Towards a people's social epidemiology: An intergenerational study of place, embodiment, health via participatory action research with residents of public housing
AbstractTOWARDS A PEOPLE'S SOCIAL EPIDEMIOLOGY:An Intergenerational Study of Place, Embodiment, Health viaParticipatory Action Research with Residents of Public HousingByRyan J. PettewayDoctor of Public healthUniversity of California, BerkeleyProfessor Rachel Morello Frosch, ChairSocial Epidemiology has made critical contributions to understanding health inequities. However, translation of social epidemiology science into meaningful and timely action remains a challenge. With so much focus within the field on issues like social position, discrimination, racism, power, and privilege, there has been surprisingly little deliberation about the extent and value of social inclusion and equity within the field itself, and how the challenge of translation might be more readily met through re envisioning the role of the people in the research enterprise reimagining what "social" could, or even should, mean for the future of the field. Place health research represents a particularly promising subfield within which to emphasize these principles, especially within the context of public housing.Thus, the overall aim for my dissertation work was to conduct research at the nexus of public health and public housing by integrating participatory research methods and information communication technologies (ICTs) to democratize the research process and facilitate local action. In this spirit, my work develops, introduces, and field tests 3 interrelated and nested concepts that, in application, represent a model for inclusive and equitable social epidemiology: A People's Social Epidemiology, the Placescape, and Geographies of Embodiment.First, Chapter 1 introduces a conceptual framework for A People's Social Epidemiology a multicomponent and tiered framework to guide social epidemiology research/practice to become more inclusive and equitable, improve knowledge translation, and facilitate timely, locally relevant action essentially, to enhance the "social" in social epidemiology. The framework draws upon theory, concepts, and principles from social epidemiology, community based participatory research (CBPR) and information and communication technologies for development (ICTD) This work specifically highlights place health research as a subfield particularly suited for A People's Social Epidemiology approach, and the framework was accordingly "field tested" through my development and implementation of the People's Social Epidemiology Project (PSEP) an intergenerational CBPR study of place, embodiment, and health with residents of public housing.For the PSEP, parent youth dyads were recruited from a predominantly Black public housing community and trained in core principles related to social epidemiology and health equity, and fundamental aspects of public health research and CBPR. They were then trained in 4 participatory research methods: Photovoice, Activity Space Mapping, X Ray Mapping, and2Participatory GIS. All research methods were completed by the participants themselves. First, participants used Photovoice (via cellphones) to identify, photo document, and describe their important daily places and specific exposures/opportunities within each place they perceive affects their health. Next, they used Activity Space Mapping to geolocate and map their Photovoice photos, identify any additional non photographed places, and to rate and provide time estimates for each mapped place. Then, using a cognitive mapping method known as X Ray Mapping, they created symbolic representations of place embodiment reflecting how each of their mapped places affects their bodies/health. Finally, constituting Participatory GIS, they integrated and digitally mapped their work via a web based multimedia enabled ICT platform, Local Ground. This platform allows participants to create, print, and digitally share their place health research maps with the broader community and city officials.Anchored in A People's Social Epidemiology, Chapter 2 introduces the Placescape framework. The goal of the work presented here was to develop and field test a place health framework that: 1) accounts for the multi nodal nature of "place" and its contingent spatial, temporal, and social inter nodal connections/divisions; 2) elucidates potential intergenerational and life stage differences in place experiences/perceptions; and 3) explicitly engages the sociopolitical mechanisms that make, unmake, and remake place over time. A framework for a placescape approach was developed drawing from place health, social epidemiology, participatory research, geography, and sociology literatures. This framework was then applied to the PSEP study, with parents and youth using the above combination of participatory methods to map their "placescapes" Findings revealed clear spatial and temporal differences in adult and youth placescapes, as well as a very distinct pattern of place "nodes" among youth indicating a multinodal placescape.Lastly, rooted in the Placescape framework, Chapter 3 introduces the Geographies of Embodiment concept through detailing the process and findings of a novel cognitive mapping methodology to elucidate subjective notions of place embodiment within place health research X Ray Mapping. This work aims to enhance place health research efforts by furthering our understanding of: 1) which places matter for health and when (i.e. spatially and temporally specific notions of "place" 2) how these places matter the processes/mechanisms of the physiological embodiment of place; and 3) intergenerational and life stage differences in place embodiment experiences/perceptions. Findings revealed clear spatial differences between adult and youth geographies of embodiment, as well clear perceptual differences in which body areas are affected by place and how.Overall, the work presented in these three chapters outlines a framework for conducting more inclusive and equitable and more practicable and actionable social epidemiology research, develops a new paradigm for understanding/researching place and health especially within public housing communities rooted in intergenerational and participatory approaches, and introduces a novel research methodology to elucidate subjective notions of place embodiment within place health research. These combined contributions improve efforts to appropriately conceptualize and measure "place" and further understanding of place, place embodiment, and health within public housing. Moreover, these contributions offer guidance on how to move towards a more inclusive and equitable social epidemiology research practice one that is of, for, and by the people, and not simply about them/us.