Blog Health Equity

Importance of social context in health research

Written by Antonia Asher, MPH Candidate in International Health & Development at the Tulane University School of Public Health and Tropical Medicine and participant in the 2019 Institute for Public Health Summer Research ProgramPublic & Global Health Track

This summer, I am working with Dr. Darrell Hudson, Associate Professor, Brown School, and his research team, and had the opportunity to co-facilitate a Journal Discussion regarding Mezuk and colleagues’ (2010) article titled “Reconsidering the Role of Social Disadvantage in Physical and Mental Health: Stressful Life Events, Health Behaviors, Race, and Depression.”

However, before discussing the article, the session began with a screening of Segregated by Design, a 17-minute documentary that details how American local, state, and federal governments segregated urban areas through law and policy. Key takeaways include: black wealth is 10% of that of whites, achievement of blacks is deterred by pollution and stress, and children in segregated neighborhoods are less likely to move into the middle-class (Lopez, 2019). This documentary provided a historical context for these takeaways and the health issues that are discussed in the article.

Graphic  depicting redlining in major U.S. cities
Graphic from Segregated by Design depicting redlining in major cities (Lopez, 2019)

Interestingly, blacks report greater psychological distress than whites, so one would think that their rates of mental disorders would be higher than those of whites, but they are not – even when accounting for the effects of socioeconomic position.

Mezuk et al. (2010) used The Baltimore Epidemiologic Catchment Area Study to examine the interaction between stress and poor health behaviors (PHB) – such as smoking, alcohol use, and poor diet – as well as the risk for depression 12 years later for blacks and whites. They found that more engagement in PHB reduced that likelihood of blacks to meet criteria for depression after three years compared to blacks that engaged in fewer PHB; this association was not significant for whites. Therefore, interventions need to consider how disadvantaged environments both cause stress and shape the coping strategies people can engage in (Mezuk et al., 2010). Thus, public health must go beyond attempting to stop PHB, but to change the environment that perpetuates stress and PHB. An environment that has been shaped by enforcement of the laws and policies of American governments. An approach solely focused on behavior change- not considering structural change- could be a detriment to the mental health of blacks who used PHB as coping mechanisms.

During discussion of the documentary and the article, students reiterated the importance of social context in behavior change interventions; for instance, when encouraging healthier diets, a researcher would need to understand food access, monetary cost of healthy items, other costs such as preparation time, and the culture of food for each particular population. Students also emphasized that public health research must consider policy implications and enforcement. I want to end with a quote from the documentary: “And if it’s unconstitutional, then we have an obligation to remedy it” (Lopez, 2019).


Lopez, M. (Director). (2019). Segregated by Design [Documentary]. United States: Silkworm Studio. Retrieved from

Mezuk, B., Rafferty, J. A., Kershaw, K. N., Hudson, D., Abdou, C. M., Lee, H…Jackson, J. S. (2010). Reconsidering the role of social disadvantage in physical and mental health: Stressful life Events, health behaviors, race, and depression. American Journal of Epidemiology, 172(11), 1238-1249. doi: 10.1093/aje/kwq283