This thesis discloses findings from a scoping review of Social and Structural Determinant of Health (SSDOH)-related academic and grey literature from neurosurgery and fields with neurosurgical overlap. The purpose of this thesis is to identify which social determinants have been assessed, for which surgical procedures they were evaluated, and what disparities were found. To identify studies to include or consider for this systematic review, the review team worked with a medical librarian to develop detailed search strategies for each database. Studies were screened by title and abstract independently by two reviewers. Disagreements between reviewers were resolved by a third reviewer, blinded to the decisions of the primary reviewers. The scoping review of the SSDOH in neurosurgical outcomes identified 99 studies from the year 1990 to 2020. Identified studies were targeted predominantly toward spine surgery patients, evenly distributed in analyses of gender, race and economic stability. The relatively low volume of neurosurgical papers focused on the SSDOH and emphasis on one subspecialty demonstrates the need for an expanded interest in the SSDOH in neurosurgery. / Urban Bioethics

The social and structural determinants play a significant role in community health, and differences in the experience of these factors facilitate some of the health disparities that are seen in the US along racial and socioeconomic lines. In this manuscript, I propose a conceptual model of the social determinants of health hierarchy and discuss the positioning of the structural determinants of the built environment within that hierarchy. I discuss the research connecting some of the structural determinants to health outcomes. Finally, I review several opportunities for local government to alter the built environment in ways that can promote community health and mitigate health inequity. / Urban Bioethics

Background: Global health is a complex, interdisciplinary, and contested field. It is rapidly growing and undergoing ideological and methodological changes. Despite many theoretical claims over what global health research ought to be, there are few empirical reports on what global health is, as a present field of research. The aim of this study is to: 1) determine patterns in global health research, based on key research characteristics; and 2) determine relationships between these characteristics to identify and define conceptual frameworks in global health research. Methodology: A systematic review of research in global health journals was conducted for papers published in the years 2010, 2015, and 2020. Categorical data on 17 research characteristics was extracted from all studies included in the analysis. The relationships between these characteristics was analyzed and visualized using multiple correspondence analysis, as implemented in the R’s ca package. Significance tests of independence determined relationships between pairs of variables. Results: The final analysis was done on 1033 included studies from 14 journals. 56% of the studies used a quantitative observational methodology. While 82% of research had at least one author affiliated with a high-income country, 96% of research funded (at least partially) by the Bill & Melinda Gates Foundation had at least one author affiliated with a high-income country. There was a significant relationship between the use of social and structural determinants of health and the authors’ affiliations (X2=59.06, p < 0.001), with the use of social and structural determinants of health lower among lower-income authors than high-income authors. The first and second dimensions of multiple correspondence analysis explained 38% of the variables’ deviation from independence. Conclusion: Multiple correspondence analysis offers a novel way of understanding global health research, contributing empirical data to the discourse on what lies ahead for the field of global health. The relationship between the use of social and structural determinants of health, authorship, and research methodologies point to the need for important conversations on the direction of global health research, starting from where we are at now. / Thesis / Master of Science (MSc) / While the importance of the field of global health is more prominent than ever, it is a field of uncertainty, controversy, contested merit, and often disreputable history. Conversations abound on the strengths and weaknesses of the field and what needs to change; yet, there is a lack of empirical grounding for these discussions. In this study, I reviewed global health research literature, identifying 17 key characteristics that surface in theoretical conversations on global health, and scored 1033 global health research studies according to these characteristics. Using multiple correspondence analysis, the 17 characteristics were analyzed together and visualized to elucidate the relationships between the characteristics. I found that: over half of the studies were quantitative observational; most research in global health had at least one author from a high-income country; and middle-income authors were less likely to study social and structural determinants of health than high-income authors. These findings lend important empirical evidence to conversations on the direction of the field, starting from where we are at now.

This study explored doctor of physical therapy (DPT) students’ attitudes, perceived knowledge, and perceived competence specific to social and structural determinants of health (SDOH). Current students in a DPT program housed within a college of public health in an urban research institution served as the participants for this research. The primary purpose of this study was to explore students’ self-evaluation and perceptions of competence with SDOH in hopes of gaining insight into elements of their education that contributed to their preparedness and/or what strategies and resources are needed to foster competence in this area. A secondary aim of this study was to explore how individual student factors and curricular factors impact students’ awareness of SDOH. A mixed methods study design employed bivariate and multivariate analysis of participants’ responses to self-report Likert scale survey questions and analysis of semi-structured interviews using qualitative description and phenomenological principles. Quantitative data analysis revealed differences in perceived skills competence based on cohort (year one, two, or three in the program) with first-year students demonstrating lower perceived competence. Analysis of attitudes and knowledge demonstrated that all participants held a positive perspective regarding the importance of SDOH as well as perceived foundational knowledge for this content. Quantitative analysis also detected subtle differences in specific sample beliefs and behaviors based on demographic variables such as gender identity, race, and first-generation student status. Qualitative data supported the quantitative findings with participants articulating specific elements of their identities and the DPT curriculum that contributed to their understanding of SDOH. An iterative coding process identified two primary themes that corresponded to the research aims: 1) Learners’ perceived importance of social and structural determinants of health and factors that impact how to address them; and 2) Learning about social and structural determinants of health: What learners bring with them and what they gain throughout the curriculum. These findings shed light on the elements of this educational program that foster students understanding of SDOH and the types of experiences that help clinical learners appreciate the impact of these upstream drivers of health for patients and populations. / Policy, Organizational and Leadership Studies