Welcome to the Clinical Center Grand Rounds,
a weekly series of educational lectures for physicians and
health care professionals broadcast from the Clinical
Center at the National Institutes of Health in
Bethesda, MD.
The NIH Clinical Center is the world's largest hospital totally
dedicated to investigational research and leads the global
effort in training today's investigators and discovering
tomorrow's cures.
Learn more by visiting us online at http://clinicalcenter.nih.gov
WELCOME TO THIS MONTH'S CLINICAL
CENTER GRAND ROUNDS.
THIS IS NATIONAL NURSING MONTH
WHERE WE TAKE THE TIME TO
CELEBRATE NURSES AND ALL THERE
ACHIEVEMENTS AND
ACCOMPLISHMENTS.
MY NAME IS SABRINA WONG, I AM
THE SCIENTIFIC DIRECTOR OF THE
NATIONAL INSTITUTE OF NURSING
RESEARCH DIVISION OF INTRAMURAL
RESEARCH AND I'M DELIGHTED TO BE
HERE ON BEHALF OF THE NATIONAL
INSTITUTE OF NURSING RESEARCH
WHO IS HOSTING THIS MONTH'S
GRAND ROUNDS.
THE NINR AND 1 OF 27 NIH
INSTITUTES AND CENTERS.
SINCE ITS FOUNDING NINR HAS
SUPPORTED RESEARCH THAT
DEVELOPED THE SCIENTIFIC BASIS
FOR CLINICAL PRACTICE AND
POLICY.
WHAT SETS NINR APART FROM OTHER
NIH INSTITUTES IS NAOUR RESEARCH
WITH OUR NURSING PERSPECTIVE AT
ITS CORE IS FOCUSED ON HEALTH
SOLUTIONS FOR PEOPLE IN THE
CONTEXT OF THEIR LIVES AND
LIVING CONDITIONS AND ACROSS THE
MANY SETTINGS WHERE NURSES
PRACTICE.
OUR STRATEGIC PLAN WAS RELEASED
LAST YEAR ON NATIONAL NURSES DAY
2022.
IT DESCRIBES HOW WE WANT TO
LEVERAGE THE STRENGTHS AND THE
UNIQUE KNOWLEDGE AND
PERSPECTIVES INHERENT IN OUR
DISCIPLINE TO THE BENEFIT OF ALL
PEOPLE THE NINR STRATEGIC
STRATEGY, SCIENTIFIC STRATEGY
IDENTIFIES 5 LENSES THAT WE
THINK BEST LEVERAGE THE
STRENGTHS OF NURSING SCIENCE TO
INNOVATE, THINK BIGGER AND
GREATLY INCREASE OUR IMPACT.
THE LENSES IN THE STRATEGIC PLAN
ARE HEALTH EQUITY, SOCIAL
DETERMINANTS OF HEALTH,
POPULATION AND COMMUNITY HEALTH,
PREVENTION AND HEALTH PROMOTION
AND SYSTEMS AND MODELS OF CARE.
IN ADDITION TO LEVERAGING THE
STREAMS OF NURSING RESEARCH, THE
LENSES PROMOTE MULTILEVEL
APPROACHES CROSS DISCIPLINEAR
EXPE CROSS SECTORAL
COLLABORATION AND COMMUNITY
ENGAGEMENT AND RESEARCH YOU CAN
FIND MORE ABOUT THE FULL
STRATEGIC PLAN ON OUR WEBSITE
NINR.NIH.GOV.
NOW, FOR WHAT YOU'VE ALL BEEN
WAITING FOR.
I WOULD LIKE TO INTRODUCING
DR. HUDSON SANTOS, WHO IS AN
INTERNATIONAL RENOWNED NURSE
KNOWN FOR HIS WORK IN SOCIAL
DETERMINANTS OF HEALTH AND
ADVERSE LIFE EVENTS,
PARTICULARLY AMONG LATIN X
COMMUNITIES.
DR. SANTOS, IS THE DELORES J.
[INDISCERNIBLE] ENDOWED CHAIR
AND ASSOCIATE DEAN FOR RESEARCH
AT THE UNIVERSITY OF MIAMI
SCHOOL OF NURSING AND HEALTH
STUDIES.
HE WAS BORN IN BRAZIL AND
OBTAINED A BACHELOR OF SCIENCE
AND NURSING THROUGH THE STATE
UNIVERSITY OF PERIDOT, AND A
Ph.D. FROM THE UNIVERSITY OF
SALL P A OLO, AND COMPLETED A
POST DOC AT DUKE UNIVERSITY.
BEFORE JOINING THE UNIVERSITY OF
MIAMI, HE WAS A TERMED
DISTINGUISHED SCHOLAR, ASSOCIATE
DIRECTOR AND DIRECTOR OF THE
BIOBEHAVIORIAL LABORATORY AT THE
UNIVERSITY OF CAR O LINEA AT
CHAPEL HILL.
HE WORKS ON CLINICAL
INTERVENTIONS TO UNDERSTAND THE
RELATIONSHIP BETWEEN BIOLODGE
XAL AND SOCIAL FACTORS IN
DETERMINING HEALTH AND DISEASE
OUTCOMES.
HIS WORK AIMS TO BRIDGE THE GAP
BETWEEN BIOLOGICAL AND SOCIAL
DOMAINS IN NURSING SCIENCE AND
ADDRESS THE DEVELOPMENTAL
ORIGINS OF HEALTH AND DISEASE.
DR. SANTOS TODAY WILL BE
DESCRIBING THE IMPORTANCE OF
IDENTIFYING AND ADDRESSING
BIOLODGE XAL EMBEDDING
CONSEQUENCES FROM SOCIAL
ADVERSITY SUCH AS
DISCRIMINATION, AS A PATHWAY TO
ACHIEVE HEALTH EQUITY.
OVER TO YOU DR. SANTOS.
SO I APPRECIATE THE INVITATION
TO THIS SPEAK TOW THE NIH
CLINICAL GRAND ROUNDS TODAY.
IT IS A PRIVILEGE AS WE HAVE
BENEFITED HIGHLY FROM THE
KNOWLEDGE AS WELL AS THE FUNDING
OPPORTUNITIES THAT COME FROM THE
NIH.
SO TODAY I AM GOING TO BE
FOCUSING ON BIOLOGICAL EMBEDDING
AND ITS IMPORTANCE TO HEALTH
EQUITY BUT IESM NOT GOING TO BE
PROVIDING A WHOLE LOT OF ANSWERS
ABOUT ANY OF THOSE TOPICS.
MY GOAL IS REALLY TRY TO HAVE A
CONVERSATION THAT WE CAN FURTHER
DEVELOP INTO RESEARCH IDEAS AND
ACTIONS TO PROMOTE CHANGE.
SO FIRST OF ALL I HAVE NO
FINANCIAL RELATIONSHIPS FOR TO
DISCLOSE AND WE WILL ALSO TALK
ABOUT NO OFFLINE DRUGS DURING
THIS PRESENTATION.
AND THE LEARNING OBJECTIVES AND
TO DESCRIBE THE RELEVANCE OF
BIOLOGICAL, HEALTH NATURE,
EQUITY AND BIOLOGICAL EMBEDDING
AND HEALTH EQUITY AS A RESULT.
SO BEFORE I GET TOO FAR DOWN THE
ROAD, I WANT TO MAKE SURE WE ARE
ALL ON THE SAME PAGE SO WE ARE
GOING TO [INDISCERNIBLE] LET ME
BEGIN WITH DEFINITION OF SOCIAL
DETERMINANTS OF HEALTH AND BY
THE WAY THESE DEFINITIONS ARE
NOT NECESSARILY SET IN STONE.
WE'VE HAD RESEARCHERS THAT
BASICALLY MIGHT HAVE DIFFERENT
DEFINITIONS BUT THOSE ARE THE 1S
THAT I WILL BE USING FOR THE
PRESENTATION.
SO SOCIAL DETERMINANTS OF
HEALTH, IT'S THE CONDITIONS IN
THE ENVIRONMENTS AND THE
ENVIRONMENTS WHERE PEOPLE ARE
BORN, LIVE, LEARN, WORK, PLAY,
WORSHIP AND AGE THAT AFFECT A
WIDE RANGE OF HEALTH,
FUNCTIONING AS WELL AS QUALITY
OF LIFE OUTCOMES AND RISKS.
SOCIAL DETERMINANTS OF HEALTH,
HOWEVER, IS NOT NECESSARILY GOOD
OR BAD.
THEY'RE JUST DETERMINANTS.
A DETERMINANT CAN HAVE A
SPECTRUM OF BOTH GOOD SIDE AND
NEGATIVE SIDE.
SO REALLY AS THESE PRESENTATIONS
WERE SPEAKING OF SOCIAL
DETERMINANTS THAT INCLUDE
[INDISCERNIBLE] HEALTH, IN THOSE
DIRECTIONS, EITHER POSITIVELY OR
NEGATIVELY.
