The health outcome I am investigating is agency, a psychological and neurophysiological construct in the NIH research domain criteria’s (RDoC) social processes domain (see https://www.nimh.nih.gov/research-priorities/rdoc/constructs/agency.shtml). The RDoC framework is a proposed transdiagnostic empirical model intended to supersede the current deficit-based model of the Diagnostic and Statistical Manual of Mental Disorders (DSM) and situate an understanding of mental disorder in objective markers at multiple explanatory levels from molecular and genetic mechanisms to social and societal processes. Clinically, as a trauma psychologist and researcher, I hypothesize that the concept of disordered agency may be a parsimonious term encompassing a constellation of phenomenological states including depressed mood, hopelessness and a sense of foreshortened future currently conceptualized as distinct clinical syndromes (eg. major depressive disorder; complex PTSD). Examples of disordered agency include both individual experiences of hopelessness and wider socio-economic processes of oppression and subordination.
Two key structural stratifiers of agency are race and education. Race, the system whereby “one group benefits from other groups, and defines itself and others through this domination and the possession of selective and arbitrary physical characteristics (for example, skin color)” (Krieger, 2002) is by this definition self-evidently a central factor in individual and community perception of the extent of scope for agentic (i.e. self-determining) action because race defines positions in a social hierarchy in which position in the hierarchy of self-determination vs. subordination is assigned arbitrarily by phenotypic characteristics, rather than merit or intrinsic universal human rights. Education functions as a stratifier by providing a level of economic and social opportunity that is variable according to a socio-economic gradient. In regard to intermediary determinants, exposure to the psychosocial stress of pervasive racial microaggressions and white supremacist/xenophobic behavior and social policy constitutes an intermediary factor that I hypothesize as a salient factor in the health outcome of agency.
Early lifecourse socioeconomic factors and neighborhood characteristics that influence agency include chronic exposure to community violence (eg. police shootings and high homicide rates). A growing body of evidence (eg. the adverse childhood events study by Felitti et al, 1998) indicates the linear dose-response relationship of chronic stress exposure to lifetime lower mental and physical health outcomes, mediated by the role of chronic stress exposure in overloading the hypothalamic-pituitary-adrenal (HPA) axis and other components of the body’s self-regulatory systems.
References
Krieger N. (2002). A glossary for social epidemiology. Epidemiological Bulletin. 23(1):7-11.
Felitti VJ; Anda RF; Nordenberg D; Williamson DF; Spitz AM; Edwards V; Koss MP; Marks JS (1998). "Relationship of childhood abuse and household dysfunction to many of the leading causes of death in adults. The Adverse Childhood Experiences (ACE) Study". American Journal of Preventative Medicine. 14 (4): 245–58