- State your health outcome of interest. (It could be the one you used for week #2 or another one.) Pick two key behaviors that are important factors leading to your health outcome. Explain the importance of these behaviors either for etiology, prevention, or intervention. (If none of the behaviors in the readings are important for your health outcome, suggest another behavior that is.)
In my work, I aim to measure whether there is a causal link between the quality of leadership and management displayed in global health programs and the health outcomes they seek to impact. For example, I am currently working on a program that seeks to reduce the rates of vertical HIV transmission in Kenya. In this PMTCT program, two behaviors that are important to reducing transmission are: seeking antenatal care services and giving birth with a skilled attendant. Both behaviors are important because it is through these interactions with the health system that HIV-infected mothers can be tested, given the antiretroviral drugs for themselves and their infant, and educated about exclusive breastfeeding and other preventative measures.
- Describe how you would study the role of one of the behaviors described for question #1 and your health outcome of interest. Incorporate a social factor (e.g. race/ethnicity, social exclusion, stress) in the study approach.
We look very closely at the rates of completing ANC care and skilled deliveries in concert with transmission rates and find that in the geographies with the lowest rates of completion and highest prevalence of HIV infection, we have the highest transmission rates. We often study the differences in who is accessing these services by county and sub-county. In part that allows us to understand where the health services are available, but it also allows us to understand some differences based on race/ethnicity as outside of cities in Kenya, people tend to live among people of a similar tribe. Perhaps a more interesting SES factor that has been in more frequent use over the past several years is to look at difference by age, given that HIV-prevalence rates have grown among adolescent girls and young women.
- If key health behaviors (e.g. smoking, exercise, nutritious diet) are strongly influenced by neighborhood, income, and/or education, do we need to continue to study how these behaviors influence health outcomes? Why or why not?
Even though we know that behaviors are strongly influenced by neighborhood, income and/or education, I believe that it continues to be important to study the way that these behaviors influence health outcomes for several reasons. First, because it is unlikely that any intervention to change behavior alone will work well enough even when implemented perfectly to improve it to the level necessary to improve health outcomes to a degree at which disease is eradicated. Second, because these behaviors and the associated health outcomes still occur in the “best” neighborhood, income and education levels, so we must understand the complete relationship between them. Finally, because many of the health outcomes of interest that are affected by these behaviors (and influenced by neighborhood, income, and/or education) are also known to have a biological component.