THE NEXT DEFINITION IS
BIOLOGICAL EMBEDDING WHICH
REALLY IS A PROCESS BY WHICH THE
SOCIAL FACTORS FROM SOCIAL
DETERMINANTS OF HEALTH AS WELL
AS EXPERIENCES CAN BECOME
BIOLOGICAL INTEGRATED TO
INFLUENCE HEALTH OUTCOMES.
REALLY WHEN WE SOCIAL LITERATURE
YOU WILL GET THINGS LIKE GETTING
A MESSAGE LIKE THINGS GETTING
UNDER THEIR SKIN SO THAT'S
BASICALLY WHAT WE MINE BY
BIOSOCIAL EMBEDDING.
AND HEALTH EQUITY WHICH IS A BIT
MORE COMPLEX DEFINITION BUT FOR
THIS PRESENTATION, IT IS REALLY
THE PRINCIPLE ON THE LINE, A
COMMITMENT TO REDUCE AND
ULTIMATELY ELIMINATE DISPARITIES
IN HEALTH AND DETERMINANTS SUCH
AS SOCIAL, ECONOMIC AND
ENVIRONMENTAL FACTORS.
WITH THOSE 3 DEFINITIONS, WE ARE
GOING TO INTEGRATE THEM IN
DIFFERENT SESSIONS, YOU GET TO
THE POINT OF THE PRESENTATION,
FOR EXAMPLE, CHRONIC STRESS, IN
THIS SITUATION WILL BE SOCIAL
DETERMINANTS OF HEALTH CAN LEAD
TO LONG-TERM HEALTH PROBLEMS
LIKE HEART DISEASE.
ANOTHER EXAMPLE, LOW LEVELS OF
EDUCATION, ARE ASSOCIATED WITH
POOR HEALTH OUTCOMES AND SO ON
AND O FORTH.
SO BIOLOGIC EMBEDDING CAN LEAD
TO THOSE HEALTH INIQUITIES AND
FOR INSTANCE THOSE WITH SOCIAL
ECONOMIC GROUPS MIGHT EXPERIENCE
SOME CHRONIC STRESS WHICH CAN
LEAD TO POORER HEALTH OUTCOMES,
HEALTH EQUITY, AIM TO CORRECT
THOSE DISPARITIES, WITH THAT
SAID, I HOPE WE ARE ALL ON THE
SAME PAGE IN TERMS OF WHAT ARE
WE GOING TO BE DISCUSSING AND I
DON'T WANT TO NECESSARILY
REINVENT THE WHEEL, OF SOCIAL
DETERMINANTS OF HEALTH AS WELL
AS HEALTH EQUITY, I THINK THE
NATIONAL CENTER OF NURSING
RESEARCH HAS DONE A TREMENDOUS
JOB OVER THE LAST COUPLE OF
MONTHS AND SETTING UP THE
NINR DIRECTOR'S LECTURE SERIES,
WITH SEVERAL TOP INCREASE IN
BODYS BUT 2 OF THEM WERE
DIRECTLY RELATED TO THIS
PRESENTATION.
SO THE FIRST TOPIC IS SOCIAL
DETERMINANTS OF HEALTH AND I
HAVE PROVIDED HERE A SCREEN SHOT
SO THAT YOU CAN SEE THAT THEY
HAVE THE TIME AS WELL AS THE
LINK TO THE YouTUBE CHANNEL
AND THE SECOND LECTURE IS HEALTH
EQUITY, AGAIN, IA SCREEN SHOT IN
TIME, AS WELL AS THE LINK TO THE
YouTUBE CHANNEL SO YOU CAN GO
THERE AND GET A BETTER MORE
COMPREHENSIVE LECTURE IN THOSE 2
TOP INCREASE IN BODYS.
BY WAY OF SOCIAL DETERMINANTS AS
WELL AS HEALTH EQUITY.
SO AS A REMINDER I'M A NURSE BY
TRAINING A LOT OF TIMES I PAY
ATTENTION TO THE NATIONAL
INTUITYS OF RESEARCH AND I TRY
TO MATCH MY RESEARCH TO SUPPORT
THAT MISSION OF THE
EN--STRATEGIESITUTE SO THE
INSTITUTE HAS RECENTLY COME UP
WITH A NEW STRATEGIC PLAN AND
THERE ARE 2 LENSES AND THESE
COLUMNS ARE THE DIFFERENT AREAS
OF PRIORITY, THIS 1 OF COURSE
HEALTH EQUITY, SECOND 1 SOCIAL
DETERMINANTS OF HEALTH AND THEN
POPULATION HEALTH, PREVENTION
HEALTH PROMOTION AND SYSTEMS AND
MODELS OF CARE.
AND HOWEVER, THOSE LAST 3
OOLINGS REALLY A CROSS CUTTING
THEME FOR A BASIC STRATEGIC PLAN
AND OF COURSE I AM EXCITED FOR
THESE BECAUSE THESE ARE
SOMETHING THAT MY TEAM HAS
INVESTED A LOT OF TIME AND
EFFORT OVER THE LAST DECADE OR
SO.
BUT OF COURSE, I'M BIASED AND
THIS IS WHAT I'M BIASED, SO, ALL
WORK WILL BE IN A LOT OF
EXAMPLES I WILL PRESENT TODAY
WILL BE RELATED TO INFANT AND
CHILDHOOD HEGHT AND THAT'S
BECAUSE THIS IS AN AREA THAT MY
TEAM CONCENTRATED EFFORT AND TRY
TO DEVELOP KNOWLEDGE SO, FOR
EXAMPLE, WE ARE--WEB CONNECTED
SPEND A LOT OF TIME TRYING TO
UNDERSTAND SOCIAL ECONOMIC
DIVERSITY AND HOW THAT SOCIAL
ECONOMIC ADVERSITY IS NOT
GETTING--AFFECTING MOTHER AND
CHILD AND FETAL CHILD HEALTH.
EVEN BEFORE A CHILD IS BORN AND
HOW DOES THAT AFFECT EARLY LIFE
AND HELP DETERMINE WHO WILL HAVE
DIFFERENT HEALTH OUTCOMES OVER
THE LONG-TERM.
WITH THE GOAL OF TRYING TO
UNDERSTAND THE PROCESS, CAN WE
HELP SOMEONE STAY HEALTHY
DESPITE LIVING THROUGH SOCIAL
ECONOMIC AND DIVERSITY.
IF SO, WHAT ARE THE PROCESSES
THAT WE HAVE [INDISCERNIBLE] TO
HELP THAT PERSON MAINTAIN
OPTIMUM HEALTH.
BECAUSE ALTHOUGH IT SOUNDS IDEAL
TO CHANGE THIS, ALL THE SOCIAL
ECONOMIC ADVERSITY THAT WE
ENCOUNTER, IS ACTUALLY HARD AND
WILL TAKE YEARS, SO IN THE MEAN
TIME, WHILE WE STILL 35 THROUGH
SOCIAL ECONOMIC ADVERSITY, WE
HAVE TO FIND ALTERNATIVE WAYS TO
HELP PEOPLE TO MAINTAIN THEIR
HEALTH.
SO IN THAT REGARD, BIOLOGICAL
EMBEDDING LITERATURE HAS
FLOURISHED OVER THE LAST FEW
YEARS AND PEOPLE HAVE COME UP
WITH A LIKE EXCITING COMPLEX
MODELS, SUCH AS THIS 1, FOR
EXAMPLE, TO THE LEFT OF THE
FIGURE TO THE LAST OF THE
FIGURE, YOU SEE THE SOCIAL
ENVIRONMENT WHICH AGAIN
[INDISCERNIBLE] MATERNAL CHILD
HEALTH BECAUSE IT'S MY AREA OF
EXPERTISE WHERE YOU SEE CHILD
DEPRIVATION, CAREGIVER,
[INDISCERNIBLE] LINKED TO CARE
GIVING ENVIRONMENT, FAMILY
CONTEXT, COMMUNITY ENVIRONMENT,
SOCIETAL ENVIRONMENT AND OF
COURSE IN THIS PROCESS, THERE
ARE SOME BUFFERING EFFECTS FOR
EXAMPLE, THE PRESENCE OF
[INDISCERNIBLE] CAREGIVER,
RESILIENCE BECAUSE THIS IS
LOOKING AT DEVELOPMENT AS YOU
CAN SEE HERE FROM PREGNANCY TO
CHILDHOOD, THE DIFFERENT
SENSITIVE PERIODS, FOR EXAMPLE,
THE NEOINATE OR CHANGE OF
STATION ARE VERY HIGH TENSITY TO
THOSE STRESSORS.
AND AS IN THIS PROCESS WE'VE
HAVE SEEN EFFECTS MUCH HIGHER,
BABIES BEING BORN PREMATURE,
GENETIC VARIATION THAT COULD SET
SOMEONE AT HIGHEST
SUSCEPTIBILITY TO THE
ENVIRONMENT AND CONDITIONS AND
OTHER COMPLEX DIFFERENTIAL
EFFECTS SUCH AS SEX, GENDER,
TEMPRAMENT AND OTHER
CHARACTERISTICS.
