Hi! This is Juan J. DelaCruz, an Associate Professor of Economics and Business at Lehman College (Bronx) and Associated Faculty of the School of Public Health and Health Policy (Harlem) of CUNY. I am proud to have been selected for the 2017 Minority Serving Institutions Program. I am a health economist studying the impact of HIV on older adults in New York City. My work assesses rival interventions for HIV-infected individuals and its economic choices that are cost-effective. Economics informs CRE. Researchers and evaluators using economic tools should have a solid perception of how diverse cultural norms and practices influence their own worldview. Economics faces challenges in the evaluation process due to its quantifiable nature. Economics for CRE is constrained by quantitative methods.
I want to contextualize the role of economics in evaluation using economic stability as a social determinant of health. Good health requires efforts that go beyond epidemiological factors, and the position in the social ladder depends on finding good jobs and staying healthy, but income is unequally distributed in society. Some factors keep vulnerable groups from reaching full economic potential making them more vulnerable to negative health outcomes. Quality jobs are associated with education, gender and age, which determine health status and job stability (better health leads to better earning and vice versa). Unemployment is linked to alcoholism, crime, drug-use, incarceration as well as housing and food insecurity. Poverty creates ill-health and persists even when constraints are alleviated by social policy. Raising healthcare costs distress people, as they forgo basic needs to choose healthcare. These difficulties are enhanced by the intersection of gender, race/ethnicity, age and other factors; needless to say, health inequities are rooted in historical, economic and political factors. The social context (criminal justice system, social segregation, income inequality and gender gaps) influences individual behaviors and determines health outcomes.
The most valuable lesson is that we can achieve cultural responsiveness when the design, execution and appraisal of any program are rooted in cultural inclusion and cultural context. Economics approaches need to develop the analytic techniques needed for evaluation studies that allow for cultural inclusion and cultural context. We need to identify analytical frames that fit the goals of CRE. Community-based and community-based participatory research helps engage and empower communities during the evaluation process.
- Adimora, A. & Schonenbach, V.J. (2005), “Social Context, Social Networks and Racial Disparities in Rates of STI’s”, J of Infectious Diseases, 191(Supplement 1):S115-S122
- Benach, J. et al. (2014), “Precarious Employment: Understanding an Emerging Social Determinant of Health”, Annual Review of Public Health, 35:229-253
- Godin, I. et al (2004), “Differential Economic Stability and Psychosocial Stress at Work: Association with Psychosomatic Complaints and Absenteeism”, Social Science & Medicine, 58(8):1543-1553
- Mosier, S and Clayton, PF (2015), “Economic Instability: A Social Determinant of Health”, Kansas Department of Health and Environment, Bureau of Health Promotion, March 2015
- Schulz, A & Northridge, ME (2004), “Social Determinants of Health Implications for Environmental Health Promotion”, Health Education and Behavior, 31(4):455-471
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