Lecture 1
Social determinants of health (SDH) and their drivers
The transcript frames health outcomes as shaped by social structures and classifications (how society categorizes people). Key categories mentioned: income level (low vs high), race, gender, and other social factors.
Core idea: these social structures influence people’s opportunities and exposures, which in turn affect health across the life course.
Examples of how SDH operate in daily life:
Income and employment: earnings differ by group; disparities in pay for same jobs historically (e.g., gender gaps) and implications for who can access benefits like maternity leave.
Occupation and working conditions: CEOs and top leaders may enjoy better conditions (air-conditioned offices, safety, higher wages) versus frontline workers (e.g., potato workers) who face pesticides exposure and poorer minimum wage standards.
Housing and environment: some communities are more likely to have pollution and toxins (lead pipes, water issues) in residential areas due to their social and economic status.
Geographic and housing-related determinants: polluted neighborhoods, environmental toxins, and infrastructure quality are socially structured.
The health consequences are supported by data showing these patterns across populations; the speaker emphasizes that health environments in Canada reflect social structures that enable healthy or unhealthy environments.
Ethical and philosophical angle: the speaker invites reflection on whether these social arrangements are right or wrong, asserting that understanding SDH is essential even if solutions are not immediately achieved.
Practical takeaway: health equity requires recognizing how social stratification creates health disparities and addressing root causes rather than only individual behaviors.
The commercial determinants of health (CDH) as a major, often under-discussed factor
CDH refers to the influence of commercial actors (big and small firms) on health outcomes and equity.
The argument is that much of what shapes health comes from the environment created by commercial entities, not just personal choices.
Acknowledgment that commercial activity is not inherently bad; benefits include vaccines and food security (e.g., pharmaceutical companies, vaccine supply, grocery availability).
Corporate influence spans the entire path from production to consumption:
Work and income: wages determined by employers; work environment, ethics, safety, and exposure at work influence health.
Product and food systems: what we eat is shaped by what companies produce and market; ultra-processed foods are prevalent, and access to healthier options is uneven.
Marketing and consumer research: marketing campaigns and product design steer consumption; research sometimes serves corporate interests (e.g., attention-span optimization, risk messaging) as well as general health knowledge.
Political and regulatory influence: corporations influence health policy, wages, licensing, environmental regulations, tax structures, and what gets funded or blocked in legislation.
Tax and social protections: some large tech and retail firms may pay relatively low taxes or resist regulations that would benefit public health; examples include comparisons of tax contributions and labor practices across industries.
Concrete examples mentioned:
Tech companies (e.g., Facebook) shaping not only how people are paid and treated at work, but also how information is disseminated and how people’s perceptions are influenced.
Retail and manufacturing firms (Walmart, Unilever, McCain, Tyson, McDonald’s, Starbucks) affecting diets, food security, and exposure to ultra-processed foods.
Marketing practices designed to push products and encourage purchases, sometimes using research that serves commercial aims (e.g., optimal video length or ad strategies).
Global supply chains and policy influence that can affect food labeling, product safety, and market access (EU vs US regulatory differences; export vs domestic product standards).
The text asserts that CDH can be quantified in terms of its contribution to health outcomes, signaling a growing body of evidence that commercial environments drive health risks and protections.
Policy implication: protective regulation and fair taxation can align corporate practices with public health goals, whereas lax regulations enable shortcuts that harm health (pollution, unsafe labor, unhealthy foods).
A simple, cross-cutting model to connect SDH and CDH to health outcomes
Conceptual framework (illustrative):
H = f(SD,
CD,
B,
A)
where:H = health outcomes
SD = social determinants (income/wealth, education, occupation, race, gender, housing, environment, social support, governance)
CD = commercial determinants (marketing, product design, pricing, labor practices, taxes, policy influence, environmental footprint)
B = individual behaviors (diet, physical activity, substance use, health-seeking behavior)
A = access to health services (insurance, proximity to care, quality of care)
This reflects the transcript’s emphasis that health results from an interplay of structural social forces and corporate influences, not just personal choices.
UNICEF conceptual framework (nutrition and early development)
Focus on mothers and children and the life course from intrauterine life onward.
The framework helps explain malnutrition, undernutrition, and the transition to healthy growth (or lack thereof) through two layers:
Immediate causes: dietary intake and illness/disease.
Underlying causes: household food security, quality and care for children, access to health services, and the living environment (water, sanitation, housing).
Basic causes: socio-economic and political context, governance, resource distribution, and structural determinants.
Emphasis on investing in mothers: studies cited in the talk indicate that putting money in the hands of moms benefits the entire household and society; neglecting mothers disproportionately harms families and economies.
The framework reinforces why early-life conditions matter for long-term health, education, and economic outcomes.
Case studies to apply the SDH lens (Malawi vs Los Angeles, USA)
Purpose: compare how social determinants shape health trajectories for two mothers in different settings and consider spillover effects on children.
Case Study 1: Malawi
A mother (referred to in the notes as Busseje) has taken in a child not her own, illustrating kinship-based or informal social networks as a form of social support.
Food access and nutrition context: mentions of school lunches as a form of support; reliance on social safety nets; possible reliance on assistance at work or school for meals and clothing (e.g., $5 clothing credit mentioned in discussion of similar cases).
Energy and storage realities: in a broader discussion of the cases, electricity access and refrigeration constraints are highlighted as factors shaping food choices and storage for households; the lack of reliable electricity would push households toward non-perishable foods and social networks that provide meals.
Social networks and caregiving: extended family and community support structures (e.g., a single mother caring for children while others contribute resources) can buffer some health risks but do not fully compensate for material poverty.