ALL THOSE FACTORS WILL BE
INTERACTING AND CREATING
BIOLOGICAL CHANGE THAT WILL
EVENTUALLY TURN INTO PHENOTYPES
OR HEALTH CHARACTERISTICS AND
SOME OF THOSE REALLY ARE GENETIC
CHANGE THAT WE WILL AFFAIRS TEAM
LEADERRER PHENOTYPES, AND IN
THIS CASE, DRIVING THE
BIOLOGICAL EMBEDDING AND THERE
ARE DIFFERENT GENETIC MECH
INFORMS WE TRY NOT--WHEN I GET
INTO AT THIS POINT, AS WELL AS
ALTER NARROWER STROKE
[INDISCERNIBLE] FUNCTION, ULTRA
HPA AND THIS REACTIVITY ACCESS
AND ADDITIONAL SYSTEMIC EFFECT
OF THESE IS NOT REALLY
HAPPENINGS IN SOME SORT OF A
SYNCHRONY AND CUMULATIVE EFFECT
WHICH EVENTUALLY START IMPACING
THE DEVELOPMENTAL TRAJECTORY OF
INDIVIDUALS THAT CAN LEAD TO
BEHAVIORIAL HEALTH RISKS, SUCH
AS SUBSTANCE USE, DIET, STRESS
MANAGEMENT, AND HAVING
BEHAVIORIAL IMPACTS AS WELL AS
ALLEVIATE SOCIAL AND ECONOMIC
SET BACKS WHICH ULTIMATELY WILL
INCREASE THE RISK FOR
CARDIOVASCULAR DISEASES,
PSYCHOPATHOLOGY, IMPAIRED
COGNITION AND SO ON AND SO
FORTH.
SO AGAIN, THERE ARE MANY
DIFFERENT MODELS LIKE THIS THAT
HAVE BEEN DEVELOPED, THIS IS
JUST AN EXAMPLE OF 1 AND HOW IT
CAN GET COMPLEX.
SO THERE'S A LOT GOING ON HERE,
BUT IF THE MESSAGE IS ACTUALLY 1
OF--THIS 1.
IS INEQUALITY.
SO THIS IS WHAT WE ACTUALLY OR
SCAN HEALTHCARE PROFESSIONAL, I
REALLY CARE ABOUT, RIGHT?
SO THE BIOLOGICAL EMBEDDING
STORY, THE SOCIAL DETERMINANTS
OF HEALTH STORY WHEN WE LOOK
THROUGH THE PAPERS WE PUBLISHED,
SEEMED VERY HYPOTHETICAL BUT
WHEN YOU LOOK AT SITUATIONS LIKE
THIS, FOR EXAMPLE, THIS IS A
PHOTO FROM THE GUARDIAN OF SAO
PAULO WHICH IS WHERE I COMPLETED
MY Ph.D. AND YOU SEE TO THE
LEFT [INDISCERNIBLE] IS A FULL
COMMUNITY AND IT'S SEPARATED BY
A WALL, YOU WILL SEE THESE HIGH
END BUILDINGS AND YOU CAN SEE
LIKE HOW THEY ARE ON 1 SIDE, YOU
HAVE A LOT OF PEOPLE WITH LOW
EDUCATION, LOW ECONOMIC
OPPORTUNITY, FRONT LINE WORKERS,
ESSENTIAL WORKERS AND TO THE
RIGHT YOU HAVE A LOT OF
PRIVILEGE THAT ULTIMATELY COMES
WITH PROTECTIVE [INDISCERNIBLE]
IN RELATION TO HEALTH.
BUT HEALTH DISPARITIES BY SOCIAL
ECONOMIC STATUS AND OTHER SOCIAL
DEPENDENTS OF HEALTH HAVE BEEN
EXTENSIVE LIE DOCUMENTED.
IT'S NOT NEW AND WE DON'T TRY TO
SPEND TOO MUCH TIME AND TRY TO
PROVE THAT BECAUSE IT HAS BEEN
REMOVED OVER AND OVER AGAIN.
BUT LETS US KNOW ACTUALLY ABOUT
THE [INDISCERNIBLE] HEALTH
IMPLICATIONS FOR EXAMPLE,
ACHIEVING UPWARD MOBILITY.
RIGHT?
SO IF YOU THINK ABOUT WHEN WE
TRY TO DO, IS WE TRY TO TAKE
SOMEONE FROM THE LEFT SIDE OF
THE PICTURE AND TO THE RIGHT
SIDE OF THE PICTURE, FOR IS SO
WE DEPEND ON THE DISCIPLINE, WE
TRY TO HELP PEOPLE GET MORE
EDUCATED, INCREASE INCOME,
EATING BETTER AND ALL BASICALLY
TRY TO MIMIC THESE HIGH RESOURCE
AND ENVIRONMENTAL THAT WE
BELIEVE IS PROTECTIVE.
BUT INSTEAD, NOW, LIKE HOW DO
WE--AND IT JUST CHANGES SOMEONE
IN THE ENVIRONMENT AND FOR
EXAMPLE, TO THE LEFT AND TO THE
RIGHTED OF THE FICTURE, HAVE YOU
2 CHILDREN, 1 OF THEM
EXPERIENCING ADVERSE CHILDHOOD
EXPERIENCES.
ON THE LEFT SIDE OF THE PICTURE
THE CHILDREN WERE EXPERIENCE
TRAUMA, NEGLECT AND ABUSED ARE
MORE LIKELY TO DEVELOP HEALTH
PROBLEMS SUCH AS HEART DISEASE,
DEPRESSION, HIGH BLOOD PRESSURE.
THE SAME THING WITH CHRONIC
STRESS, CHRONIC STRESS
COMPLICATIONS SUCH AS
NEIGHBORHOODS OR IMPOVERISHED
AREAS ARE THINGS THAT EXIST AT
HIGHER RATES OF STRESS-RELATED
ISSUES LIKE HYPERTENSION, MENTAL
HEALTH DISORDERS.
NOW LET'S THINK OF EXAMPLE
NUMBER 1, THIS IS THE FIRST
CHILDHOOD EXPERIENCES THAT CHILD
MAY BE EXPERIENCING NEGLECT,
ABUSE AND LET'S JUST SEE, YOU
KNOW THE EVENT THAT IS TAKING
PLACE, OF THE ENVIRONMENT THAT
IS THE [INDISCERNIBLE] AND IF WE
WISH TO REMOVE THAT CHILD FROM
THE HOUSEHOLD AND PUT IN ANOTHER
HOUSEHOLD WHERE THERE'S NO
NEGLECT AND ABUS THAT'S THE
EFFECTS OF NEGLECT AND ABUSE GO
AWAY, THAT IS A QUESTION EYE AM
TRYING TO RAISE TODAY.
YOU KNOW THERE IS SOME
BIOLOGICAL CONSEQUENCES SHOULD
THOSE STRESSORS THAT BY WHOSE
CHANGING THE OVERALL
INFRASTRUCTURE WITH THE OVERALL
SOCIAL DETERMINANT OF HEALTH
ENVIRONMENT, IT MAY NOT BE
ENOUGH TO UNDUE THE CONSEQUENCES
OF THE STRESSORS.
SO GETTING A LITTLE BIT MORE
INTO LOOK AT THE ROLE OF
[INDISCERNIBLE] AND PROMOTING
HEALTH EQUITY AWNCH TIME WE SEE
POLICIES AND INTERVENTIONS THAT
CAN ACTUALLY AND HAVE BEEN
SUCCESSFUL ADDRESSING SOCIAL
DETERMINANTS OF HEALTH AND USING
THE CANNED WHAT TO PROMOTE
HEALTH EQUITY AND HERE, I PUT
HEALTH EQUITY IN QUOTES.
FOR EXAMPLE, A SCHOOL DISTRICT
IMPLEMENTS A PROGRAM TO PROVOID
FREE, HEALTHY MEALS TO STUDENTS.
THIS POLICY ADDRESSED SOCIAL
DETERMINANTS OF HEALTH, FOR
EXAMPLE, ACCESS TO NUTRITIOUS
FOOD AND CAN HELP IMPROVE HEALTH
OUTCOMES FOR CHILDREN
DEMONSTRATING HOW POLICY CAN
PROMOTE HEALTH EQUITY.
I MYSELF HAVE AN INTERVENTION
THAT WE JUST FINISHED--A
CLINICAL TRIAL WHERE WE OFFER
BEHAVIORIAL INTERVENTION TO
MOTHERS AND CHILDREN OF LATINO
BACKGROUND TO TRY TO PROMOTE
HEALTHY WEIGHT AS WELL AS
CONTROL THE ONSET OF DIABETES
AND WE OFFER THOSE EDUCATIONS
WHICH THE IDEA THAT THE CHANGE
IN BEHAVIOR IS ENOUGH TO UNDUE
THE CHRONIC CONSEQUENCE OF BEING
EXPOSED TO THOSE STRESSES.
