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 current research is centered on studying the neural mechanisms and clinical effects of complementary medical practices such as contemplative (meditation) practice and mindfulness based intervention programs which target the neural networks involved in self referential processing and executive/cognitive control. Research identifying the social stratifiers for specific mental health outcomes is shocking sparse based on an initial Pubmed search. Interesting research has shown that meditation practice and mindfulness can positively affect people's’ lives by relying less on previously established associations and has been shown to decrease implicit racial biases. Clearly, the social determinants of medical (therefore mental) health have been explicitly outlined throughout the readings for this course. The extent to which a socioecological framework incorporating issues related to social determinants in mental health can be highlighted by the relationship between racial discrimination and psychological functioning in African American adolescents, and by findings suggesting that lesbians and gay men are at higher risk for stress-sensitive psychiatric disorders than are heterosexual persons. Perceived discrimination is associated with both harmful effects on quality of life and indicators of psychiatric and medical morbidity. A major opportunity for improving our understanding of these disparities in mental health should be targeted primarily at the institutional level, given that the quality of many social determinants of health is conditioned by approaches to public policy. Governments should be investing and funding the resources necessary to facilitate community and counselling programs for individuals experiencing burn out, stress, and depression. By targeting efforts at the institutional level, the downstream effects would ripple into our society at large and at the local community (e.g., by decreasing discrimination due to elevated standards of basic care and access to health care services for everyone and therefore increasing overall improved health and functioning at the individual level). Our research here at UCSF aims to clarify the mechanisms by which meditation practices work on an individual level, and by joining with groups such as the East Bay Meditation Center in Oakland, we are attempting to facilitate greater community engagement in order to increase the diversity of meditators within neuroscience studies, including people with disabilities, racial and ethnic minorities, and the LGBTQ population. This may facilitate a better understanding of how these practices exert their effects across diverse populations and whether the mechanisms differ on a an individual basis.
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 would be an important determinant of a health outcome of your choosing. The association c ould be reported in published research or it could be your hypothesized relationshi p. Consider whether how these factors might function over the lifecourse and/or intergenerationally.
Education: Access to education is critical for a mentally healthy, informed and functional society. The lack of affordable access to higher levels of education (and therefore lack of skills necessary to acquire skills and information) in the United States explains many of the mental health disparities experienced by individuals who are systematically denied the right to pursue the education necessary to engage in their full potential. Education level can influence how people approach their experience of mental health problems, as well as their ability to recognize when it becomes detrimental to the overall functioning. It also impedes an individuals ability to take advantage of the resources that are available. The more educated an individual is, they are also more likely they are to recognize when people in their community or family are experiencing mental health problems.
Psychosocial Circumstances: Stressful living environments and relationships negatively impact general mental well being, and one's ability to assess their own mental health. Furthermore, social support and community is key to mental well being and. Psychosocial factors influence whether individuals seek and accept mental health interventions. Depressed persons often struggle to take care of themselves and their families, and manage their day to day affairs and often do not perceive themselves, nor do they want to be perceived as suffering from a mental illness. These factors play a powerful role in the adherence to interventions, and ultimately, depression outcomes. Similarly, social attitudes and beliefs about mental illness can promote resilience or exacerbate symptoms in a suffering individual (Sirey et al 2008). More personalized and culturally sensitive perspectives are needed to tailor and facilitate intervention programs.
Health system: The United States health care programs directly enable (mental) health inequities by refraining from adopting universal health care policies. When an individual is born into a stressful or dangerous environment with limited material resources, these circumstances will almost definitely lead to some form of mental health disorder or instability. The health system should address the gross differences in exposure and vulnerability not only by improving equitable access to care, but also in the promotion of intersectoral action to improve (mental) health status. Factors such as a lack of food supplementation, lacks of transport, and the large barriers to accessing healthcare directly impact daily and cumulative stress and anxiety levels thus directly impacting both mental and medical well being.