1. Write a paragraph describing the extent to which an 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?
My interest topic is Diabetes. Diabetes is the leading cause of disability-adjusted life year (DALYs) lost in Mexico (Institute for Health Metrics and Evaluation (IHME), GBD 2016). In the US, Hispanics have a higher prevalence of diabetes than Caucasian population.
Two of the main risk factors are low physical activity and inadequate diet, such as high consumption of sugar-sweetened beverages (SSB). Environmental factors such as availability of drinking water, access to parks and public spaces for physical activity, availability of healthy food in schools and workplaces are strategies that have shown have an impact reducing the prevalence of the main risk factors of diabetes.
Diabetes prevention is a priority in the health system in Mexico. However, it is important as well the treatment of the 11.5 millions of adults living with diabetes in Mexico. The treatment and control of diabetes are also affected by socioeconomic status, education, living in rural or urban areas, and access to a healthcare system. Therefore, addressing those disparities, and implementing strategies focus on the most vulnerable population could improve the prevention and treatment of diabetes.
There have been implemented some strategies in Mexico to reduce those disparities such as taxes on SSB. It showed, have a higher impact on the reduction of SSB purchases in the lower-income households (10.3% reduction) compared to the high-income households (5.8% reduction) (Colchero J Nutr. 2017;147(8):1552-1557).
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.
Education. Education could influence diabetes control through the knowledge of the importance to access to medical care; people with higher education could be more aware of their health and have an early diagnosis of the disease. Also, people with higher education could be more receptive to the doctor’s recommendations. Another consideration is that education also captures the transition of the socioeconomic status of their parents, which could influence the lifestyle behaviors since the childhood.
Ethnicity. Ethnicity could have an impact on diabetes control through the access to health care. For example, in the US, Latino patients showed to have lower adherence to the treatment than white patients (Fernandez A. JAMA Intern Med. 2017;177(3):371-379). Language and sociocultural barriers could influence the control of diabetes according to ethnicity
Health System. In Mexico, there are different types of health insurance. There is the health insurance for people with a formal job (IMSS), and health insurance for those who can’t have access to IMSS, which usually are people with low socioeconomic status, unemployed or with an informal job. The difference on the health system could also affect the early diagnosis and the treatment and control of diabetes.