Health Disparities Forum

1. Write a paragraph describing the extent to which a socioecological framework incorporating issues related to social determinants has been applied to your area of research. Are there opportunities for improving our understanding of or approach to disparities in your area with a greater emphasis on a socioecological framework?

I do not personally work in an area with a large focus on health disparities; however, in the field of urology many disparities have been documented. In particular, disparities have been written about in the field of prostate cancer. Hispanic/Latino and Black/African American men are less likely to undergo definitive treatment for localized prostate cancer (Underwood et al, 2004). There has also been a lot of research showing that African American men are more likely to have aggressive prostate cancer, which has traditionally been associated with biological differences. This class for me has challenged this notion. African American men are more likely to be upstaged to more advanced cancer grades in those who had been on active surveillance (Sundi et al, 2013). I think there is a great area for growth to increase our socioecological framework around the association of being African American and having more advanced prostate cancer. This could be differences in screening rates between white v. black men due to a multitude of factors, including mistrust of the healthcare system. 

2. In the WHO reading, A conceptual framework for action on the structural determinants of health, the authors describe structural stratifiers (e.g. income, education, etc) and intermediary determinants such as material and psychosocial circumstances. Pick 3 of these factors (at least one structural and one intermediary). Explain why you chose the factors (might use Braveman article to provide justification) and describe how each could be an important determinant of a health outcome of your choosing. The association could be reported in published research or it could be your hypothesized relationship. Consider whether how these factors might function over the lifecourse and/or intergenerationally.

I believe access to care could be a structural stratifier in this situation. Those with less access to care would have less access to screening and perhaps less access to specialists who ultimately treat localized prostate cancer (i.e. radiation oncologists, urologists). Additionally, as mentioned above there is a certain level of mistrust within the prostate cancer screening world and this has been documented in men in general. This is generally because of the notion that many indolent forms of prostate cancer are treated unnecessarily (which is a true statement). however, I believe that the disparity we see could be due to differential levels of mistrust within the healthcare system. Other social or economic factors could be education and income level.