Social Determinants Of Health Research Research Articles

Social Determinants of Health Research at NIMHD: An Analysis of Studies Funded During 2019–2023

IntroductionSocial determinants of health (SDOH) contribute to differences in health outcomes and exacerbate health disparities. This study characterizes the National Institute on Minority Health and Health Disparities’ (NIMHD) portfolio of funded grants in SDOH research, identifies gaps, and provides suggestions for future research. MethodsUsing the National Institutes of Health's SDOH Research, Condition, and Disease Categorization, research projects funded from 2019 to 2023 were identified and linked with NIMHD's internal coding system to extract in-depth study characteristics, including sociodemographics of study participants, disease and condition focus, and alignment with strategic priorities. Natural Language Processing methods were used to categorize projects into five Healthy People 2030 SDOH domains. ResultsThe resulting sample included 675 unique research projects. Most projects included racial and ethnic minority groups (89%), followed by people with lower socioeconomic status (33%), underserved rural communities (16%), and sexual and gender minority groups (13%). Most projects focused on the Etiology of health disparities (61%), followed by Interventions (54%), and Methods and Measurement (39%). Of the Healthy People 2030 domains, Social and Community Context had the greatest representation (61%) whereas Education Access and Quality had the least (6%). Variation in research project characteristics across SDOH domains is also presented. ConclusionsThis study documents characteristics of SDOH research funded by NIMHD and explores how they differ across Healthy People 2030 SDOH domains. Findings highlight how study characteristics and foci align with strategic priorities and suggest opportunities for future research.

The health implications of neighborhood networks based on daily mobility in US cities

A large body of research has been dedicated to understanding the neighborhood conditions that impact health, which outcomes are affected, and how these associations vary by demographic and socioeconomic neighborhood and individual characteristics. This literature has focused mostly on the neighborhoods in which individuals reside, thus failing to recognize that residents across race/ethnicity and class spend a non-trivial amount of their time in neighborhoods far from their residential settings. To address this gap, we use mobile phone data from the company SafeGraph to compare racial inequality in neighborhood socioeconomic advantage exposure across three scales: the neighborhoods that residents live in, their adjacent neighborhoods, and the neighborhoods that they regularly visit. We found that the socioeconomic advantage levels in neighborhood networks differ from the levels at the residential and adjacent scales across all ethnoracial neighborhoods. Furthermore, socioeconomic advantage at the network level is associated with diabetes and hypertension prevalence above and beyond its impact at the residential and adjacent levels. We also find ethnoracial differences in these associations, with greater beneficial consequences of network socioeconomic advantage exposure on hypertension and diabetes for white neighborhoods. Future social determinants of health research needs to reconceptualize exposure to include the larger neighborhood network that a community is embedded in based on where their residents travel to and from.

Invited commentary: is the polysocial score approach valuable for advancing social determinants of health research?

Social determinants of health encompass the social environmental factors and lived experiences that collectively shape an individual's health. Recently, the polysocial score approach has been introduced as an innovative method for capturing the cumulative impact of a broad spectrum of social factors. This approach offers a promising opportunity to complement and enhance conventional methodologies in the advancement of research on social determinants of health. In this issue of the Journal, Jawadekar etal (Am J Epidemiol. 2024;193(9):1296‑1300) evaluate the value of the polysocial score for predicting cognitive performance and mortality among middle-aged and older adults. Models built on a smaller set of social determinants, including race/ethnicity, sex, and education, performed comparably to the polysocial score models in which a more complex set of social factors was included. In this invited commentary, I evaluate the predictive ability of the polysocial score and discuss its merits and limitations. I also summarize the practical utility of the polysocial score in predicting health outcomes and its mechanistic significance in unveiling the relationship between genetics, social environment, and lifestyles in shaping an individual's health and elucidate health disparities. Lastly, I propose several avenues for future research.

The PhenX Toolkit: Recommended Measurement Protocols for Social Determinants of Health Research.

