Sarah Frances - Social Determinants of Health in Concussion Treatment (by Danielle Steinbach)

This past Friday (8/15/25), on the NeuroBeacon podcast, I had the opportunity to interview Sarah Frances, a rising medical student at McGill University who studied public health as a graduate student at Columbia University.  

After suffering from a concussion herself, Sarah became driven to understand the social and cultural factors that contribute to incidence rates of concussions, especially among young athletes. 

This personal question led her to research the broader topic of social determinants of health and how one’s personal background impacts their vulnerability to concussions. Having studied both neuroscience and public health in her undergraduate education, Sarah wanted to use her background on the neurological impacts of concussions and understand the sociocultural root causes behind these traumatic brain injuries. Essentially, Sarah aspired to execute large-scale community interventions to prevent concussions before they occur. 

Before delving further into Sarah’s research, I asked her to briefly define what is meant by the term ‘social determinants of health’. She explained that social determinants of health refers to “non-medical factors that play a role in determining someone’s health and well-being”, including one’s neighborhood, nutrition intake, environmental pollution, and access to walking spaces. 

The cumulative effect of these individual social, cultural, and environmental factors ultimately play a larger role in one’s health than people realize. In fact, Sarah stated that “zip code is actually a stronger predictor of one’s health than one’s genetic code”. Thus, social factors serve as a strong predictor of health outcomes, making one’s health an even more complex, multivariate problem that extends beyond their DNA. Sarah asserted that understanding the social and cultural factors behind each patient is key to personalizing treatments to each person. Ultimately, she stressed that the heterogeneity of patients’ sociocultural profiles furthers the need for personalized medicine because, as Sarah said, “no one size fits everyone in medical treatments”.   

While working under the mentorship of Dr. James Noble at Columbia University, Sarah used a statistical analysis software called SPSS (Statistical Package for the Social Sciences) to detect trends in a CARE (Concussion Assessment, Research, and Education) Consortium dataset and document which social factors were most highly correlated with concussion incidence. The CARE consortium dataset tracks multiple factors about individual patients’ profiles (i.e. family income, race, age, years playing a sport, etc.) and the number of concussions they have suffered. Sarah’s initial results suggested that family income was negatively correlated with one’s likelihood to suffer a concussion. Additional analyses revealed concussion rates correlated with neighborhood violence, bullying, and food insecurity. Sarah stated that verifying these initial findings will be a focus of future studies. 

When speaking about the importance of one’s family background in predicting health outcomes, Sarah spoke about the generational impacts of health literacy as well. Specifically, Sarah explained that athletes with higher concussion rates tended to have less educational background on symptoms and long-lasting impacts of concussion. However, additionally, these same athletes’ parents were also less likely to be educated about concussion prevention, diagnoses, and symptoms. This general trend further emphasizes the need for accessible public health resources to spread health literacy and break these generational cycles. 

Shifting gears towards the future, I asked Sarah what steps can be taken to remedy social disparities in health outcomes and health literacy. Sarah responded with two primary suggestions. 

First, thinking from the perspective of a researcher, she highlighted the need for proper and complete data collection to understand the demographics most affected by concussions. Speaking from her own experience trying to compile concussion data from Quebec hospitals, Sarah mentioned the problem of incomplete and inconsistent documentation of concussions between medical institutions. She recalled how these problems with documentations presented difficulties with compiling data and performing a holistic, combined analysis of multiple datasets. 

Second, Sarah underscored the incredible impact that introducing health education early into a child’s life can have on their future health. One of Sarah’s suggestions was that elementary schools begin integrating educational programs about common diseases and acquired conditions into the curriculum. By doing this, Sarah believes we can make progress in breaking generational disparities in health literacy. 

– Danielle Steinbach