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.
In their discussion of pathways for the biological embedding of disadvantage, Hertzmann and Boyce present a convincing case for their argument that “it is gene-by-environment interactions that influence developmental trajectories.” It seems clear that a gene-by-environment interaction has a role to play in the way that perinatal and early childhood experiences impact development and lifecourse trajectories, in ways that directly impact health and well-being. It is important to understand these processes, in part because such an understanding may legitimize the reality or urgency of health disparities for certain audiences. Rather than thinking of gene-by-environment interactions as contributing to disparities, however, I find it more constructive to think of them as reflecting or, more literally, embodying disparities along dimensions of disadvantage and discrimination. These pathways of biological embedding may explicate the actual physiological process of disadvantage “getting under the skin,” but they aren’t the true cause or the solution to systemic disparities in health and illness. For example, in thinking about rural health disparities, I can see how intergenerational poverty, with all of the varied stressors associated with it, could impact individual development of the HPA axis. But to most effectively disrupt such pathways, interventions will move beyond the individual to look at social policies and structural constraints that generate entrenched poverty.
2. Discuss implications of epigenetic mechanisms of disease for intergenerational effects on health disparities, as well as for interventions designed to address health disparities.
It seems that epigenetic mechanisms of disease may be one biophysiological pathway by which disparities are embodied. The increasing evidence for intergenerational epigenetic transfer offers evidence of the very real intergenerational consequences for health of social and structural discrimination and disadvantage. This points to the importance of a lifecourse perspective for interventions to address health disparities. It also amplifies the potential impact that health disparities interventions can have in disrupting the perpetuation of health disparities in future generations.
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.
Robinette and colleagues’ findings around the relationships among neighborhood and individual factors with allostatic load demonstrate the multidimensional interaction between the levels of individual, community, and society hypothesized in the socioecological model.