1. After reading the article by Thomas et al., comment on where your research, or your research interests, fit into the generational framework for health disparities research. If your work is 1st or 2nd generation, comment on how your work could lead in the future to 3rd or 4th generation work. If your work is 3rd or 4th generation, comment on what 1st and 2nd generation work was necessary as a foundation for your current work (or current interests)
Some work that I have done in Mexico fits between first and third generation. My interest I s diabetes. We found, using the National Health and Nutrition survey that there were disparities in the early diagnosis of diabetes, as well as higher complications of diabetes (chronic kidney disease and retinopathy) among people living in rural vs. urban area, which could be due to lack of health services in rural areas. Therefore, we developed a project with Mobil units that went to communities with low access to health care. We screened for diabetes to 12,000 participants. We gave general recommendations of diet, and physical activity to those with impaired glucose, as well as they were referred to the physician to get treatment. Furthermore, we screened for retinopathy to those with diabetes, and those with retinopathy were also referred for treatment. Even though it was a good project in which we could make early detections of diabetes and its complications, it was not enough, because we were not addressing the main problem in rural areas which got health care services. People were referred to get treatment, but it is likely that they don't have the resources to go to the city to get the adequate treatment. However, the idea of this project was to develop a National program for diabetes and its complications in Mexico to get health care access to the most vulnerable population
2. The barbershop hypertension intervention, while essentially a clinical services intervention operating at either the fence or safety-net level as described by Jones, has some engagement with the social determinants of health. Interventions like that described in the Walton article are designed to mitigate the impact of social determinants. How could you apply one of these two types of interventions to your area of research? Propose one or two interventions that engage with social determinants on some level. (Note: Next week we will discuss policy-level interventions designed to directly impact social determinants).
I think that a good way to address the problem is with mobile health units that can go to places with lack of access to health care, as I mentioned in the previous question. However, I would implement interventions for diabetes prevention rather than for diabetes treatment, targeting people with overweight and obesity. We have also found that people of low socioeconomic status have a higher consumption of sugar-sweetened beverages (SSB), which is one of the main risk factors for diabetes. Therefore, the intervention could be focussed on eliminating the intake of SSB and increase physical activity. In Mexico, in some places, the bottled water is more expensive than a soda. Therefore, another way to address the disparity in SSB consumption in Mexico, could be with interventions in rural areas or low SES neighborhoods with the objective to increase the accessibility of free drinking water in public spaces, like schools, streets, parks, or other recreative places.