latino populations according to the literature. I worry that this gene is now being use to explain why patients who identify as Latino are having poorer outcomes, when in reality, it may be more often due to social determinants of health. As expected, not all liver patients undergo genetic testing, so many assumptions have to be made based on these findings in limited studies. Additionally, I can imagine that if genetic testing does become more common in hepatology, a Latino patient that tests negative for this gene may then be thought of as lower risk for poorer outcomes - the test would provide inappropriate reassurance. When in reality, despite not have the genetic risk factor, the patient may be at risk for poorer outcomes due to social determinants of health, which then may be ignored.
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.
In the Robinette paper, they describe how allostatic load (the effect of increased stress on the performance of the body over time and its effect on health outcomes) is related to neighborhood income. The authors looked at different behaviors that may be related to allostatic load and the prevalence of these behaviors by neighborhood. Other variables examined were safety, neighborhood cohesion, and health behaviors based on neighborhood.