I apologize for this late assignment. My responses to the prompts are below:
1. Although their specific examples are compelling, I am personally always wary of incorporating genetic explanations for health disparities, even if they are used in context of an interaction with the environment, due to the risk of perpetuating dangerous and racist stereotypes based on genes. Particularly with behavior, which they use in their examples, there are possibly an infinite number of factors that affect one’s behavior, many of which are nearly impossible to quantify or measure. It was previously presented in this class that the majority of illness stems from social conditions and that genes, in fact determine a relatively small proportion of disease and disease course. I worry that the focus on the mechanism of how SDH lead to poor health outcomes centers the intervention on the outcome rather than the exposure (SDH), which are in large part due to this country’s violent white supremacist history and current practices.
2. Similar to my response above, epigenetic explanations for how traumatic experiences or SDH can become encoded in the genome and cause intergenerational disease is compelling and exciting for the broader medical community. However, the push to develop scientific explanations for how structural violence leads to poor health outcomes through methods only actionable by the most educated people on the planet further concentrates knowledge and power to an already privileged few. I think a reasonable argument can be made that pandering to a need for a biological proof of the relationship between racism and health encourages the silencing of the voices of many, many people of color who have been exclaiming this for centuries. We know with certainty, from the work of mostly non-scientists, that white supremacy, discrimination, and other political, social, and historical forces of domination dictate nearly every aspect of our lives, including health. The solution then, is to dismantle these systems of domination, which has also been known and worked on by non-scientists for centuries.
3. In this paper the authors were able to build a socioecological network of measured determinants of health. They found allostatic load-an individual level measure of lifetime stress-was associated with neighborhood income, even after controlling for individual level income. This would be a relationship between the individual level and the macro level economic and social opportunities and resources level. They further incorporate behavioral factors, and find that these too are associated with allostatic load. Finally, they incorporated all levels of a socioecological framework in their model to try to build a complete picture of how allostatic load is related to neighborhood-level income and still find an association.