Creative Minds: Considering the Social Determinants of Health

Posted on May 12, 2016 by Dr. Francis Collins

Sanjay Basu

When Sanjay Basu was growing up in Arizona in the 1980s, his mother contracted a devastating lung infection known as valley fever. Caused by a fungus (called Coccidioides) common in the southwest United States, the condition often affects construction or agricultural workers who inhale the fungal spores while working the soil. Basu’s mother didn’t work in agriculture or construction, but the family did happen to live near a construction site. She spent about nine years in and out of intensive care units battling her illness. She survived, but still has difficulty breathing.

This wrenching experience gave Basu a first-hand appreciation for the social determinants of health—the conditions in which people live and the myriad internal and external forces that dynamically shape them. Now an assistant professor at Stanford University, Palo Alto, CA, Basu has dedicated his career to studying the social determinants of health disparities, health differences that adversely affect disadvantaged populations. He recently received an NIH Director’s New Innovator Award to examine U.S. social assistance programs and their effects on a range of health outcomes over the last 40-plus years. He’ll consider eight federal and state programs—including income, housing, and food assistance programs—that reach more than 1 in 3 Americans.

Basu’s two-fold goal is to discover whether these programs have reduced health disparities and where they can be tweaked to work more effectively. He will address a host of issues, ranging from whether affordable housing programs can help lower-income people with asthma better control the condition to whether welfare programs have an influence on the health of single mothers.

A major theme of Basu’s work is that small differences in assistance programs can have surprisingly large social effects. For example, when people are provided funds for food once a week, instead of monthly, they are more likely to buy fresh fruits and vegetables in place of pre-packaged and often less-nutritious goods. In other instances, he’s found that affordable housing programs lead to better nutrition, because people no longer must compromise on food in order to pay the rent.

One of Basu’s major research interests is nutrition. By exploring how states implement nutrition programs—such as the federal Supplemental Nutrition Assistance Program (SNAP)—he hopes to discover the subtle differences that can influence a person’s sense of well-being. He also wants to examine how slight changes in the eligibility criteria for nutrition programs might influence the risk for obesity, type 2 diabetes, and heart disease.

Basu plans to develop novel methods to study social determinants of health disparities. These methods will control for factors that can confound rigorous, unbiased analysis. His overall approach, called “cohort filtering,” factors in the small but meaningful differences in assistance programs, allowing him to match people and their social determinants better across states and draw sound comparisons.

Basu’s work serves up a healthy reminder that successfully improving public health and reducing health disparities depends on a wide range of complicated and often subtle factors. Putting them in perspective, and implementing carefully designed research that will provide rigorous evidence about causes and possible interventions, will require many creative minds, including those who focus their attention well beyond what happens in the medical exam room.

Links:

Social Determinants of Health (World Health Organization)

Basu Lab (Stanford University, Palo Alto, CA)

Basu NIH Project Information (NIH RePORTER)

NIH Director’s New Innovator Program (Common Fund)

NIH Support: Common Fund; National Institute on Minority Health and Health Disparities