JUST LIKE HERE, LIKE WE OFFERING
NUTRITIOUS FOODS IN THE
DISTRICT.
AND OFTEN TIMES WE MAKE THE
ASSUMPTION THAT ARE OFFERING
THOSE NUTRITIONS FOOD IS ENOUGH
TO ACTUALLY ACHIEVE HEALTH
EQUITY, BUT IS THIS TRULY HEALTH
EQUITY THAT IS THE QUESTION WE
BEG.
THERE ARE SOME REALLY
FASCINATING RESEARCHERS THAT I
REALLY APPRECIATE THE WORK THEY
DO, DR. CHAN, BRODY, AND MILAR,
ALL OF THEM AT OUR UNIVERSITY
WHERE THEY HAVE SPENT A LOT OF
TIME UNDERSTANDING WHAT ARE THE
CONSEQUENCES OF FOOD MOBILITY
RIGHT.
SO IF YOU THINK ABOUT THOSE
SOCIAL DETERMINANTS OF HEALTH
CONDITIONS WHAT WE TRY TO DO AND
TEND TO THINK OF SOCIAL
DETERMINANTS FOR NEGATIVE LENSES
WHERE SOCIAL DETERMINANTS OF,
YOU KNOW PULL LOW EDOCCASION,
LOW INCOME, HIGH LEVEL
NEIGHBORHOOD, BIOLENS AND SO ON
AND SO FORTH AND WE TRY TO
ELIMINATE THOSE WITH THE IDEA
THAT THOSE ARE NOT ENOUGH TO
ADDRESS HEALTH INIQUITIES.
BUT THIS GROUP OF RESEARCHERS
FOR EXAMPLE HAVE STUDIED QUITE
EXTENSIVELY THE CONSEQUENCE OF
UPWARD MOBILITY.
FOR EXAMPLE, WHAT IS THE--IT IS
BASICALLY ASKING THE QUESTION
WHAT IS THE CAUSE OF SOMEONE
COMING, LEAVING FROM LIKE A LOW
SOCIOECONOMIC STATUS TO A HIGH
STABLE SOCIOECONOMIC STATUS?
AND THEY HAVE SHOWS IN DIFFERENT
STUDIES, DIFFERENT PROCESSES,
THIS IS A PICTURE THAT I HAVE
PUBLISHED IN THE PAPER AT THE
ANNUAL REVIEWS OF PSYCHOLOGY AND
YOU CAN SEE 2 PROCESSES, 2
MECHANISMS FOR UPWARD MOBILITY
SUCH AS HEALTH BEHAVIORS, AT THE
TOP WHERE YOU HAVE--THEY PRESENT
2 OF THEM, SO FOR EXAMPLE, THEY
TRY REDUCING BEHAVIORS WHERE YOU
CAN'T OVEREAT, TRY TO MANAGE
YOUR STRESS AND RESTERRAATIVE
BEHAVIORS SUCH AS SLEEPING,
ACTIVITIES, BUT ALSO THE BOTTOM
THE HIGHLIGHT, THAT I
IMPLICATED, UPWARD MOBILITY.
THIS REVELATION TRIES TO RESPOND
TO SYSTEMS, CHANGE AND COMMON
INFESTATIONS IN TISSUE AND TO
THE LEFT OF THE MODEL, YOU SEE
THE FACTORS THAT ARE IMPLICATED
WITH THE IDEA OF FORWARD
MOBILITY WHERE THE INDIVIDUAL
HAS BEEN DRIVING, THEY'RE
COMPETING, LACK OF BELONGING TO
THE NEW SOCIAL ECONOMIC LEVEL,
THEY HAVE ACHIEVED AND ON THIS
MATCH OF TRADES AND HIGH SCS
ENVIRONMENT MEANING MEANING
REMOVING THEM IN ANOTHER
ENVIRONMENT, IF THAT'S NOT
COMING OUT AT COST AND OF COURSE
IN THEIR FOCUS OF RESEARCH THEY
LOOK AT METABOLIC HEALTH AND TO
HAVE SHOWN THAT THESE HAVE
CONSEQUENCE ISSUE, MORE
METABOLIC SYNDROME DIABETES,
STROKE AND HEART DISEASE.
SO IN THE SO WHAT THEY HAVE GOT
THIS SENTENCE WHICH IS REALLY
HIGHLIGHT SOMETHING I WANT TO
EMPHASIZE IN THIS PRESENTATION
WHICH IS 1 OF THE PATHWAYS TO
HEALTH IS BIOLOGICAL AND IN
THEIR WORDS IT MEANS THE
STRESSORS ASSOCIATED WITH UPWARD
MOBILITY DISREGULATE THE
ACTIVITY THE BODY'S STRAINS AND
SYSTEMS AND PERSISTENT CHANGE IN
THESE SYSTEMS.
WE WILL ALTER THE BEHAVIORS OF
THE CELLS AND TISSUES AND
ORGANS, LEADING EVENTUALLY TO
PRECLINICAL MANIFESTATION AND
SUBSEQUENT RISK OF METABOLIC,
PATTERN METABOLIC DISEASES.
SO THIS IS REALLY THE FOUNDATION
OF WHAT WE SPEAKING ABOUT
BIOLOGICAL EMBEDDING.
SO THESE ARE THE STRESSORS, EVEN
IF THE STRESSOR IS TAKING YOU IN
A MORE SOCIALLY OUTLOOK WAY THAT
LOOKS PAST THERE MEANING UPWARD
MOBILITY, SOCIOECONOMIC STATUS,
AND [INDISCERNIBLE] CONSEQUENCE,
THAT WILL IMPACT YOUR HEALTH.
SO THIS TAKES ME TO THE
FRAMEWORK THAT REALLY GUIDES OUR
WORK HERE AT THE UNIVERSITY OF
MIAMI SCHOOL OF MEDICINE AND
HEALTH STUDIES WHICH IS REALLY A
MODEL OF THE SOCIAL
DENAMES--NAMESSICS OVER THE LEFT
COURSE.
MEANING IT'S NOT ENOUGH TO
ELECTRIC AT A BIOLOGICAL SYSTEMS
BUT ALSO NOT ENOUGH TO LOOK AT
SOCIAL SYSTEMS WITHOUT
UNDERSTANDING THE INTERACTION
AND INTERPLAY THAT BOTH OF THEM
HAVE IN THE HUMAN DEVELOPMENT
AND THAT INTERACTION IS TAKING
PLACE DURING GUESTATION OR EVEN
BEFORE THAT AND IT'S CARRIED
THROUGHOUT THE INFANCY,
CHILDHOOD AND SO ON AND SO
FORTH.
BECAUSE WE ARE A CHILD MATERNAL
HEALTH RESEARCH GROUP, WE TEND
TO FOCUS ON GUESTATION, ALL THE
WAY TO [INDISCERNIBLE] BUT THIS
MODEL REALLY APPLIES THROUGHOUT
AND INDEPENDENT OF BASIC PLANS
FOR SUCH TOPIC, SO WITH THAT IN
MIND, BIOSOCIAL APPROACH TO
HEALTH IS REALLY A WAY OF
UNDERSTANDING THE HELP OF
INDIVIDUALS IN A WHOLISTIC
MANNER.
WITH THAT SAID, I AM GOING TO
START FOCUSING ON THE PRIMER
THAT I WANT TO HIGHLIGHT HERE
WHICH IS DISCRIMINATION AND
DISCRIMINATION TO BE SPECIFIC.
OVER THE LAST--WE'VE HEARD MANY,
MANY TIMES ABOUT DISCRIMINATION
IN THE NEWS, IN THE
[INDISCERNIBLE] ISSUES HERE
ABOUT IT.
AND NIH ACTUALLY HAVE STARTED
PLAYING INTEREST AND
UNDERSTANDING THE EFFECTS OF
DISCRIMINATION, IN HEALTH
OUTCOMES.
FOR EXAMPLE, COUPLE YEARS AGO,
THEY RELEASED A SPECIAL CALL
TRYING TO FIND THE STUDIES IN
THIS AREA OF STUDY, IN THIS
CONCENTRATED AREA.
THEY REISSUE THE CALL RECENTLY
AND TRY TO MAKE SOME HEAD WAY IN
THAT REGARD.
BUT THERE ARE DIFFERENT FORMS OF
DISCRIMINATION AND
DISCRIMINATION IS REALLY JUST A
PREJUDICE AND INDIVIDUAL
TREATMENT OF INDIVIDUALS BASED
ON SPECIFIC CHARACTERISTICS AND
THOSE CAN BE NOT LIMITED TO BUT
THEY CAN BE RACE AND ETHNICITY,
GENDER, AGE, SEXUAL ORIENTATION,
ABILITY, BUT THERE'S REALLY 3
MAJOR CATEGORIES OF
DISCRIMINATION WHICH IS THE
STRUCTURAL, INDIVIDUAL AND
CARRIERS, THE STRUCTURAL IS
REALLY WITH WE ARE TRYING TO
THINK OF FOR EXAMPLE,
RESIDENTIAL SEGREGATION AND
OFTEN TIMES WHEN WE THINK OF
RESIDENTIAL SEGREGATION, WE
THINK THAT THERE IS SOMETHING
FROM THE PAST, FROM THE
[INDISCERNIBLE] AREA BUT IT'S
REALLY NOT, IF WE WERE TO COME
TO MIAMI WHERE WE ARE LOCATED,
AND YOU DRIVE AROUND THE CITY,
YOU ACTUALLY SEE THAT THE
NEIGHBORHOODS ARE FAIRLY
SEGREGATED.
