Featured AME Researcher: Agus Surachman, PhD

Agus Surachman, PhD. is an assistant professor in the Department of Epidemiology and Biostatistics at Drexel’s Dornsife School of Public Health. 

Dr. Agus Surachman (he/him/his) received his Ph.D. from the Pennsylvania State University and completed a postdoctoral fellowship at the UCSF’s Aging, Metabolism, and Emotion Center. He is currently an assistant professor in the Department of Epidemiology and Biostatistics at Drexel’s Dornsife School of Public Health, with a secondary appointment in Nursing at Drexel's College of Nursing and Health Professions. Surachman joined the Dornsife School of Public Health as part of the Drexel FIRST (Faculty Institutional Recruitment for Sustainable Transformation) program. Dr. Surachman’s work centers on how health disparities are linked to social, psychological, and biological factors, as well as how physiological and psychological responses to stress are predictive of long-term health issues.

We spoke with him about his work in an exclusive Q & A.


How did you get into research into socioeconomic and racial health disparities?

My motivation to research socioeconomic and racial disparities in health grows from personal experiences. I am the first in my family to attend college and seek graduate degrees. I grew up in a small rural area in West Java, Indonesia, where poverty is the norm. Growing up, my family experienced financial hardships that directly impacted my and my family’s health. My mother was struggling with chronic health conditions most of her life, and she passed away at the age of 42. At 18, I was diagnosed with nephrotic syndrome, a health condition associated with a dysregulation in kidney filtration. These experiences have motivated me to study SES in the context of health and human development since the beginning of my academic career.

I came to the United States for graduate school in 2014, during the protest against racial injustice in Ferguson, MI, after the police shooting of Michael Brown. I recognize that injustice happens in multiple forms, which inspired me to direct my research on the topic of intersectionality, focusing on the complexity of how marginalization through socioeconomic inequality, racial injustice, and gender discrimination creates health disparities.

Can you talk a little bit about your research program?

Guided by the Fundamental Cause theory, I view systemic racism and socioeconomic inequality as fundamental causes, or cause of the cause, of health disparities, especially in the United States. My research program examines the two hypothesized pathways through which systemic racism and socioeconomic inequality at the macro-level are linked to differences in health and well-being: socioeconomic-related and non-socioeconomic-related pathways. At the individual or household level, systemic racism and socioeconomic inequality manifest in racial differences in SES or valued and scarce material and social resources (e.g., education, income, and social status). My research on examining socioeconomic-related factor as the cause of health disparities due to systemic racism and socioeconomic inequality focus on three frameworks: 1) testing direct association between early life SES and adult health, 2) examining the accumulation of SES across the life course and its impact on health, and 3) investigating whether the experience of upward mobility can mitigate the negative impact of growing up in a lower SES environment. While socioeconomic-related pathway is an essential factor of how social structures and systemic forces lead to differences in life course SES, it cannot fully explain health disparities in health. Systemic racism is also associated with negative sentiment toward non-white racial or ethnic groups that justify differential treatment, reflected in the higher experience of discrimination among non-white individuals. Discrimination is a critical non-socioeconomic-related pathway that links systemic racism to health disparities, independent of socioeconomic factors.

Furthermore, my research examines the impact of social stratifications on psychological and biological factors implicated in health disparities through the lens of the daily stress process and accelerated aging. The daily stress process, especially how individuals react to daily stressor exposure, is a robust predictor of multiple major health outcomes, including chronic conditions and even mortality. My research contributes to this area by situating the daily stress process as a critical psychosocial mediator that links social stratifications to health disparities. My works provide early evidence of the importance of the daily stress process as the psychosocial mediator that links life course SES to disparities in health across adulthood. Finally, my research examines the impact of societal and psychological factors on accelerated aging or progressive deterioration of integrity across various physiological systems. Accelerated aging is a critical biological marker for multiple chronic diseases for which there are known SES and racial disparities. In my works, I examine accelerated aging through multiple physiological pathways, including gene expression and epigenetic modification, inflammation, metabolic syndrome, and disease-specific pathways (i.e., accelerated renal aging). Taken together, my research program seeks to understand the embodiment of social stratifications in health through the daily stress process and accelerated aging.