Health disparities are driven by unequal conditions in the environments in which people are born, live, learn, work, play, worship, and age, commonly termed the Social Determinants of Health (SDoH). The availability of recommended measurement protocols for SDoH will enable investigators to consistently collect data for SDoH constructs. The PhenX (consensus measures for Phenotypes and eXposures) Toolkit is a web-based catalog of recommended measurement protocols for use in research studies with human participants. Using standard protocols from the PhenX Toolkit makes it easier to compare and combine studies, potentially increasing the impact of individual studies, and aids in comparability across literature. In 2018, the National Institute on Minority Health and Health Disparities provided support for an initial expert Working Group to identify and recommend established SDoH protocols for inclusion in the PhenX Toolkit. In 2022, a second expert Working Group was convened to build on the work of the first SDoH Working Group and address gaps in the SDoH Toolkit Collections. The SDoH Collections consist of a Core Collection and Individual and Structural Specialty Collections. This article describes a Basic Protocol for using the PhenX Toolkit to select and implement SDoH measurement protocols for use in research studies. © 2024 The Authors. Current Protocols published by Wiley Periodicals LLC. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA. Basic Protocol: Using the PhenX Toolkit to select and implement SDoH protocols.

Methodology for Analyzing Qualitative Data in Multiple Languages.

Translation strategies are commonly used for qualitative interview data to bridge language barriers. Inconsistent translation of interviews can lead to conceptual inequivalence, where meanings of participants' experiences are distorted, threatening scientific rigor. Our objective is to describe a systematic method developed to analyze multilingual, qualitative interview data while maintaining the original language of the transcripts. A literature review of translation strategies, cross-language, and multilingual qualitative research was conducted. Combined with criteria for qualitative content analysis and trustworthiness, the methodology was developed and used for a qualitative descriptive study. The study had interview data in both English and Spanish. The research team consisted of both native Spanish and English speakers, who were grouped based on language. Verbatim transcription of data occurred in the original languages. All codes were kept in English, allowing the research team to view the data set as a whole. Two researchers within each group coded each transcript independently before reaching a consensus. The entire research team discussed all transcripts, and finally, major themes were determined. Participants' quotes remained in the original language for publication, with an English translation included when needed. Analyzing transcripts in the original language brought forth cultural themes that otherwise may have been overlooked. This methodology promotes conceptual equivalence and trustworthiness that is paramount in cultural, linguistic, and social determinants of health research to advance health equity.

173 The State of Neurosurgical Disparities Research: Past, Present, and Future

INTRODUCTION: Social determinants of health (SDH), which influence health care access, patient outcomes, and population-level burden of disease, contribute to health disparities experienced by marginalized patient populations. METHODS: Embase, Ovid-MEDLINE, Scopus, Web of Science, Cochrane Library, and ProQuest Dissertations databases were queried for original research on health disparities regarding access to, outcomes of, or postoperative-management following neurosurgical procedures in the U.S. with at least one neurosurgical-affiliated author. RESULTS: Of 642 studies screened, 109 were included. Eighty-eight articles met all inclusion criteria other than having a neurosurgical-affiliated author and were excluded. Six studies were published prior to 2010 and 56 in the past 5 years with 62% utilizing national databases, 28% institutional databases, and 11% employing local/state/regional databases. Disparities analyzed were racial/ethnic (79%), economic/socioeconomic (59%), gender (19%), and disabled populations (0.9%) with 43% analyzing multiple/intersecting disparities. Common outcome measures were postoperative outcomes (59%), access to neurosurgical procedures (48%), and post-operative management (9%). Neuro-oncology was the most prevalent subspecialty evaluated (28%) followed by spine (26%), then pediatrics (14%), functional (11%), vascular (12%), general (7%), and trauma (3%). Senior authors with neurosurgical affiliations accounted for 87% of papers, 99% of whom were academically affiliated, and were most located in the South (29%), followed by the Northeast (28%), West (27%), and Midwest (15%). CONCLUSIONS: The majority of studies used national databases, assessed racial/ethnic disparities, and focused on postoperative outcomes. Many articles did not have a neurosurgery-affiliated author and the subspecialties of pediatrics, functional, vascular, and trauma were relatively underrepresented. Future research regarding SDH for neurosurgical patients will be crucial to increase healthcare access, improve outcomes, and achieve equity for marginalized patient populations. Moreover, it will be crucial for neurosurgery-affiliated researchers to engage in SDH research to increase visibility and impact of this area in neurosurgery.

How Can We Address What We Do Not Measure? A Systematic Scoping Review of the Measurement and Operationalization of Social Determinants of Health Research on Long-Acting Reversible Contraceptive among Adolescents in the US.

