Individual, contextual and population level social determinants of health
Our
researchers have expertise in key areas in the fields of population and
public health:
• Individual- and population-level social determinants of health and health
inequalities over the life course
• Multi-level and multi-sector geographic and contextual factors influencing
health risk and disease outcomes
• Planning, implementation and evaluation of multi-level disease prevention
and health promotion interventions in disadvantaged populations
• Aboriginal health
• Early origins of adult health and disease.
The result of Professor John Lynch’s significant
work in this area, is that while social and structural arrangements in a
society are important for population health there is no “meta-theory” for
universal linkage between social determinants and population health. This
requires developing better evidence around the effectiveness of both
“upstream” and more mechanistic public health interventions and their role
in improving population health and reduce inequalities. This is because
understanding the determinants of population health depends on how social
factors are mechanistically linked to major risk factors for different
health outcomes and such linkages change over time, space and culture.
Professor John Lynch has undertaken research in this area which has involved
compiling and integrating international (e.g., WHO mortality database, World
Values Survey) and national data sources (e.g., US NCHHS Compressed
Mortality File).
In adopting a lifecourse approach to health and inequalities in health,
Professor Lynch and colleagues have undertaken research to assess the
contributions of biological, psychological, behavioural or socioeconomic
early-life exposures, trying to understand their social distribution, how
they interact and accumulate over the lifetimes of individuals and across
generations to affect health in populations. This approach explicitly
recognizes that influences on health across the life cycle are strongly
shaped by birth cohort, and time-varying social and economic circumstances
that may differ geographically.
This means historically contextualizing the experiences and exposures of
particular cohorts in time and place, and linking individual with
population-level processes. Professor Lynch’s work has made important
substantive and methodological contributions in this area. His work has
involved research using various datasets including the Kuopio Ischemic Heart
Disease Risk Factor Study (Finland), Alameda County Study and Framingham
Offspring Study (USA), Marginalization and Health (Denmark), Malmo
Ultrasound Follow-up Study (Sweden), Rapid Industrialization and Coronary
Heart Disease (CHD) Risk Factors (Korea), and ALSPAC (UK).
Dr Katina D’Onise’s NHMRC and National Heart Foundation funded PhD research will examine the association between education and health from a lifecourse perspective. It will involve an exploration of the impact of early childhood education on adult metabolic syndrome and its associated diseases. This work aims to untangle aspects of the association between education and health, in particular for disadvantaged populations. The research has the potential to lead to defined policy options to improve social determinants and health across the population.
Professor Mark Daniel has expertise in the areas of
- chronic disease epidemiology,
- disease prevention and intervention evaluation, and
- sociospatial epidemiology.
His research targets an understanding of the biological pathways between social and physical environments and health, focusing on population resources and opportunities, social standing, contextual stressors, allostatic load, and psychosocial and behavioural mediators of the relationships between geographic/contextual factors and outcomes including metabolic syndrome, obesity, cardiometabolic diseases, HIV/AIDS and adverse births. He has experience with population data and evaluating community interventions with at-risk populations in Canada, the USA, and Australia. Currently he is spearheading an international collaboration of researchers using geographic information systems to study person-place interactions in Canada, the USA, the UK, Australia and France.
Professor Daniel has supervised 11 PhD students, 12 MSc students, and six postdoctoral fellows. He has local and international research opportunities for interested postgraduate students in the areas of health and place (i.e., ‘neighbourhood’) research, particularly: the development and use of environmental measures for assessment of area-level resources, opportunities and conditions of living; use of geographic information systems and geospatial methods in multi-level health surveys; urban area effects on cardiometabolic diseases, obesity and behaviours including dietary fat consumption, physical activity and smoking; and use of biomarkers for estimating the impact of environmental stressors. Other opportunities exist for students interested in the epidemiologic analysis of Aboriginal health outcomes, and the development, implementation and evaluation of disease prevention intervention projects with Aboriginal as well as mainstream populations.
