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?
My research over the last several years has focused on examining and identifying various health disparities and resiliencies within the LGBTQ community. Currently, there is a lot of research that cites theories of sexual and gender minority stress as a key model for understanding health indicators and the healthcare status of this group. These minority stress models already largely incorporate a socioecological framework by understanding that marginalized communities have additive sociocultural and political stress, in addition to the everyday stressors that everyone faces. For the LGBTQ community this minority stress would be related to constructs like sexual orientation, gender identity, gender expression, and gender presentation. Minority status, as it relates to the increased stress of being a member of a marginalized and socially stigmatized group, then leads to systems of oppression that foster decrease access to care and increased exposure to both systematic and personal discrimination, bullying, and violence related to this minority status. Related, these models also provide some assurance for increased community resiliency to cope with external social hardships, which may positively impact some aspects of LGBTQ health.
Though current LGBTQ-focused health research already incorporates a decent understanding of various social determinants of health, I believe one of the largest areas for improvement in this body of work, is to actively engage with a wider variety of sexual and gender identities. Most prior research focuses on gay men, lesbian women, and bisexual men and women with little to no consideration of transgender, genderqueer, or genderfluid identities or non-same-sex sexual identities (i.e., asexual, pansexual). Similarly, of the few large population-based studies that have been conducted, sexual and gender minority status is typically referred to as a homogenous identity category rather than a heterogeneous set of constantly changing identities that are deeply informed by the current sociocultural and political discourse of identity formation. This discourse affects and informs what forms of attraction and presentation are deemed “socially acceptable,” which has a large impact on how we interpret current research and subsequently incorporate social determinants of health into future research within this body of work.
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.
Income and employment are definitely structural stratifiers in this body of work. Prior work has shown that the LGBTQ community, particularly transgender and genderqueer folks experience extremely high rates of employment-related discrimination and un/under-employment. Higher rates of un/under-employment negatively correlates with income, access to affordable employer-based healthcare insurance, and social stability. Though location-based, it has also been noted that gay men are typically high earners and frequently belong to the highest earning income brackets only further showcasing the heterogeneity between identity groups and the differential structural exposures different identity groups face throughout the life course. Similarly, race/ethnicity is also a structural stratifier since LGBTQ folks of color, typically have compounded minority stress and face increased exposure to racial injustice and sexual and gender minority-based discrimination.
As mentioned above, psychosocial circumstances, due to minority stress also have long-term impacts on community responses to stress, which subsequently affect various health outcomes over the entire life course.