Teen pregnancy is often considered an adverse health outcome that accentuates gender inequities, diminishes opportunities, and jeopardizes the safety of adolescent and young adult birthing people. Long-Acting Reversible Contraceptives (LARC) have been hailed as a panacea for teen pregnancy. However, adolescents and emerging adults intersect with multiple assaults on their health and well-being due to gender inequity and racism. To establish equitable care, it is imperative to discern all barriers that influence their reproductive autonomy. This study evaluates the measurement, operationalization, and quality of research conducted on adolescents and emerging adults that analyzed the use of LARC within the social determinant of health framework (SDOH) in the US. SDOH were assessed using the Dahlgren and Whitehead model, and reports were analyzed using a modified version of the Joanna Briggs Institute (JBI) Critical Appraisal tools. Nineteen articles were included in this study. Researchers found the insufficient measurement of race, ethnicity, sexuality, and gender among studies on LARC and SDOH in adolescents and emerging adults. Future studies must measure a full range of identities in data collection to generate knowledge on the impact of SDOH and LARC use among diverse populations.

Knowledge mapping and research trends of the social determinants of health (SDoH): a scientometric analysis.

Social determinants of health (SDoH) play an essential role in the risk of developing diseases or medical disorders. Conducting a comprehensive retrospective analysis is necessary to better understand the development status, research hotspots, and development trends of SDoH research. The bibliometric analysis method is applied based on CiteSpace and VOS viewer to quantitatively analyze and visually review the articles published in the field of SDoH from Web of Science core databases from 2000 to 2021. We quantitatively analyzed the author, institution, and other basic information to probe the development of SDoH and then visually investigated the high-frequency keywords, burst keywords, and keyword clusters to understand better the evolution of hotspots and development directions of SDoH during the study period. Health inequality is the main keyword of the SDoH field, and disease burden is expected to maintain a hotspot in recent years. Further, research methodologies could be improved to explain how upstream SDoH influences human lived experience. Additionally, the SDoH field needs to utilize the horizons of the multidisciplinary approach to consider and discuss sustainable development issues to offer implications for health improvement policy and interventions.

Transforming Atrial Fibrillation Research to Integrate Social Determinants of Health

Only modest attention has been paid to the contributions of social determinants of health to atrial fibrillation (AF) risk factors, diagnosis, symptoms, management, and outcomes. The diagnosis of AF provides unique challenges exacerbated by the arrhythmia's often paroxysmal nature and individuals' disparate access to health care and technologies that facilitate detection. Social determinants of health affect access to care and management decisions for AF, increasing the likelihood of adverse outcomes among individuals who experience systemic disadvantages. Developing effective approaches to address modifiable social determinants of health requires research to eliminate the substantive inequities in health care delivery and outcomes in AF. The National Heart, Lung, and Blood Institute convened an expert panel to identify major knowledge gaps and research opportunities in the field of social determinants of AF. The workshop addressed the following social determinants: (1) socioeconomic status and access to care; (2) health literacy; (3) race, ethnicity, and racism; (4) sex and gender; (5) shared decision-making in systemically disadvantaged populations; and (6) place, including rurality, neighborhood, and community. Many individuals with AF have multiple adverse social determinants, which may cluster in the individual and in systemically disadvantaged places (eg, rural locations, urban neighborhoods). Cumulative disadvantages may accumulate over the life course and contribute to inequities in the diagnosis, management, and outcomes in AF. Workshop participants identified multiple critical research questions and approaches to catalyze social determinants of health research that address the distinctive aspects of AF. The long-term aspiration of this work is to eradicate the substantive inequities in AF diagnosis, management, and outcomes across populations.

Post-9/11 veterans perceptions of the pandemic: Areas of greatest impact on health and well-being.

Assess potential impacts of the COVID-19 pandemic on a subset of Post-9/11 U.S. Veterans included in a study of post-traumatic epilepsy (PTE). Two measures were added to a structured health interview for Veterans during temporary pandemic research shutdown: a validated health questionnaire [1] previously completed by survey, and a semi-structured instrument developed to assess whether pandemic conditions affected responses to the health questionnaire and identify unique impacts. Interviews were conducted between August 2020 - February 2021. Scaled items were calculated and t-tests used to compare results. Open-ended items were coded using thematic analyses. Veterans identified eight major areas of impact with negative and positive impacts: mental health, family, social, work/employment, access to resources, physical health, finances, and education. The temporary shut-down of a large health study for Post-9/11 Veterans provided an opportunity to devise an instrument to assess COVID-19's impact on health and well-being. The instrument was accepted as of the first Veteran instrument in a pandemic SDOH research repository [2], and is being used in other studies. This study highlights the need to assess and understand interrelated relationships of factors impacting health and well-being, especially as COVID-19 moves from pandemic to endemic with reverberating effects across multiple social determinants of health (SDOH).

Legal Determinants of Health.