Dr Margaret Cargo is Senior Lecturer in Health Promotion, School of Health Sciences. She has expertise in the evaluation of clinical, school, and community-based interventions in Aboriginal and non-Aboriginal children and youth, using qualitative and quantitative methods. Her research investigates the broader social context within which theory-driven programs are governed and implemented to promote positive youth development and to prevent obesity and suicide.
She has received research grants as Chief Investigator from the Canadian
Institutes of Health Research, Social Sciences and Humanities Research
Council of Canada, Canadian Diabetes Association, and South Australia
Department of Health Strategic Health Research Program. Her research is
built on respectful partnerships with Aboriginal communities, and commitment
to developing research capacity of Aboriginal community researchers/
students, and integrating Indigenous knowledge systems. She has guided
qualitative data analyses for several PhD and MSc theses, including
Indigenous students.
Dr Cargo’s research challenges the democratic ideal of participatory
research in Aboriginal community-university partnerships and suggests these
partnerships are community-directed or controlled. She has a broad
understanding of the historical and multi-level contextual factors affecting
the implementation of health promotion, mental health and disease prevention
interventions in Aboriginal communities.
Her international networks includes key researchers working on Aboriginal mental health and well-being interventions in Canada, the U.S. and New Zealand. Her current work focuses on context and implementation in research syntheses of evidence from disease prevention and health promotion interventions.
Dr Catherine Paquet is currently involved in a number of projects examining social determinants of health including:
- The validation and reliability assessments of measurements of residential neighbourhood characteristics, such as measures of availability of food and physical activity (obtained from secondary data sources) and objective ratings of positive and negative neighbourhood attributes (through direct observations).
- Investigation of the relationship between a number of residential area measures (e.g. park characteristics) obtained through the MEGAPHONE GIS and all-cause and cardiovascular mortality.
- Participation in an international collaboration effort to investigate social and physical environmental factors relating to lifestyle and body weight.
- Research into the mechanisms through which residential area characteristics and individual psychological factors combine to influence health behaviours and cardiovascular health outcomes as measured through biological markers.
Dr Beverly Muhlhausler, an NHMRC Peter Doherty Research Fellow is currently involved in a collaborative research project entitled the WISH study. The study adopts a unique approach to defining risk factors for childhood obesity through the parallel study of parents and children within household. The research examines household structure, socioeconomic status and health through use of a questionnaire. clinical testing will be used to determine of body composition, metabolic status, blood pressure and fitness.
Physical activity will be assessed using the MARCA system (in collaboration with Professor Timothy Olds) and dietary patterns will be assessed by 24 hour recall over a period of 3 days. This will be the first study to undertake a detailed parallel study of parents and children from within the same household, and will therefore provide valuable insights into the critical risk factors for the early onset of obesity in childhood.
Dr Muhlhausler is also currently undertaking collaborative research to evaluate the hypothesis that maternal n-3 LCPUFA supplementation during pregnancy can reduce the proportion of fat mass in early childhood and improve insulin sensitivity. The ‘CHOIR (Childhood Obesity and Insulin Resistance) prevention study’ involves a follow-up study of an existing multi-centre randomized controlled trial (the DOMInO trial), investigating the impact of high dose n-3 LCPUFA (chiefly as docosahexaenoic acid, DHA) in the last half of pregnancy. Recruitment for the DOMInO trial is now complete (n=2399 nationally with 1630 in Adelaide), and the oldest child will turn 3 years of age in March 2009.
By conducting a follow-up study of the DOMInO children at age 3 and 5 there is a unique opportunity to determine the impact of maternal DHA supplementation on the percentage of body fat and insulin sensitivity in early childhood. This study has the potential to identify an effective and feasible intervention during pregnancy which can reduce fat mass and hence improve health outcomes in children at a population level.
Professor Adrian Esterman has been involved in
research aimed at understanding how menopausal women make choices about
hormone therapy (HT) and a randomized control trial of an intervention to
assist their knowledge of the menopause and decision making skills.