1) My area of research is analysis of neurovascular disease outcomes through a global health perspective. Specifically, I am using large databases to track ischemic stroke outcomes in low- and middle-income countries over the last 20 years and find correlations to country-level political or financial changes over that same period. I think the two fields that I am combining in my work take a different approach to patient care. Global health, by necessity, is rooted in an socioecological framework. Past studies have shown not only that interventions that work well in high-income countries don’t generally work well in low-income countries, but also that there is great variety in the efficacy of interventions among countries and even regions which share similar socioeconomic and cultural spreads. I would even argue that community acceptance of the intervention and traditional interactions with health care providers are characteristics that matter more than individual SES or health behaviors when one designs a global health program. By contrast, the algorithm for neurovascular disease prevention and treatment, particularly in the US, is narrowly focused on the individual. Health behavior is assessed and modified if possible. Sex, race, and family/personal history of cardiovascular disease inform the level of treatment a patient receives. Since much of stroke prevention is performed in the primary care setting, there is a missed opportunity to incorporate a more socioecological perspective.
2) Focusing on ischemic stroke outcomes,
a. Income: Both lower GDP at a country level and lower SES at an individual level have a correlation with increased stroke incidence, morbidity, and mortality. This relationship could be explained by a multitude of factors, including availability of primary care, insurance provision, accessibility of healthy foods and health maintenance medications, proximity to high-level care hospitals with ability to image and adequately intervene to limit stroke morbidity, etc.
b. Race/ethnicity: There is limited research regarding this racial disparity in the global health field, but in the US, the ischemic stroke burden is higher in communities of color. Blacks are more likely to have stroke risk factors, to have a stroke at an earlier age, to suffer more severe deficits after that stroke, and to have less access to high-quality stroke care (Feng 2013, AHA).
c. Psychosocial stressors: Especially when considering impoverished populations, war-torn populations, etc, psychosocial stress could be an important risk factors. Studies have shown that stress contributes to chronic diseases and ischemic stroke risk factors like coronary artery disease and hypertension (Jood 2009, BMC Med). I hypothesize that this stress contributes to the burden of ischemic stroke in these communities, since preventative efforts and public health campaigns do not rank highly on the list of priorities for survival.