Education and opportunity: limited resources affect school attendance and educational prospects, tying into the broader SDH framework that links early-life conditions with later health and economic outcomes.
Practical observation from the discussion: school lunch programs serve as a critical safety net; food exchange practices within households may reflect scarcity and trade-offs between nutrition sources (e.g., fruits vs meat) and the constraints of a low-income setting.
Case Study 2: Los Angeles, USA
A mother in the LA setting faces electricity scarcity and relies on nearby stores or quick-preparation foods, with limited ability to store fresh foods at home (refrigeration challenges) and heavy reliance on convenience stores.
Food access and storage constraints push toward shelf-stable or processed foods; energy limitations shape what is feasible for cooking and meal planning.
School nutrition and social support: children may benefit from school meals; family may access assistance programs; ongoing need to balance work, childcare, and education with resource constraints.
Social support networks: maternal support from family (e.g., mother’s own mother) and access to transportation affect the ability to reach groceries, school, and health services.
Broader implications: the case demonstrates how urban poverty and structural barriers (electricity access, food deserts, time poverty, and transportation) contribute to poor nutrition and educational outcomes, illustrating how SDH and CDH interact in a high-income country.
Cross-case insights from the discussion:
Investing in mothers is repeatedly highlighted as a lever for improving outcomes for children and households.
School lunch programs and health insurance are important safety nets that can mitigate negative SDH and CDH effects.
Food system design (availability of fruits and non-processed options versus ultra-processed foods) and energy access strongly influence nutrition and long-term health.
Social networks and community supports (e.g., kinship care, neighbors, school programs) provide essential buffers but may be insufficient alone to overcome material hardship.
The contrast between Malawi and LA underscores how context shapes which determinants are most salient and which policy responses are feasible.
Practical and policy implications drawn from the discussion
Health equity requires addressing both SDH and CDH, not just individual choices or behavior change.
Protective public policies matter: fair wages (inclusive of living wages), robust labor rights, environmental protections, safe housing, reliable utilities (electricity and water), and access to nutritious foods.
Taxation and corporate accountability: ensuring accountable taxation and policies that discourage harmful production practices while encouraging beneficial ones (e.g., vaccines, nutrition programs) can influence health outcomes.
Regulation as a public health tool: EU-style labeling, content restrictions, and product reformulation (lower sugar, sodium, and additives) can support healthier consumer choices; conversely, lax US-like practices may perpetuate unhealthy options.
Role of civil society and governance: governance levels (local, national, international) influence which policies get implemented; the influence of industry in politics can hinder or help progress toward healthier environments.
Ethical dimension: the speaker notes that allowing structural determinants to perpetuate inequality is not neutral; addressing SDH and CDH is a matter of social justice and societal responsibility.
Connections to broader themes and prior concepts
The discussion aligns with foundational public health principles that health is produced by environments and systems, not solely by individual behaviors.
It connects to the idea that health equity requires structural change, not just behavior modification campaigns.
The UNICEF framework reinforces the importance of early-life conditions for lifelong health and the intergenerational transmission of health and socioeconomic status.
The case studies illustrate how real-world settings illuminate abstract determinants and how policy interventions could alter trajectories for children and families.
Ethical, philosophical, and practical takeaways
Ethical: if social structures systematically disadvantage certain groups, health equity becomes a moral imperative rather than a optional goal.
Philosophical: whether current social arrangements are just is a topic for reflection; the material reality of health disparities demands action.
Practical: policies should focus on protecting the most vulnerable (e.g., mothers, children, low-income communities) and bolstering social safety nets (school lunches, health insurance, affordable housing, electricity, clean water).
Key terms and concepts to memorize
Social determinants of health (SDH)
Commercial determinants of health (CDH)
UNICEF conceptual framework for malnutrition and child development (2013; revised later)
Immediate vs underlying vs basic causes (UNICEF framework)
Living wage vs minimum wage (policy and economic implications)
Food deserts and food insecurity
Environmental determinants: lead pipes, water quality, pollution
Structural determinants: governance, policy, economic systems, and social stratification
Quick exam prompts or discussion questions
Explain how SDH and CDH interact to shape a health outcome in a given population.
Discuss why investing in mothers can yield population-wide health and economic benefits, using the UNICEF framework.
Compare and contrast the Malawi and Los Angeles case studies through the lens of SDH. Identify at least three determinants that most strongly influence child health in each setting.
Provide examples of how corporate practices (marketing, product design, and policy influence) can either harm or improve public health outcomes.
Propose policy interventions at local and national levels that could reduce health inequities highlighted in the case studies.
Notation and numerical references mentioned in the transcript
US federal minimum wage discussion: ext{minimum wage}
ightarrow ext{ ext{about } } 9 ext{ dollars/hour (mentioned in transcript)}Timeline reference: 02/2009 (mentioned as a benchmark for minimum wage history)
Activity timing references: 25 minutes for case study discussion, 15 minutes for group work, 20 past two and half past (class timing cues)
Case study names/settings: Malawi and Los Angeles, USA
Example figures and labels used in the dialogue (not numeric data points): $5 clothing credit; mentions of oranges, bananas, watermelons as foods but without quantified dietary data
Summary takeaway
Health is produced by a complex system of social and commercial determinants. Understanding both SDH and CDH, plus using frameworks like UNICEF’s, helps reveal why health disparities persist and where interventions can be most effective. The two case studies illustrate how maternal support, energy and food security, social networks, school-based programs, and policy environments intersect to shape health outcomes for children across different contexts.