Finally, I approach the linkage between biopsychosocial factors and health disparities from a methodologically innovative angle. I utilize multilevel structural equation modeling (MSEM) to test the question of how socioeconomic-related and non-socioeconomic-related factors are associated with day-to-day daily stressors and well-being. MSEM combines the strengths of multilevel modeling (e.g., to tease apart between-person and within-person associations) and structural equation modeling (e.g., examine path models such as chain-of-risk models) that is useful to examine how life course factors are associated with biopsychological mediators of health. I also utilize the person-centered statistical approach, especially latent class analysis (LCA to examine the heterogeneity of life course factors contributing to socioeconomic and racial disparities in health.

Looking forward, how do you see your research growing?

Building on my current work, I look forward to expanding my research program in Drexel’s Dornsife School of Public Health. There are two major directions that I would like to pursue in my next academic career as a faculty. First, my goal is to significantly contribute to the knowledge of how psychosocial factors across the life course (e.g., early life adversity, adult daily stress process) are contributed to accelerated age-related declines in kidney function across adulthood as a major pathway to socioeconomic and racial disparities in chronic kidney disease and end-stage renal disease. Second, I aim to expand my research on the intergenerational and transgenerational transmission of social disadvantages and health. Specifically, I am to significantly contribute to this area of research by focusing on the epigenetic and life course factors as the major pathways that contribute to the persistence of socioeconomic and racial disparities in health across multiple generations. My ultimate goal is to identify modifiable factors across the life course and across generations to eradicate socioeconomic and racial disparities in health.

Can you talk a bit about your work and mentorship under Dr. Elissa Epel, the director of the AME Center?

My first interaction with Dr. Epel was in 2019 through my doctoral mentor at Penn State, Dr. David Almeida. Dr. Almeida informed me that a team from UCSF, led by Dr. Epel, was looking for an innovative method to examine how early life adversity, through the daily stress process in adulthood, may be associated with major health outcomes. As a graduate student at that time, I was nervous about collaborating with an established and prolific researcher such as Dr. Epel. However, I instantly sensed that Dr. Epel is a kind and compassionate mentor. She constantly encouraged me to share my ideas with the team on better utilizing their data to match the complex questions regarding the mediating role of the daily stress process on the association between early life adversity and adult health. I mentioned that I have been working on utilizing social epidemiology’s chain-of-risk framework using multilevel structural equation modeling that may apply to their research questions. She fully embraced my idea and trusted my analytical skills to move the project forward. Our collaboration leads to an important publication on the role of daily psychosocial stressor appraisal in adulthood as a modifiable factor that potentially buffers the negative impact of early life adversity on adulthood depression.

Dr. Epel was instrumental in helping me to secure an academic job during the past academic market. Dr. Epel firmly believes in my strong record, so she suggested I try the job market in my first year of postdoc. She convinced me that this could also be a good practice in case I need to apply again next year. Dr. Epel helped me in multiple ways during the job application, interview, and negotiation process. She took the time to read and provide feedback on my job market materials. When I received campus interview invitations, Dr. Epel gave me the opportunity to practice my job talk in front of other postdocs and faculty. Finally, when I received job offers, Dr. Epel helped me negotiate and make sure that I got all the things that I needed to continue my research as a faculty. I had a successful job market, and I must acknowledge the significant role Dr. Epel has contributed. Even after I left UCSF, Dr. Epel took her time to write a send-off email to the dean at Drexel, where I am now a faculty. I have witnessed this personal touch from Dr. Epel multiple times during my time at UCSF. She is a truly special mentor, and I am excited to continue collaborating with her in a different capacity. Dr. Epel is a genuinely amazing mentor who has significantly shaped my career. She is an inspiration for the kind of mentor that I would like to emulate. She is a prolific researcher that has contributed significantly to the field. At the same time, she is a kind and compassionate mentor that cares about her mentee’s well-being and success.

How would you describe your time at UCSF?

I am so grateful for the time that I had at UCSF. It was such a supportive and academically stimulating environment. I met a lot of extraordinary individuals during my time there, and I will miss them dearly. I miss the weekly postdoc work-in-progress meeting led by Dr. Wendy Mendes and Dr. Aric Prather. It was such an excellent opportunity for the postdocs to get to know each other work and to get feedback on improving our quality of work. I cannot wait to come to visit sometime in the future.

Visit Dr. Surachman's UCSF profile here.