HW week 9
1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1rst or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1rst and 2nd generation work was necessary as a foundation for your current work (or current interests).
In reproductive health, there is a good amount of first-and second-generation research. The first- generation research examined that disparities exist based on geographic area, based on race and ethnicity and based on SES for maternal mortality, infant mortality and for access to contraception and abortion services. The second-generation research has showed that these disparities exist because of racism and stratified reproduction, limit to access based on geography and lack of education, and also based on SES because of both limits to access due to location and distance to care and high-quality facilities and also due to some states not covering services for people with low-income. Third generation research has shown some interventions have improved disparities. I would say that my work is motivated by fourth generation work because it is motivated by an ethics/justice framework in which I am currently thinking about how we can change institutional structures to accommodate for other models of care, i.e. de-medicalizing in a way that will be supportive and inclusive and will not recapitulate disparities that exist (in other words, will not make it such that only people who have less power seek out de-medicalized care and then have two systems of care).
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Gottleib article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level.
Both of these models would be easy to apply to my current research looking into best models for de-medicalizing medication abortion. The barbershop example is one that has been brought up when I have talked with people about models of de-medicalizing care-- about in terms of getting mife-miso kits from ones hairdresser (many people feel comfortable speaking to and learning about information from their hairdresser and may be willing to obtain mife-miso from their hairdresser who could also walk them through evidence-based qualification questions). This kind of public health model decreases stigma and increases likelihood and ease for people to receive care where and when they want it. Using Gottlieb’s example of social service navigation tools, the hairdresser (or anyone else) could use the Euki app and help people get lists of people who could help them through a medication abortion, based on the amount of interaction the person did want with the health care system. The euki app already provides location-specific information to people about support groups, clinics, etc.