Social determinants of health are the social and economic conditions that have a determining impact on health at an individual and population level. Working within this framework, in 2019 the O’Neill Institute for National and Global Health Law at Georgetown University and The Lancet published The legal determinants of health: Harnessing the power of law for global health and sustainable development. This report identifies and promotes four legal determinants: provision of universal health coverage under the Sustainable Development Goals; governance of national and global health institutions; implementation of evidence-based health interventions; and building legal capacity. These determinants are dominated by the role of law in founding and governing health institutions and regulating their interventions. Such work is essential. However, the relationship between law, health improvement, and health equity articulated through these four determinants risks marginalising questions of disadvantage and inequality that social determinants of health research—and the report itself—mandate we attend to. Addressing the UK experience of COVID-19, and how social inequalities profoundly impacted experiences and outcomes in the first year of the pandemic, this article builds on the Lancet-O’Neill Commission’s important work to argue that any articulation of legal determinants of health must foreground law’s role in improving fairness in social arrangements and the distribution of resources.

Engaging Public Health Critical Race Praxis in Local Social Determinants of Health Research: The Youth Health Equity and Action Research Training Program in Portland, OR-yHEARTPDX.

The social determinants of health (SDH) have long been considered a core mechanism through which racial health inequities are (re)produced and incubated in the U.S. Moreover, scholars have expressly—and appropriately—named structural racism as a precursor to inequities associated with SDH. However, while research on racial health inequities—SDH-related or otherwise—continues to grow, communities of color remain grossly underrepresented as public health researchers and practitioners. Additionally, although SDH are experienced in a very local sense, much research and practice fails to more deeply and thoroughly engage and center local community knowledges. Thus, much work around SDH and racial health inequities presents, ironically, as structurally racist itself—being done/led mostly by White scholars and in ways that do not “center the margins”. Moreover, in the context of public health practice, youth perspective is seldom centered within local health department (LHD) community SDH assessment efforts. With these challenges in mind, this paper introduces and discusses the development of the youth health equity and action research training (yHEART) program as a model for public health researchers/practitioners to engage public health critical race praxis (PHCRP) to better understand and respond to local SDH in communities of color. Specifically, we highlight the significance of PHCRP principles of “voice” and “social construction of knowledge” in advancing antiracism in research and LHD practice related to local SDH. First, we articulate core conceptual and theoretical groundings that informed the yHEART program’s development and animate its ongoing training and research activities. Second, we outline the program’s core training components and overall process, and provide some brief illustrative examples of work completed during the program’s first iteration—yHEART PDX, Vol.I: Youth Participatory Research on Local Social Determinants of Health. We then close with a discussion that reflects on program strengths, challenges, and implications for SDH and racial health equity research/practice in light of growing calls for an antiracist public health.

National Heart, Lung, and Blood Institute: Social Determinants of Health Research, Fiscal Year 2008–2020

Social determinants of health influence the prevention, treatment, and progression of chronic diseases, including heart, lung, blood, and sleep diseases and conditions. Healthy People 2020 classifies Social Determinants of Health into 5 subcategories: (1) Neighborhood and Built Environment, (2) Education, (3) Economic Stability, (4) Social and Community Context, and (5) Health and Health Care. This study's goal is to characterize the National Heart, Lung, and Blood Institute's Fiscal Year 2008-2020 funding in overall Social Determinants of Health research and in the Healthy People 2020 subcategories. The Social Determinants of Health Research, Condition, and Disease Categorization code was used to identify funded grants in this area. Natural language processing methods further categorized grants into the 5 Healthy People 2020 Social Determinants of Health subcategories. There were 915 (∼4.3%) social determinants of health‒funded grants from 2008 to 2020 representing $1,034 billion in direct costs. Most grants were relevant to cardiovascular diseases (n=653), with a smaller number relevant to lung diseases (n=186), blood diseases (n=47), and translational and implementation science (n=29). Grants fit multiple Social Determinants of Health subcategories with the majority identified as Health and Health Care (62%) and Economic Stability (61%). The number of National Heart, Lung, and Blood Institute social determinants of health grants awarded increased by 127% from Fiscal Year 2008 to Fiscal Year 2020. This study identifies Social Determinants of Health grants funded by the National Heart, Lung, and Blood Institute during 2008‒2020. Enhancing the understanding of these determinants and developing effective interventions will ultimately help to advance the mission of the National Heart, Lung, and Blood Institute.

Social Determinants of Cardiovascular Disease.

