Unequal access

Paola Gilsanz, SD '14

Doctoral student studies social disparities and health

May 28, 2013 — Conducting research projects among mothers and infants in Brazil in the mid-2000s, Paola Gilsanz got to see firsthand the effects of health inequalities. She saw that, all too often, good health was elusive if you were poor, lacking education, or didn’t have access to adequate care.

Gilsanz is now on track to graduate with a doctor of science in social and behavioral sciences from Harvard School of Public Health (HSPH) in May 2014. Her research is in social epidemiology, which focuses on societal factors that affect health. “The reward is great,” she said. “I can use the tools of public health I’ve learned at HSPH to help others.”

Gilsanz is currently at work on her dissertation, which is focused on the association between depressive symptoms and risk of stroke. She hopes her research will provide clues to if and how depressive symptoms physiologically impact health. “A lot of research has been done on stroke before depression,” she said, “but I’m looking at it in the other way. I hope to improve our understanding of how emotions like stress or depressive symptoms can also have physical health repercussions.”

Before coming to HSPH, Gilsanz earned a bachelor’s degree in community health from Brown University and an MPH from the University of California, Berkeley. At Brown, she studied social risk factors associated with infant mortality in Brazil. Her master’s thesis at Berkeley focused on infections among low-income women in Brazil. After earning her MPH, Gilsanz worked for two years as a Centers for Disease Control-sponsored epidemiology fellow for the Massachusetts Department of Public Health, where she examined issues such as teen health risk behaviors, youth oral health disparities, LGBT health, maternal mortality disparities, and bullying among students with disabilities.

Impact of social disparities

Gilsanz’s research in Brazil was spurred, in part, by her roots—her mother is Brazilian and her father is from Spain, and Gilsanz has visited both countries many times. Even when not formally conducting research in Brazil, she was aware of inequalities in income, education, and access to health care in that country, in part from dinner table conversations among her extended family and in part from seeing for herself how people lived. “The inequality is blatant,” she said.

Such disparities resonated with Gilsanz. Her parents, both doctors, had long instilled in her the notion that everyone should have a right to good health. Gilsanz’s younger brother was born with a congenital heart condition and her parents had often said how fortunate the family was to have access to good care.

At HSPH, Gilsanz has received two years of financial support from the Initiative to Maximize Student Diversity (IMSD) program, a National Institutes of Health (NIH)-funded initiative to support underrepresented students in doctoral programs. During the program’s weekly seminar, Gilsanz developed a network of friends and mentors with whom she still collaborates. With skills learned during the program’s professional development sessions and the guidance of her dissertation committee, she applied for, and is currently funded through, the National Institutes of Health Ruth L. Kirschstein National Research Service Award for Individual Predoctoral Fellowship to promote diversity in health-related research.

The power of data

Gilsanz’s favorite course at HSPH was SHH 245: Social and Behavioral Research Methods. “It teaches the skill sets beyond statistics needed to conduct research,” she said. “You design a survey, collect and analyze the data and write a mock article. The professors then provide comments as though they were journal editors and you resubmit the article with a cover letter. It was a lot of work, but I learned so much about the research process.” Gilsanz has twice been the teaching assistant for the course.

In the future, Gilsanz hopes to continue studying cardiovascular epidemiology (influenced partly by the experience of her younger brother), especially looking at the role of psychosocial factors such as stress or depression. She plans to conduct research from a life-course perspective, examining how factors across the lifespan may or may not affect health in older years. And she will continue to employ the rigorous “causal inference” research methods she has learned at HSPH—methods robust enough to suggest causality instead of just association in determining the factors that affect disease.

“These methods can help give a voice to underexamined issues,” said Gilsanz, “and can play an important role in influencing policy change.”

Karen Feldscher

photo: Aubrey Calo