FOR EXAMPLE, WE HAVE LITTLE
HAVANA AND WE HAVE OTHER
NEIGHBORHOODS THAT ARE VERY
SPECIFIC TO DIFFERENT
ETHNICITIES AND RACE AND THEY
CLEARLY DON'T INTERACT MUCH.
THERE'S NOT A WHOLE LOT OF
INTERACTION BETWEEN DIFFERENT
NEIGHBORHOODS SO THIS WOULD
EVENTUALLY LEAD TO STRUCTURAL
CHANGE AND OPPORTUNITIES THAT
WILL AFFECT THE HEALTH OF
INDIVIDUALS.
THE SECOND 1 IS THE INDIVIDUAL
FOR PROFESSIONAL DISCRIMINATION
AND THAT IS REALLY THAT YOU
RECEIVED UNDERSTANDING THAT
SOMEONE IS TREATING YOU AND JUST
BEING INJUST TO YOU OR PREJUDICE
TO YOU, SO THE INDIVIDUAL HAS TO
PERCEIVE THAT EVENT TO
UNDERSTAND THAT THEY HAVE BEEN
DISCRIMINATED AGAINST AND THEN
[INDISCERNIBLE] IS THE
[INDISCERNIBLE] EFFECT MEANING
THE PERSON THAT EXPERIENCED THIS
DISCRIMINATION, THE EFFECT OF
DISCRIMINATION DOESN'T STOP AT
THEM.
IT CAN GET CARRIED ON TO THE
CLOSE FAMILY MEMBERS AND
PARTNERS SUCH AS A MOTHER THAT
HAS BEEN DISCRIMINATED AGAIN,
THE STRESSES OF THE PARENT IN
SOME FASHION, BEING TRANSFERRED
INTO THE HER CHILDREN.
AND THAT IS 1 AREA WHERE WE HAVE
BEEN SPENDING A LOST EFFORTS.
JUST GETTING MORE INTO THE
REASONS WHY I'M HOSTING FOR
DISCRIMINATION ON THIS TALK IS
CHRIS NIM NATION IS A SOURCE
WAS--DISCRIMINATION IS A SOURCE
OF CHRONIC STRESS.
AND CHRONIC STRESS IS PROBABLY
THE SINGLE MOST IMPORTANT
PATHWAY FOR BIOLOGICAL
EMBEDDING.
DISCRIMINATION CAN LEAD TO
STRESS THROUGH FEELINGS OF
SOCIAL IEBSOLATION, EXCLUSION,
REDUCING STRESSES AS WELL AS
CREATING HOSTILE ENVIRONMENT.
FOR EXAMPLE, WE SEE THE SOCIAL
MEDIA AND OFTEN THE NEWS AND
SOMEONE, THE NEWS PORTRAYING
THINGS LIKE SOMEONE IS WALKING
TO THE GROCERY STORE AND WERE
PICKING OUT A DIFFERENT LANGUAGE
OTHER THAN ENGLISH AND SOMEONE
[INDISCERNIBLE] SPEAK AMERICAN,
DON'T BELONG TO THIS COUNTRY,
AND SO ON AND SO FORTH.
THOSE THINGS CAN CREATE A
SERIOUS SOURCE OF STRESS TO
THOSE INDIVIDUALS AND STOP THEM
FROM NOT GETTING SOCIETY AS THEY
SHOULD.
SO THIS STRESS CAN CONTRIBUTE TO
THE DEVELOPMENT OF HEALTH
DISPARITIES AND OF COURSE,
NEGATIVELY IMPACT OVERALL WELL
BEING.
DISCRIMINATION EFFECTS ON
HEALTH, HOWEVER, AGAIN, IS NOT A
NEW THING BUT WE KNOW IT'S BAD
AND WE KNOW IT HAS A LOT OF
EFFECTS SUCH AS DISCRIMINATION
HAS BEEN ASSOCIATED WITH REDUCED
PHYSICAL ACTIVITY, THIS HAS BEEN
ASSOCIATED WITH INCREASED RISK
OF DEPRESSION, ANXIETY, HIGHER
LEVELS OF PSYCHOLOGICAL STRESS,
NEGATIVE IMPACT ON SELF-ESTEEM
AND SELF-WORTH, BEING ASSOCIATED
BI HIGHER RISKS OF HYPERTENSION,
CARDIOVASCULAR DISEASE AND THIS
WOULD FEBRUARY EXAMPLE, A LOT OF
IT HAS BEEN DONE BY NURSE
RESEARCHERS, DR. JACK TAYLOR.
DISCRIMINATION HAS BEEN RELATED
TO POOR OVERALL HEALTH OUTCOME
AND OF COURSE INCREASE SUBSTANCE
ABUSE.
AND IT MAY SOUND OBVIOUS BUT
SOMETIMES WE TAKE THOSE FACTORS
SUCH AS DISCRIMINATION AND IT'S
NOT TREATING THEM AS IF THERE
ARE SOME THING IN ISOLATION FROM
SOCIAL DETERMINANTS OF HEALTH
BUT THIS IS A SOCIAL DETERMINANT
OF HEALTH IN THIS SITUATION AND
THERE'S INTERPLAY BETWEEN
DISCRIMINATION AND OTHER SOCIAL
DETERMINANTS OF HEALTH.
FOR EXAMPLE, DISCRIMINATION,
INTERACTS WITH SOCIAL
DETERMINANTS, OTHER SOCIAL
DETERMINANTS SUCH AS INCOME,
EDUCATION, NEIGHBORHOOD,
CONDITIONS, THAT CAN EXACERBATE
HEALTH DISPARITIES.
FOR EXAMPLE, WE SEE CASES WHERE
SOMEONE AFFECTS SKIN COLOR IN
BROWSING THROUGH A STORE AND OUR
SECURITY GUARD STARTING
FOLLOWING THEM BECAUSE THEY
DON'T THINK THEY BELONG IN THAT
ENVIRONMENT OR THEY DON'T HAVE
THE ECONOMIC ABILITY TO BE A
CLIENT OF THAT ENVIRONMENT AND
SO, THOSE ARE INTERACTIONS OF
SOCIAL DETERMINANTS OF HEALTH,
PERCEIVED BEDDING, SKIN COLOR,
BELONGING TO DIFFERENT INCOME
GROUPS OR EDUCATION GROUPS AND
THE THACT THAT YOU ARE
DISCRIMINATED ON BASED ON THOSE
CHARACTERISTICS.
ADDRESSING SOCIAL DETERMINANTS
OF HEALTH OF COURSE IS CRUCIAL
TO REDUCING THEIR DISCRIMINATION
BECAUSE IF YOU WERE ABLE TO
ERASE FROM SOCIETY THE IDEA THAT
SKIN COLOR IS ASSOCIATED WITH
LEVELS OF INCOME AND EDUCATION
AND AND SENSE OF BELONGING,
THOSE INTERACT WITH THE
DISCRIMINATION ITSELF AND THE
DISCRIMINATION WILL BE REDUCED.
OF COURSE, I HAVEN'T SAID MUCH
ABOUT WHAT ARE THE OTHER SOCIAL
DETERMINANTS OF HEALTH ARE BUT
IF YOU HAVE THIS PICTURE HERE
THAT GETS 0 GOOD HIGHLIGHT OF
DIFFERENT CATEGORIES AND YOU CAN
GO BACK TO THE LECTURE THAT I
POINTED OUT EARLIER TOGETHER,
VERY GOOD UNDERSTANDING OF THE
SOCIAL DETERMINANTS OF HEALTH
BUT GOING BACK TO THE EMBEDDING
RESEARCH AGAIN,
DR. [INDISCERNIBLE] AND
[INDISCERNIBLE] WERE MONTH THE
FIRST TO REALLY PUT IN THESE
BIOLOGICAL MECHANISMS IN PLACE,
TRY UNDERSTAND THE EFFECTS OF
PROFESSIONALS AND HOW THEY
AFFECT BIOLOGICAL SYSTEMS AND
YOU CAN SEE HERE THEY GO FROM
DISCRIMINATION TO THE HYPOTHAT
WILLUS, TO THE PITUE TARY GLANT,
SO ON AND SO FORTH AND BASICALLY
ALL TRAINING AND LEAVING TO BOTH
WAY, THE HYPERTENSIONAL BASE,
THEY END UP GENETIC PROCESSES,
BASICALLY PROCESSES THAT REALLY
CHANGE HOW YOUR GENOME IS ACTING
WHICH SENDS FEEDBACK INTO THIS
WHOLE SYSTEM.