Social determinants of health (SDoH), which encompass the economic, social, environmental, and psychosocial factors that influence health, play a significant role in the development of cardiovascular disease (CVD) risk factors as well as CVD morbidity and mortality. The COVID-19 pandemic and the current social justice movement sparked by the death of George Floyd have laid bare long-existing health inequities in our society driven by SDoH. Despite a recent focus on these structural drivers of health disparities, the impact of SDoH on cardiovascular health and CVD outcomes remains understudied and incompletely understood. To further investigate the mechanisms connecting SDoH and CVD, and ultimately design targeted and effective interventions, it is important to foster interdisciplinary efforts that incorporate translational, epidemiological, and clinical research in examining SDoH-CVD relationships. This review aims to facilitate research coordination and intervention development by providing an evidence-based framework for SDoH rooted in the lived experiences of marginalized populations. Our framework highlights critical structural/socioeconomic, environmental, and psychosocial factors most strongly associated with CVD and explores several of the underlying biologic mechanisms connecting SDoH to CVD pathogenesis, including excess stress hormones, inflammation, immune cell function, and cellular aging. We present landmark studies and recent findings about SDoH in our framework, with careful consideration of the constructs and measures utilized. Finally, we provide a roadmap for future SDoH research focused on individual, clinical, and policy approaches directed towards developing multilevel community-engaged interventions to promote cardiovascular health.

Integrating DNA Methylation Measures of Biological Aging into Social Determinants of Health Research.

Acceleration of biological processes of aging is hypothesized to drive excess morbidity and mortality in socially disadvantaged populations. DNA methylation measures of biological aging provide tools for testing this hypothesis. Next-generation DNA methylation measures of biological aging developed to predict mortality risk and physiological decline are more predictive of morbidity and mortality than the original epigenetic clocks developed to predict chronological age. These new measures show consistent evidence of more advanced and faster biological aging in people exposed to socioeconomic disadvantage and may be able to record the emergence of socially determined health inequalities as early as childhood. Next-generation DNA methylation measures of biological aging also indicate race/ethnic disparities in biological aging. More research is needed on these measures in samples of non-Western and non-White populations. New DNA methylation measures of biological aging open opportunities for refining inference about the causes of social disparities in health and devising policies to eliminate them. Further refining measures of biological aging by including more diversity in samples used for measurement development is a critical priority for the field.

Land and nature as sources of health and resilience among Indigenous youth in an urban Canadian context: a photovoice exploration

BackgroundPopulation and environmental health research illustrate a positive relationship between access to greenspace or natural environments and peoples’ perceived health, mental health, resilience, and overall well-being. This relationship is also particularly strong among Canadian Indigenous populations and social determinants of health research where notions of land, health, and nature can involve broader spiritual and cultural meanings. Among Indigenous youth health and resilience scholarship, however, research tends to conceptualize land and nature as rural phenomena without any serious consideration on their impacts within urban cityscapes. This study contributes to current literature by exploring Indigenous youths’ meaning-making processes and engagements with land and nature in an urban Canadian context.MethodsThrough photovoice and modified Grounded Theory methodology, this study explored urban Indigenous youth perspectives about health and resilience within an inner-city Canadian context. Over the course of one year, thirty-eight in-depth interviews were conducted with Indigenous (Plains Cree First Nations and Métis) youth along with photovoice arts-based and talking circle methodologies that occurred once per season. The research approach was also informed by Etuaptmumk or a “two-eyed seeing” framework where Indigenous and Western “ways of knowing” (worldviews) can work alongside one another.ResultsOur strength-based analyses illustrated that engagement with and a connection to nature, either by way of being present in nature and viewing nature in their local urban context, was a central aspect of the young peoples’ photos and their stories about those photos. This article focuses on three of the main themes that emerged from the youth photos and follow-up interviews: (1) nature as a calming place; (2) building metaphors of resilience; and (3) providing a sense of hope. These local processes were shown to help youth cope with stress, anger, fear, and other general difficult situations they may encounter and navigate on a day-to-day basis.ConclusionsThis study contributes to the literature exploring Indigenous youths’ meaning-making process and engagements with land and nature in an urban context, and highlights the need for public health and municipal agencies to consider developing more culturally safe and meaningful natural environments that can support the health, resilience, and well-being of Indigenous youth within inner-city contexts.

Integrating Latina/o ethnic determinants of health in research to promote population health and reduce health disparities.

