> thus, the argument may go, we don’t need to worry about health
inequities, 
> substandard housing, and violence in communities, because we can
develop 
> biomedical techniques to “correct” for the neural pathways that
produce 
> later-life problems. 

That is scary!  And in a weird way, it reminded me of the absurdity of a
good Monty Python sketch, like the one about the bankers having a
hostile takeover, pirate-style.

> To the extent, however, that these kinds of studies simply reinforce
deeply-
> rooted tendencies in Western culture (and American culture in
particular) to
> reduce complex social problems to molecular exchanges, they have a
very great 
> potential to do more harm than good.

Important point taken.


>>> "Goldberg, Daniel" <[log in to unmask]> 04/17/09 1:57 PM >>>
Particularly since some of my work relates to neuroethics (the ethical
implications of neuroscience and neuroimaging techniques), I share both
Ketan's enthusiasm and Dennis's concern.  One the on hand, some of these
findings provide a compelling explanatory mechanism for causation that
coincide
nicely with much of the seminal work in the SDOH literature related to
the pathways in which socioeconomic conditions affect the neuroendocrine
system, which in turn produces cascades that implicate all manner of
chronic illness.  Moreover, these pathways operate on the molecular
level, which
provides a rhetoric that may be convincing to those otherwise
disinclined to think broadly about the effects of social and economic
conditions on health.  I have personally found that some of these
theories are practically important in explaining to stakeholders the
profound differences between
health and health care, and the importance of primordial prevention, as
compared to preventive medicine.

 

On the other hand, there is an enormous tendency within contemporary
neuroscience to engage in biological and scientific reductionism.  It is
difficult to relate just how strenuously I object to the efforts to
reduce complex and nonlinear social phenomena to brain states.  The
reductionist impulse
within Western biomedicine and science seeks always to find technical
resolutions to all problems; thus, the argument may go, we don't need to
worry about health inequities, substandard housing, and violence in
communities, because we can develop biomedical techniques to "correct"
for the neural
pathways that produce later-life problems.  (Of course, this latter is
currently science fiction, but I am criticizing the tendency and the $$
that will surely be allocated to the effort).  Insofar as these kinds of
studies provide one possible causal mechanism for the ways in which
social
determinants produce or impede population health, that is all to the
good, especially if these matters help convince stakeholders of the need
to attend to social policy as a means of improving health.  To the
extent, however, that these kinds of studies simply reinforce
deeply-rooted tendencies in
Western culture (and American culture in particular) to reduce complex
social problems to molecular exchanges, they have a very great potential
to do more harm than good.

 

Daniel S. Goldberg, J.D., Ph.D(c)

Health Policy & Ethics Fellow 

Chronic Disease Prevention & Control Research Center

Department of Medicine

Baylor College of Medicine

1709 Dryden, Suite 1025

Houston, TX 77030

713.798.5482 (Tel.)

713.798.3990 (Fax)

[log in to unmask]

____________________

Research Faculty

Initiative on Neuroscience & Law

Department of Neuroscience

Baylor College of Medicine

________________________

Lecturer

Rice University

 

 

 

 

 

From: Social Determinants of Health [mailto:[log in to unmask]] On Behalf Of
Dennis Raphael
Sent: Friday, April 17, 2009 11:33 AM
To: [log in to unmask]
Subject: Re: [SDOH] Poverty on the brain

 

On the one hand it good to provide the strong evidence of how poverty
wrecks brains...

On the other hand, among those who have no interest in doingIt is a difficult issue.  I have recently written...

 

Latency Effects

            Biological embeddedness describes how specific exposures and
experiences come to have long-lasting effects upon health and
developmental outcomes.(17)  Much of the evidence that cognitive,
affective, and social processes are set at early ages come from animal
studies and there is debate
as to the permanence of these effects. What appear to be latency effects
may actually be contemporaneous effects associated with the tendency of
children to maintain their general life circumstances over time. The
lack of longitudinal data that can isolate these effects makes
interpretation
difficult. 

            However on the health side, there is clear evidence - based
on human longitudinal studies -- that early childhood and even pre-birth
experiences predispose children to either good or poor health regardless
of later life circumstances.(12) As one example, low birth weight babies
are
generally more susceptible to a variety of child health problems during
childhood.  Indeed, low birth weight babies, and this is especially the
case for those living under conditions of disadvantage, are more likely
to experience cardiovascular disease and type II diabetes as adults.(18)
 But all is
not determined by early childhood experiences. Among advantaged
populations -- which first of all are less likely to be of lower birth
weight - low birth weight children are much less likely to show these
health problems.(19)  

            These latency effects result from biological processes
during pregnancy associated with poor maternal diet, risk behaviours, or
experience of stress.(20, 21)  Early childhood experiences such as the
experience of numerous infections or exposures to adverse housing
conditions also appear
to have later health effects regardless of later life circumstances.
Psychological health-related effects may also result from early
experience.  A general non-adaptive reaction to stress may be
established during early childhood as well as a general sense of
hopefulness and control, both of which
are important determinants of health.(22)  


Dennis Raphael, PhD
Professor of Health Policy and Management
York University
4700 Keele Street
Room 418, HNES Building
Toronto, Ontario M3J 1P3
416-736-2100, ext. 22134
email: [log in to unmask]
http://www.atkinson.yorku.ca/draphael

Of interest:

*NEW*  Social Determinants of Health: Canadian Perspectives, 2nd
edition, edited by Dennis Raphael
Forewords by Carolyn Bennett and Roy Romanow
http://tinyurl.com/5l6yh9

Poverty and Policy in Canada: Implications for Health and Quality of
Life by Dennis Raphael
Foreword by Jack Layton
http://tinyurl.com/2hg2df

Staying Alive: Critical Perspectives on Health, Illness, and Health
Care, edited by Dennis Raphael, Toba Bryant, and Marcia Rioux
Foreword by Gary Teeple
http://tinyurl.com/2zqrox

See a lecture!  The Politics of Population Health
http://msl.stream.yorku.ca/mediasite/viewer/?peid=ac604170-9ccc-4268-a1af-9a9e04b28e1d

Also, presentation on Politics and Health at the Centre for Health
Disparities in Cleveland Ohio
http://video.google.com/videoplay?docid=-4129139685624192201&hl=en

To leave, manage or join list:
https://listserv.yorku.ca/cgi-bin/wa?SUBED1=sdoh&A=1 


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