AND SO THOSE AGAIN, CHOOSE 1
EXAMPLE, OF DIFFERENT MODELS
THAT HAVE BEEN CREATED TO GET AT
THESE.
THE LAST SET CREATED A SERIES ON
RACISM SHOWING PHOBIA AND
DISCRIMINATION AND THEY HAVE
DONE A MUCH BETTER JOB AT
ACTUALLY CREATING THIS FIGURE
THAT SHOWED THE WHOLE FRAMEWORK
OF HOW THINGS MAY TAKE PLACE AND
FOR EXAMPLE, HAD TO BREAK THE
FIGURE INTO 2 PORTIONS HERE AND
YOU REALLY CAN'T SEE THAT WELL
BUT I PUT THE LINK FOR THE
SERIES HERE.
AND YOU BASICALLY SEE FOR
INDIVIDUAL PERSPECTIVE AND
DISCRIMINATION, BEHAVIOR,
PSYCHOLOGICAL AND PHYSIOLOGICAL
AND YOU WILL HAVE
INTERGENERATIONAL IMPACTS
LEADING INTO THE CHILDHOOD AND
ADOLESCENTS, OUTCOMES AS WELL AS
WHOLE ADULT AND [INDISCERNIBLE]
OUTCOME BUT OF COURSE GOING
THROUGH BIRTH AND ADULTHOOD AND
IN THE BIG PICTURE THEY REALLY
SHOW OW SOCIETAL FACTORS AND
SPECIAL, THE NEIGHBORHOOD
SEGREGATION, NAIB OAR HOOD
ENVIRONMENT, ACCESS TO GREEN
SPACES, ECONOMIC FACTORS REALLY
PLAY INTO THIS SYSTEM AND HOW
THE HEALTH SYSTEM ACTUALLY
ENABLES OR EVEN SUSTAINS ALL
THOSE DETRIMENTAL EFFECTS.
WITH THAT SAID THIS IS A
FANTASTIC BIG PICTURE OF WHAT'S
GOING ON BEHIND THE SCENES, THAT
GOES FROM THIS IDEA OF BIOSOCIAL
MECHANISM THAT GOES FROM BIOLOGY
TO SOCIETY.
WHICH I WILL SHIFT, FOAMUS A BIT
AMONG DISCRIMINATION, SO I CAN
SHOW DATA POINTS FROM OTHER
GROUP, FOR EXAMPLE, AS OF 2018,
4 AND 10 LATIN X DISEASES
REPORTED DISCRIMINATION IF FOR
[INDISCERNIBLE] 68% OF THEM WERE
MORE LIKELY THAN U.S. BORN WERE
LIKELY TO EXPERIENCE
DISCRIMINATION AND THEY WERE
RELATED TO RACE ETHNICITY,
LANGUAGE AND SKIN COLOR AND
MIGRATION STATUS.
SO, OUR GROUP AGAIN, STARTED
ASKING THE QUESTIONS, YOU KNOW
TO A DEGREE THAT DISCRIMINATION
ACTUALLY IS ASSOCIATED WITH
THINGS SUCH AS STRESS AND
DEPRESSIVE SYMPTOMS BECAUSE
THOSE MOMS OFTEN TIMES I
EXPERIENCE IN THE PROCESS
SYMPTOMS AT A HIGHER RATE THAN
THE [INDISCERNIBLE].
SO THIS IS HOW OUR NETWORK MODEL
OF SYMPTOMS WELL IT'S NOT REALLY
SYMPTOMS BUT INDIVIDUAL FACTORS
AND AT THE TOP, YOU SEE
[INDISCERNIBLE] AT THE BOTTOM,
YOU SEE DEPRESSIVE SYMPTOMS AND
LOW BIRTH WEIGHT, ECONOMIC
HARDSHIP AND WHETHER THEY WERE
U.S. BORN, SO THE
[INDISCERNIBLE] ARE CALLED THE
NODES, THE LITTLE CONNECTION
BETWEEN THEM ARE CALLED THE
EDGES AND THE THICKNESS OF THE
EDGE MEANS IT'S TRYING TO HELP
THE RELATIONSHIP AND IF IT HAS
BLUE IT'S A POSITIVE
ASSOCIATION, AND IF IT'S RED, IT
IS A NEGATIVE ASSOCIATION.
SO QUICKLY HERE, YOU SEE IN THE
FIRST FIGURE, YOU DON'T SEE DID
CONNECTION BETWEEN DEPRESSION
AND THE [INDISCERNIBLE] BUT IN
THE SAME MODEL IF YOU CHOOSE THE
ONLY THING THAT WE CHANGE AT
DISCRIMINATION IN THE MODEL IS
THE OTHER DISCRIMINATION
ACTSAs A BRIDGE CONNECTING
THOSE 2 STRESSORS WHICH THEY ARE
BELIEVE THEY DISCRIMINATION
MAJOR TRIGGER TO HEALTH OUTCOMES
IN THE PREGNANCY AND POST
ENVIRONMENT PERIOD.
BUT OF COURSE, I FOCUS ON HOW
THINGS GET UNDER THEIR SKIN SO
WE CAN TRY TO ADDRESS THOSE
THINGS BEFORE THEY GET OUT OF
CONTROL AND BECOME CHRONIC
CONDITIONS.
SO 1 OF THE THINGS WE FOCUS ON
DNA METHYLATION, AND DNA
METHYLATION IS REALLY
[INDISCERNIBLE] THE TOP OF YOUR
DNA, THAT CAN TURN THE FUNCTION
OF THE GENE ON AND OFF.
FOR EXAMPLE, IN THIS PICTURE,
YOU HAVE A [INDISCERNIBLE]
ISLAND, IF YOU THINK OF THIS AS
[INDISCERNIBLE], AND THE
BEGINNING OF THE STREET AND THE
COOL PART OF THE STREET WHERE
EVERYBODY CONGREGATES SO THIS
[INDISCERNIBLE] IS THE PART OF
THIS TREE AND HERE NONE OF THOSE
ARE TAGGED SO THERE'S FULL
INFORMATION HAPPENING.
SO THE GENE EXPRESSION TAKES
PLACE AND THE LYSIS FOR WHICH
THEY'RE METHALATED AND TAGGED IN
THOSE AREAS OF THE GENES,
THERE'S NO GENE EXPRESSION AND
THE GENE NOW REPRESSED MEANING
THEIR NOT FUNCTIONING AS THEY
SHOULD, SO IF YOU THINK OF THE
EXAM OR AN EXAMPLE, YOU THINK OF
A CHRISTMAS TREE THE CHRISTMAS
TREE IS AN INDIVIDUAL, AND THEN
YOU HAVE THESE LITTLE STRESSOR
WHICH WOULD BE THE LITTLE KITTY
THAT YOUR FAMILY BROUGHT HOME
AND THE KITTY DEFINITELY
DESTROYED THE TREE BUT IT CAN
MESS UP DIFFERENT SECTIONS OF
THE TREE THAT IT LIKES, IT
CANNOT DETECT THE SYNCHRONY OF
THE TREE AND TREE IN DIFFERENT
AREAS, SO THESE ARE A STRESSOR
THAT WE'RE LOOKING FOR AND TRY
TO IDENTIFY HOW CAN WE BRING
THAT CHRISTMAS TREE BACK TO FULL
FUNCTION.
SO I BIT OF DATA POINT.
FOR EXAMPLE, WHEN WE ELECTRIC AT
PRENATAL DISCRIMINATION EXPOSURE
AND POSTNATAL ONSET OF
DEPRESSION, ANXIETY, WE OBSERVE
THAT ONLY THE MOTHERS THAT SHOW
HIGH [INDISCERNIBLE] METHYLATION
AND TNF ALPHA METHYLATION GO ON
TO DEVELOP CLINICAL SIGNIFICANT
LEVELS OF DEPRESSION AND ANXIETY
HOWEVER, THE MOTHERS THAT HAVE
BEEN EXPOSED TO DISCRIMINATION
DOES NOT HAVE THAT METHYLATION
PROFILE.
THEY DO NOT GO ON TO DEVELOP
THAT CLINICAL OUTPUT.
SO WE HAVE THE IDEA THAT THE
METHYLATION HERE WITH THE
BIOLOGICAL IMPACT HERE IS NOT
NECESSARILY ALL NEGATIVE SO THE
BODY IS TRYING TO AX DATA
PROTECTION AND THE BIOLOGICAL
EMBEDDING COULD ACTUALLY BE
SERVING AS A PROTECTIVE
MECHANISM FOR SOME INDIVIDUALS.
THE QUESTION IS WHEN DOES IT
HAPPEN AND IN WHAT CONDITION
DOES IT HAPPEN IN AND THAT IS
WHAT WE ARE TRYING TO UNDERSTAND
AND CAN WE MANIPULATE THOSE
CONDITIONS TO ALLOW PEOPLE TO
LIVE HEALTHIER LIVES.
