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).
My research is first and second generation in that I am testing a hypothesis that improved management will lead to better health outcomes, which will require identifying and documenting the disparities in management quality and then to describe the causal relationship between management quality and health outcomes. The hope is, that this work will lead to the development of interventions to improve management quality, including policy and system changes to the way health delivery systems are designed and operated.
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. What types of clinical interventions can you think of in your area of research that could similarly bridge levels of the socioecological model?
I think the most critical part of my research into the role of management quality on health outcomes in terms of social determinants is to focus on organizations and individuals working in LMICs at the middle level of management, rather than the leaders of organizations. There are a number of interventions that aim to improve leadership and management capacities, but these are often focused on Ministers of Health, NGO Founders or Executive Directors and similarly senior officials. It seems to me that I need to look at a different set of variables for what gives one privilege in these organizations than would be used when working with patients in the US. The variables are often about access to resources and power and in the context of my research, this might mean looking at things like: country of origin, level of education attained, location of university, level within organization (number of direct reports), type of education attained, years of service, etc.