Integrating the Atlas with SDOH
An Interview with Dr. Aresha Martinez-Cardoso
The US Covid Atlas was thrilled to be joined by Dr. Aresha Martinez-Cardoso earlier this year as a new, core team member to engage more deeply on the complex topic of the Social Determinants of Health (SDoH) and its many intersections with the Pandemic, across different populations. Our team’s view of SDoH has always been multidimensional, with a regional perspective; Aresha also views SDoH as a multilevel phenomenon, but dives in deeper to explore the biosocial mechanisms for each phenomenon of interest and population(s) impacted.
She brings her invaluable experience as an SDoH scholar and social epidemiologist to lead engagement with the Community Advisory Board, advising on a forthcoming oral histories component of the Atlas, as well as inspiring, challenging, and collaborating with our coalition to think in new ways about SDoH, the Pandemic, and social, racial, & spatial inequity.
Aresha Martinez-Cardoso is an interdisciplinary public health researcher and Assistant Professor in the Department of Public Health Sciences at the University of Chicago. Her research integrates theoretical perspectives from the social sciences with epidemiological methods in public health to examine how social inequality in the US shapes population health, with a particular focus on the health of racial/ethnic groups and immigrants.
I asked Dr. Martinez-Cardoso a few questions about her work, inspirations, and future directions:
Q: How did you find your way to studying SDoH and Public Health?
A: I was raised in the Central Valley of California and I feel like I was acutely aware of the SDoH and health inequities from an early age. For those who aren’t familiar, the Central Valley is a large agricultural region which sits between Los Angeles and San Francisco and comprises small farm towns with large immigrant communities. My grandparents were farm workers from Mexico, and I was the first of my cousins and siblings to go to college. I was always interested in health but it wasn’t until my sophomore year of college that I stumbled upon a public health faculty mentor who took me under his wing and inspired me to pursue public health work. It’s a field I came to love because I could study all of the things I’m interested in like immigration policy, workplaces, racism, under the umbrella of health.
Q: You direct the Embodying Race(ism) Lab at the University of Chicago, integrating social science, epidemiology, and public health. What drives your lab, and what research projects does your group take on?
A: At UChicago, we’re encouraged to pursue big research questions, so in a sense my lab tackles the big question, “How does social inequality affect human health and how can we intervene?”. That of course would take many lifetimes to study and answer so our lab really tackles projects at the intersection of race and immigration inequalities. In our projects, I really try to think about and study new ways in which social inequalities manifest in US society, and because most health data isn’t designed to study these social phenomena I’ve had to become a Macgyver of sorts, manipulating datasets and moving across health outcomes to study these questions.
Q: In much of your work, you’ve explored how challenging experiences, like violent political rhetoric, immigration raids, or social isolation, impact the health of different immigrant populations. What are some of the bigger takeaways in this body of work, and what questions remain unanswered?
A: So when I was an undergrad I was in a lecture where the speaker was presenting data on overcrowding in LA among immigrant communities. I remember my classmates arguing that perhaps immigrants wanted to live in overcrowded apartments because of familial ties, and that 2–3 people to a room was really similar to their own circumstances living in college dorms. I was, as the kids say, shook. Unfortunately, so much of the narrative within public health and beyond misrepresents the true experiences of immigrant communities, and obscures the long history of marginalization borne by immigrants. In health research, immigrants tend to fare pretty well in terms of health, so it all seems ok at first glance. My work has tried to challenge these assumptions and misconceptions and use health as a lens with which to study the social milieu that immigrants face. I think we won’t understand the true toll that today’s anti-immigrant context will play on the socioeconomic and health profile of immigrants, and their children, for years to come. I think the pandemic, as well, has and will continue to put into stark relief just how vulnerable immigrant communities are, and how much we depend on immigrants in all facets of our lives.
Q: In one of your recent works, you wrote that “SDoH frameworks show that sociopolitical contexts and ideologies form the soil that create the policies and practices that shape health and institutionalize systems of inequality.” This was an exceptionally powerful, resonating statement — could you expand on this a bit more?
A: Camara Jones, who is a brilliant scholar and past-president of APHA, uses many allegories and metaphors in her work and this idea borrows from her work on the Gardener’s Tale. SDoH are described as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health” but missing from this definition is an explanation of why are the environments and conditions like this in the first place. Structural factors “form the soil” from which SDoH emanate and include things like our sociopolitical systems that emphasize capitalism and class inequality, as well as pervasive cultural ideologies like American exceptionalism, individualism, and racism. Understanding who we are as a nation and people is central to understanding the formation of SDoH.
Q: In early 2020, you wrote an op-ed with Robert Vargas calling for more attention to structural factors of the pandemic, and how the existing response was overlooking built-in racial inequities. How did the Covid-19 Pandemic shape your view of SDoH — or rather, how did your view of SDoH shape your understanding of the Pandemic? Did it transform your approach as a scholar and public intellectual?
A: Robert and I wrote that piece because we were so frustrated with the pandemic response; public health could have predicted who was going to fare worse in the pandemic. It was clear, though, that despite the best of intentions, the system is not designed to protect the most vulnerable even if we know the SDoHs matter. Producing health inequalities is simply how a system designed on race and class inequality will function, every time. It’s clear from the pandemic as well as our current political moment, though, that those of us who work on SDoH have to do more than just saying, “hey, your neighborhood matters, your workplace matters, your social network matters”, because so much of American individualism responds “well if you don’t like it, work harder to change your neighborhood, job, or network”. It’s much harder to explain and convince folks that the odds are truly stacked up against vulnerable and marginalized communities (even if you live, work, and suffer in those communities as we’ve seen with many poor, rural, white communities). There’s a lot of interesting work being done on framing SDoH and the narratives that need to be applied to this work. So I think the pandemic has taught me that we need to do some SDoH brand management, but I haven’t fully figured out what that looks like for my own work yet.
Q: How would you define SDoH today? Or — what should researchers be focusing on SDoH next, as the term has become more popularized with each day?
A: Back in the 90s, David Williams drew on the rich qualitative work of Philomena Essed to create the everyday and lifetime discrimination scales;it was an immense addition to the field that had understood but never really captured discrimination or racism. Fast forward to now and these scales are in many major health studies and surveys but discrimination and racism has changed, and the measures that really worked then aren’t so great now. Drawing on this lesson, I think we need to continue to think about how we measure SDoH and use the data tools at our disposal to understand the social factors that shape health. At the same time, these lived experiences are messy and aren’t well distilled into single measures, social determinants are connected and mutually reinforcing, conditions are changing all the time (e.g. 9-to-5, union work to a gig economy, for example), so I think we need to continue to do the best science we can while keeping these complexities in mind.
Q: Finally, what advice would you give to inspire new and emerging public health scholars?
A: One of the hardest questions I get asked when I teach or speak is “what do we do about all of this, how do we solve health inequities”. I would encourage students to start imagining what they would do if they were in a position of power to move the needle on health inequities, so that when it’s their turn at the table they come prepared with some answers. At the same time, so many of our policy and practice interventions have failed because we haven’t fully considered the deep-rooted, stubborn ways that social inequalities will continue to pop-up. So dream about your policy proposals, study fancy machine learning methods, take that causal inference class, but also go learn about and from different types of people and study the history of how our various social systems produced and continue to reproduce inequities. I don’t always have the answer to, “what do we do about all of this, how do we solve health inequities”, but my goal is that by training the next generation of critical scholars we can arrive at better answers together.
Explore SDoH and other community data on the US COVID Atlas at www.uscovidatlas.org/map.