SO WE HAVE PUBLISHED EXTENSIVELY
IN THIS AREA OF CONCEPT AND WE
LOOKED AT TELOMERE LEPGHT AND
OTHER MECHANISMS BUT BASICALLY
THE BOTTOM LINE HERE IS THAT
TIMING MAKES A DIFFERENCE.
FOR EXAMPLE, SOME PEOPLE THIS IS
A PATH MODEL, LOOK AT CHILDHOOD
IN THE U.S., CHILDHOOD RACISM,
RACISM AND THEN SEROREACTIVE
PROTEIN WHICH IS A CHRONIC
STRESS MARKER AT 6 MONTHS
POSTPARTUM AFTER PREGNANCY AS
WELL AS BMI AND THEN WE DO THE
SECOND MODEL, WE HAD 12 MONTHS
POSTPARTUM AND THE CHILDHOOD
RACES AND 6 MONTHS POSTPARTUM WE
SEE THE ASSOCIATION OF CRP AS
WELLA AS HIGH BMI BUT WE WE LOOK
AT 12 MONTHS POSTPARTUM, THE TSP
ASSOCIATION GOES AWAY SO TIME
MIGHT MATTER.
AND WE--WE DON'T YET FULLY
UNDERSTAND WHAT ARE THE
CONDITIONS THAT MAKE THOSE
ASSOCIATIONS BECOME STRONGER OR
GO AWAY.
BUT THE BIGGEST QUESTION HERE IS
WHAT ARE WE REALLY LOOKING AT?
ALL RIGHT?
SO DISCRIMINATION IS A COMPLEX
FACTOR THAT IS INTERACTING
STRONGLY WITH THE ENVIRONMENT
AND ALSO ALL THE SOCIAL
DETERMINANTS OF HEALTH AND WE
REALLY CANNOT GET CAUSAL EFFECT
BECAUSE WE DON'T REALLY KNOW
WHEN THINGS BEGAN AND WHEN
THINGS END BECAUSE THAT IS THE
CONDITIONS THAT PEOPLE ARE IN SO
THAT IS WHY WE TRY TO FOCUS ON
EARLY LIFE TO TRY TO GET INTO
THAT, BUT REALLY THE BIG PICTURE
HERE, IS THAT WHERE WE ARE AT,
AT THE ISSUES UNDER SIGNED THE
TIP OF THE PROBLEM A WHOLE LOT
MORE THAT WE ARE TRYING TO
UNDERSTAND, SO WE CAN TAILOR OUR
INTERVENTIONS TO ERASE THE
CONSEQUENCES THAT THESE SOCIAL
INSTANCES HAVE CREATED IN OUR
BODY.
SO SOME FINAL THOUGHTS,
BIOSOCIAL PERSPECTIVE IS
INTEGRAL TO HEALTH EQUITY.
IT'S NOT ONLY FORMED BY
EXPERIENCES WORKING BY PEOPLE IN
THE CLINIC AND THE COMMUNITY BUT
ALSO INCLUDES A WHOLISTIC VIEW
OF THE BIOLOGICAL PROCESSES AND
CONDITIONS.
WE REALLY SHOULD START TO TRY TO
UNDERSTAND THE ENVIRONMENT,
SOCIAL CULTURE, GENETIC AND
GERONTOLOGYSTS GOMMIC AND OTHER
FACTORS THAT DRIVE OTHERS TO
DEVELOP PRECISION HEALTH
INTERVENTIONS THROUGHOUT SUCCESS
HEALTH EQUITY WE NEED TO GO
BEYOND THE BIOAND BEYOND THE
SOCIAL TO INTEGRATE THE
APPROACHES THAT ACCOUNT FOR THE
WHOLE PERSON AND THE CONTEXT
THEY LIVE IN.
SO REALLY BIG QUESTIONS REMAIN.
FOR EXAMPLE, IS THIS ENOUGH--IS
IT ENOUGH TO END DISCRIMINATION
IS IT ENOUGH TO PROMOTE POSITIVE
SOCIAL DETERMINANTS OF HEALTH?
I DON'T KNOW THE ANSWER.
THAT IS WHAT I THINK THE NEXT
WAVE OF STUDIES SHOULD BE
LOOKING AT.
AND TO END, I REALLY WANT TO
BRING THE ISSUE TO THE
FOREFRONT, A TOLL ON THE BODY
CAN HAVE LONG-TERM REPERCUSSIONS
OF HEALTH.
ADDRESSING DISPARITIES MUST GO
AS CAN BE AND GO ON, SO I STOP
HERE AND TAKE ANY QUESTIONS.
>>THANK YOU DR. SANTOS THAT WAS
FANTASTIC.
SO YOU ASKED 2 QUESTIONS AT THE
END.
THE 2 BIG QUESTIONS.
SO WHAT'S GOING TO BE--WHAT ARE
YOU THINKING ABOUT IN TERMS OF
YOUR TEAM AND SORT OF NEXT STUDY
SET?
BECAUSE YOU REALLY ARE TAKING
ABOUT MOVING BEYOND THE BIO AND
BEYOND THE SOCIAL.
SO WHAT DO YOU THINK ARE SORT OF
PROMISING POTENTIAL NEXT STEPS
FOR STUDIES?
>>YEAH, YOU THINK I KNOW, I
THINK THE BIGGEST NEXT STEP, OF
COURSE LIKE ENDING
DISCRIMINATION WOULD BE
FANTASTIC RIGHT?
I THINK IT WOULD BE A GREAT
THING TO DO.
HOWEVER, IT MAY TAKE DECADES.
IT MAY NEVER HAPPEN SO WHAT I
WILL DO IS JUST SIT AND WAIT,
RIGHT, SO WEARY LIE ON
POLITICIANS TO MAKE--WE RELY ON
POLARIZED CISIONS TO MAKE CHANGE
AND WE RELY ON EDUCATION OF
SOCIETY TO CHANGE THE WAY THEY
PERCEIVE AND THEY BEHAVE.
IN THE MEAN TIME I THINK WE CAN
BE BETTER AT PROVIDING THE DATA
THAT CAN SUPPORT THOSE CHANGE.
FOR EXAMPLE, IS IT REALLY ENOUGH
FOR ME TO GO TO A POLITICIAN OR
A POLICY MAKER TO SAY, YOU KNOW
THIS PERSON IS PERCEIVING THESE
AS STRESSFUL WHEN WE ACTUALLY
CAN HAVE CONCRETE EVIDENCE THAT
IS DETRIMENTAL TO HEALTH.
BUT ALSO TO THE POINT OF IS IT
REALLY JUST ENOUGH TO PROVIDE
THEM WITH A MONTHLY STIPEND SO
THEY CAN HAVE A BETTER FOOD
SOURCE?
YES, THAT IS A FANTASTIC
RESOURCE, BUT WE CANNOT ALLOW
THOSE POLICIES TO END THERE.
WE HAVE TO CREATE INTERVENTIONS
THAT REALLY BRING THE PERSON
BACK TO ITS FULL CAPACITY.
SO WE PROVIDE THE STRUCTURAL
CHANGE, THE PERSON NOW IS LEFT
TO THEIR OWN DEVICES TO TRY TO
UNDUE THE CONSEQUENCES OF LIVING
AND THE ADVERSITY IN THEIR OWN
BODY, SO THEY'RE STILL GOING TO
DIE SOONER, THEY'RE STILL GOING
TO DEVELOP EARLY CHRONIC
CONDITIONS, BECAUSE WE HAVE NOT
GONE THE NEXT STEP WHICH IS HOW
DO WE ACTUALLY ENABLE THEM, NOW
THAT WE HAVE [INDISCERNIBLE] HOW
ABOUT WE ENABLE THEM TO CHANGE
THE ALL SYSTEMS.
AND I'M REALLY NOT TAKING ABOUT
A SPECIFIC SYSTEM LIKE GENETICS
OR GENOMICS OR WHATEVER IT IS.
YOU KNOW LIKE HOW DO WE GET
THERE AND HOW CAN WE QUANTIFY
THAT IN A WAY THAT IS
INFORMATIVE FOR THE PERSON.
AND OF COURSE FOR NURSES TO BE
IN OTHER HEALTHCARE
PROFESSIONALS TO BE ABLE TO USE
THOSE DATA POINTS TO BE--TO BE
EDUCATIONAL FOR THE CLIENTELE
THAT WE TRY TO SUPPORT, AND
PROTECT THE HEALTH.
>>YEAH, NO, THAT'S REALLY,
THAT'S REALLY GREAT.
SO I HAVE A FOLLOW UP QUESTION
TO THAT, BUT I WANTED TO ASK 1
THAT CAME IN FROM THE AUDIENCE
AND THAT IS WHICH CELL TYPE WAS
TESTED FOR DNA METHYLATION FAT
IN YOUR STUDIES?