Social determinants of health (SDOH) such as environmental conditions and the nature of social settings have become highly influential in public health policy-making circles worldwide, yet they may not address clearly the role of ethnicity in health processes. Drawing from the National Institutes of Health's disparity research frameworks, this papers illustrates a set of variables that are advanced as having a unique role in disparities experienced by ethnic populations and Latina/os, in particular. The proposed ethnic determinants of health tap environmental, community, and social-cognitive levels of analyses and are defined as variables that have discernable differences-relative to other subpopulations-in their levels or in the way that they impact health. Health process models illustrate that ethnic determinants such as racism, family cultural norms and cultural change, and ethnic identity can, for example, mediate ethnic health disparities or condition (moderate) the levels of impact that SDOH have on health outcomes. Qualitative research analyses also strengthen ethnic and SDOH research by diversifying researchers' a priori assumptions and methodological limitations imposed by quantitative approaches. The expected dividends of the proposed Latina/o ethnic determinants of health research agenda amount to the generation of research that clarifies the role of ethnicity in SDOH and population health processes that are highly influential in ongoing regional and national health agendas. (PsycINFO Database Record (c) 2019 APA, all rights reserved).

Trends in Health Disparities, Health Inequity, and Social Determinants of Health Research

The theoretical landscape of health disparities research now emphasizes health inequities and the role that social determinants of health (SDOH) play in creating and perpetuating them. Whether National Institutes of Health (NIH) funding patterns reflect this theoretical shift is unknown. The aim of this study was to examine the National Institute of Nursing Research's (NINR) funding for research focused on health disparities, health inequities, and SDOH, relative to other key NIH institutes. Data on 32,968 projects funded by NINR, the National Cancer Institute, the National Heart, Lung, and Blood Institute, and the National Institute of Minority Health and Health Disparities (NIMHD) during the years 2000 through 2016 were downloaded from NIH RePORTER; those with health disparities, health inequity, or SDOH terms used in the abstract were identified. Descriptive statistics and a general linear model approach were used to assess differences in cumulative project counts and funding proportions, and funding trends over time. Overall, funding for health disparities projects was 14-19 times greater than for health inequity and SDOH projects and was more concentrated in centers and institutional training than in individual research projects. NINR's proportion of funding for disparities projects was consistently greater than that of the National Cancer Institute and the National Heart, Lung, and Blood Institute, but not for inequities and SDOH projects. NIMHD's proportion of funding for disparities, and inequities and SDOH projects (combined) was 2-30 times greater than that of other institutes. Over the 16-year period, funding for disparities, inequity, and SDOH projects each increased (all ps < .05); however, growth in inequities and SDOH funding was not evident in more recent years. Funding for projects focused on health equities and the SDOH lag behind theoretical shifts in the broader health disparities research arena. With the exception of NIMHD, there is a disconnect between funding for projects with a disparities orientation in institutional training and center projects relative to individual research projects. These trends have implications for nurse scientists seeking NIH funding to support health equity-oriented research.

Open science initiatives: challenges for public health promotion.

While academic open access, open data and open science initiatives have proliferated in recent years, facilitating new research resources for health promotion, open initiatives are not one-size-fits-all. Health research particularly illustrates how open initiatives may serve various interests and ends. Open initiatives not only foster new pathways of research access; they also discipline research in new ways, especially when associated with new regimes of research use and peer review, while participating in innovation ecosystems that often perpetuate existing systemic biases toward commercial biomedicine. Currently, many open initiatives are more oriented toward biomedical research paradigms than paradigms associated with public health promotion, such as social determinants of health research. Moreover, open initiatives too often dovetail with, rather than challenge, neoliberal policy paradigms. Such initiatives are unlikely to transform existing health research landscapes and redress health inequities. In this context, attunement to social determinants of health research and community-based local knowledge is vital to orient open initiatives toward public health promotion and health equity. Such an approach calls for discourses, norms and innovation ecosystems that contest neoliberal policy frameworks and foster upstream interventions to promote health, beyond biomedical paradigms. This analysis highlights challenges and possibilities for leveraging open initiatives on behalf of a wider range of health research stakeholders, while emphasizing public health promotion, health equity and social justice as benchmarks of transformation.

The potential contributions of geographic information science to the study of social determinants of health in Iran

Recent interest in the social determinants of health (SDOH) and the effects of neighborhood contexts on individual health and well-being has grown exponentially. In this brief communication, we describe recent developments in both analytical perspectives and methods that have opened up new opportunities for researchers interested in exploring neighborhoods and health research within a SDOH framework. We focus specifically on recent advances in geographic information science, statistical methods, and spatial analytical tools. We close with a discussion of how these recent developments have the potential to enhance SDOH research in Iran.