>>SO FOR THAT STUDY IN ITSELF,
IT WASN'T FOCUSED ON A SINGLE
CELL TYPE.
WE USE BLOOD OF A BIOLOGICAL
SAMPLE AND THE ASSESSMENT WE
HAVE DONE WAS A CANDIDATE GENE
APPROACH ALTHOUGH WE DO HAVE
GENOME WIDE ANALYSIS.
IN THAT CASE WHAT WE WOULD DO IS
TRY TO CONTROL FOR THE CELL
COMPOSITION BECAUSE IN THIS CASE
DNA METHYLATION IS HIGHLY
DEPENDENTOT TISSUE BECAUSE AS
YOU THINK, YOU KNOW, YOUR HAIR
AND YOUR SKIN, THEY ALL HAVE THE
SAME GENETIC MAKEUP BUT THEY
LOOK VERY DIFFERENT, RIGHT?
THAT IS DNA METHYLATION.
IT'S TURNING ALL THE GENES ON
AND OFF SO THEY HAVE DIFFERENT
FUNCTIONS, SO WE TAKE BLOOD AND
WE TAKE SKIN, WE HAVE TO CONTROL
FOR THE CELL COMPOSITION SO
WE'RE NOT LOOKING AT THINGS THAT
ARE JUST DUE TO THE FUNCTION OF
THE TISSUE.
SO WE DO THOSE ADJUSTMENTS IN
OUR MODELS.
>>THAT'S GREAT.
THANK YOU.
>>OKAY, SO ANOTHER QUESTION
CAME IN AROUND THE PICTURE THAT
YOU WERE SHOWING IN BRAZIL, SO
YOU BEGAN BY SAYING THAT THE
OBJECT WAS TO MOVE PEOPLE FROM
THE LEFT SIDE OF THE WALL TO THE
RIGHT SIDE OF THE WALL IN THAT
PICTURE AND AN AAPARTMENT HOUSE,
WOULDN'T IT BE BETTER TO REWORK
THE RULES OF THE GAME SO THAT
THE SHARP DIFFERENCE COULD BE
ARK VOIDED?
>>YES, A HUNDRED PERCENT AND
PROBABLY WASN'T THE BEST EXAMPLE
I GAVE BUT YEAH, THE IDEA WOULD
BE THAT THERE'S NO SEPARATION,
RIGHT?
THAT EVERYBODY'S EQUAL AND HAVE
SIMILAR OPPORTUNITIES BUT IT'S
REALLY, REALLY, YOU KNOW, IS
THAT REAL REALLY A REALITY?
TO BE HONEST WITH MYSELF, I
DON'T THINK IT IS AND THEN
PEOPLE LIKE FOR EXAMPLE,--THE
REASON I USE THAT EXAMPLE IS
BECAUSE I WAS GETTING PREPARED
FOR THE SOCIAL MOBILITY STUDIES
WHICH IS REALLY PEOPLE WORKING
REALLY HARD TO TRY TO MOVE AWAY
FROM THAT ENVIRONMENT, TO YOU
KNOW THE BETTER ENVIRONMENT
MEANS, WHATEVER BETTER MEANS IN
THAT SITUATION.
BUT THE PERSON IS COMPLETELY
RIGHT.
THE IDEA IS THAT THINGS SHOULD
BE EQUALIZED AND NO SUCH
DISCREPANCIES SHOULD EXIST IN
SOCIETY.
>>YEAH IN AN IDEAL SOCIETY,
THAT WOULD BE GREAT.
>>THAT WOULD BE BEAUTIFUL.
>>SO I WANT TO ASK YOU A
QUESTION ABOUT SO IF WE CAN'T
END DISCRIMINATION, WE CAN TRY
TO DO STRUCTURAL DECREASING OF
INIQUITIES AND WE CAN TRY TO
PROMOTE POSITIVE SOCIAL
DETERMINANTS OF HEALTH.
WHAT DO YOU SEE THE ROLE OF
COMMUNITIES BEING BECAUSE THAT'S
WHERE INDIVIDUALS THAT LIVE,
WORK, PLAY AND AGE, IF YOU WILL?
>>I THINK COMMUNITY HAS A BIG
ROLE, YOU KNOW FOR 1 WE CAN
TEACH WHAT WE SHOULD REALLY BE
FOCUSING ON TO DO RESEARCH, ON,
RIGHT BECAUSE OFTEN TIMES WE
HAVE THIS TOP DOWN APPROACH
WHERE WE COME UP WITH THIS
BEHAVIORIAL INTERVENTION WHERE
WE NOW GOING TO TEACH PEOPLE NOW
TO BE [INDISCERNIBLE] AND WE GO
IN AND WE TEACH THEM BUT WHEN WE
GO IN, WE OFTEN LACK THAT DEEP
KNOWLEDGE OF HOW THE COMMUNITY'S
ADAPTING TO THAT SITUATION.
SO THERE YOU ARE SYSTEMS FOR
EXAMPLE, COMMENT HEALTH WORKERS
THAT HAVE BEEN SO SUCCESSFUL,
YOU KNOW IN COUNTRIES SUCH AS
CANADA, BRAZIL BECAUSE IT
INDICATES PRESENCE OF THE
COMMUNITY NOT JUST ON THE HEALTH
SYSTEM ITSELF BUT YOU KNOW IN
THE DEVELOPMENT OF KNOWLEDGE
THROUGH SCIENCE AND I THINK, YOU
KNOW THE SOLUTION REALLY IS AT
THE HEAD OF THE COMMUNITY.
AS RESEARCHERS I REALLY
SHOULD--I THINK WE SHOULD KNOW A
PATHWAY TO GET THAT--THE DATA
AND TO TEST SOME OF THE
POTENTIAL SOLUTIONS.
BUT I REALLY TRULY BELIEVE, THAT
YOU KNOW IT'S VERY HARD FOR A
SCIENTIST IF THEY'RE NOT IN THE
COMMUNITY TO COME UP WITH
EFFECTIVE SOLUTIONS TO WIN
PROBLEMS, ESPECIALLY COMPLEX 1S
LIKE DISCRIMINATION AND POVERTY.
>>YEAH, YEAH, NO, THAT'S GREAT.
THIS IS GREAT, DISCUSSION, OKAY,
SO I HAVE 1 MORE FOR YOU,
BECAUSE WE HAVE 2 MINUTES LEFT.
SO THIS IS FROM SOMEBODY
WATCHING.
SO DO YOU THINK IT'S POSSIBLE
THAT OVEREMPHASIS ON
DISCRIMINATION STUDIES
PERPETUATE MORE
DISCRIMINATION/FEELINGS OF
VICTIMIZATION VERSUS GROWING
RESILIENCE AND POSITIVE COPING
IN MARGINALIZED GROUPS?
>>THAT IS A TOUGH 1.
YOU KNOW, LIKE, I CAN SEE BOTH
SIDES OF THE ARGUMENT OF SAYING
IF WE DON'T EMPHASIZE IT, THEN
IT'S NOT HAPPENING, BUT POSING
THE EYE TO THE PROBLEM, DOESN'T
MAKE THE PROBLEM GO AWAY.
SO AGAIN, I THINK THAT IS
BASICALLY A PRIVILEGED POSITION
FOR US TO BE ABLE TO CLOSE OUR
EYES AND HOPE THAT CLOSING OUR
EYES TO IT, WILL MINIMIZE THE
PROBLEM.
BUT FOR THE PEOPLE THAT ACTUALLY
LIVING WITH IT, ON THE
DAY-TO-DAY LIFE, I DON'T KNOW
THAT THE PROBLEM WILL GO AWAY.
MY BET IS IT WON'T.
SO JUST BECAUSE WE NAME THE
PROBLEM AND WE ARE TALKING ABOUT
THE PROBLEM, DOESN'T NECESSARILY
CREATE THE PROBLEM.
I THINK INCREASING OUR AWARENESS
THAT SOMETHING IS HAPPENING CAN
ACTUALLY BE BENEFICIAL HOWEVER
WE NEED TO BE MINDFUL HOW WE
CREATE AWARENESS SO WE DON'T
MISEDUCATE THE SOCIETY INTO
CREATING FURTHER
MISUNDERSTANDINGS AND AND
FURTHER, YOU KNOW PERCEPTIONS
THERE THAT ARE DETRIMENTAL TO
THE PEOPLE THAT ARE VULNERABLE
TO MORE SITUATIONS.
, THAT'S GREAT.
THANK YOU.
THANK YOU SO MUCH FOR COMING AND
DOING CLINICAL GRAND ROUNDS AND
CELEBRATING NATIONAL NURSES
MONTH.
ON BEHALF OF NINR AND THE
CLINICAL CENTER, I WOULD REAL
LIE LIKE TO THANK YOU FOR COMING
AGAIN AND SPENDING TIME WITH US.
>>AND GO NURSES!
YOU KNOW, YOU CAN CHANGE THE
PLANET!
>>WE DEFINITELY HOPE SO.
>>THANK YOU.