The Social Determinants of Health with Professor Laura Senier

This unit teaches students to understand what large-scale population health databases do or do not capture.  It begins by considering the ideological, political, and social forces that shape the questions we ask about health. It then considers how large-scale, population-level health data may nevertheless be useful in research on health inequities and how scientists and communities are working to collect additional data that will document evidence of health inequities. By identifying injustices, the unit posits, we can work for more protective policies that will create a healthier world for everyone. 

The first week explains social determinants of health, especially helping students understand the distinction between health disparities and health inequities. It reviews what kinds of data are collected to measure population-level health inequities and assesses the strengths and limitations of those data. It also explores the ways that researchers have leveraged population-level data collected by the US Centers for Disease Control & Prevention to advance health equity and social justice. Finally, the materials consider how community groups have mobilized to collect their own data on locally relevant hazards, in attempts to press for environmental cleanup and social justice. 

The second week offers some conceptual frameworks from sociology and public health that link information on environmental exposures to health outcomes, explicitly seeking to account for the effects of power and oppression. 

Week 1, Day 1: Measuring the Social Determinants of Health, Part I

Watch the Module Overview

Read before the first class:

• Galea, Sandro, Nicholas Freudenberg, and David Vlahov.  2006.  “A framework for the study of urban health.”  pp. 3-18 in Cities and the Health of the Public, edited by Nicholas Freudenberg, Sandro Galea, and David Vlahov.  Nashville, TN: Vanderbilt University Press.  
• Arcaya, Mariana C., Alyssa L. Arcaya, and S. V. Subramanian. 2015. “Inequalities in Health: Definitions, Concepts, and Theories.” Global Health Action 27106. doi: http://dx.doi.org/10.3402/gha.v8.27106.

Watch Lecture 1: Social Determinants of Health and Health Inequities

Week 1, Day 2: Measuring the Social Determinants of Health, Part II

Watch Lecture 2: Leveraging CDC Data to Assess Health Inequities

Read before the second class:

• Frieden, Thomas R. 2013. “Foreword.” In “CDC Health Disparities and Inequalities Report – United States, 2013,” supplement, Morbidity and Mortality Weekly Report 62: 1-2.
• Meyer, Pamela A., Paula W. Yoon, Rachel B. Kaufman. 2013. “Introduction.” In “CDC Health Disparities and Inequalities Report – United States, 2013,” supplement, Morbidity and Mortality Weekly Report 62: 3-5.
• Meyer, Pamela A. 2013. “Conclusion and Future Directions.” In “CDC Health Disparities and Inequalities Report – United States, 2013,” supplement, Morbidity and Mortality Weekly Report 62: 184-186.

In-Class Activity

• Divide class into three groups.
  • One group should read the “Social Determinants of Health” section of the 2013 CDC report on Social Determinants of Health, one groups should read the section on “Environmental Hazards,” and one group should read the section on “Behavioral Risk Factors.”
• Each team should prepare a presentation on the social determinants of health covered in their section of the report. For each indicator mentioned in the report:
  • Explain what is being measured and how
  • Explain where the data come from
  • Describe the overall health of the population, in terms of rates, absolute and relative percentages, odds ratios
  • Identify the subgroups that are at the greatest risk of exposure
  • Identify if there were any significant changes between the 2011 and 2013 reports
  • Comment on the strengths and limitations of the data
• Teams should report to the class as a whole. In large-group discussion, have students assess:
  • Patterns of disparities across types of exposures. Are there certain groups that are consistently at higher risk than other groups? 
  • Do you think these differences represent health disparities or health inequities?

Week 2, Days 1: Sociological Frameworks for Analyzing Health Inequities, Part I  

Watch Lecture 3: Sociological Frameworks for Determining Health Inequities

Week 2, Day 2: Sociological Frameworks for Analyzing Health Inequities, Part II  

Read before this class:

• • Senier, Laura, Phil Brown, Sara Shostak, and Bridget Hanna. 2017. “The Socio-Exposome: Advancing Exposure Science and Environmental Justice in a Postgenomic Era.” Environmental Sociology 3(2):107–21. doi: 1080/23251042.2016.1220848.
  • Zota, Ami R., and Brianna N. VanNoy. 2021. “Integrating Intersectionality Into the Exposome Paradigm: A Novel Approach to Racial Inequities in Uterine Fibroids.” American Journal of Public Health 111(1):104–9. doi: 2105/AJPH.2020.305979.
  • Zota, Ami R., and Bhavna Shamasunder. 2017. “The Environmental Injustice of Beauty: Framing Chemical Exposures from Beauty Products as a Health Disparities Concern.” American Journal of Obstetrics and Gynecology217(4):418.e1-418.e6. doi: 1016/j.ajog.2017.07.020.

Optional Supplementary reading for this week:

• Ruckenstein, Minna, and Natasha Dow Schüll. 2017. “The Datafication of Health.” Annual Review of Anthropology46(1):261–78. 

​These readings cover both introductory material discussing Health Inequities (Arcaya et al., Frieden, Meyer 2013a and b) as well as the way social and environmental factors structure health (Galea et al., Senier et al., Zota and VanNoy, Zota and Shamasunder). Finally, supplementary reading (Ruckenstein and Shüll) covers the challenges of the increasing datafication of health.

• Arcaya, Mariana C., Alyssa L. Arcaya, and S. V. Subramanian. n.d. “Inequalities in Health: Definitions, Concepts, and Theories.” Inequalities in Health 12.
• Ruckenstein, Minna, and Natasha Dow Schüll. 2017. “The Datafication of Health.” Annual Review of Anthropology46(1):261–78. 
• Frieden, Thomas R. 2013. “Foreword.” In “CDC Health Disparities and Inequalities Report – United States, 2013,” supplement, Morbidity and Mortality Weekly Report 62: 1-2.
• Meyer, Pamela A., Paula W. Yoon, Rachel B. Kaufman. 2013. “Introduction.” In “CDC Health Disparities and Inequalities Report – United States, 2013,” supplement, Morbidity and Mortality Weekly Report 62: 3-5.
• Meyer, Pamela A. 2013. “Conclusion and Future Directions.” In “CDC Health Disparities and Inequalities Report – United States, 2013,” supplement, Morbidity and Mortality Weekly Report 62: 184-186.
• Galea, Sandro, Nicholas Freudenberg, and David Vlahov.  2006.  “A framework for the study of urban health.”  pp. 3-18 in Cities and the Health of the Public, edited by Nicholas Freudenberg, Sandro Galea, and David Vlahov.  Nashville, TN: Vanderbilt University Press.   (15 pages)
• Senier, Laura, Phil Brown, Sara Shostak, and Bridget Hanna. 2017. “The Socio-Exposome: Advancing Exposure Science and Environmental Justice in a Postgenomic Era.” Environmental Sociology 3(2):107–21. doi: 
• Zota, Ami R., and Brianna N. VanNoy. 2021. “Integrating Intersectionality Into the Exposome Paradigm: A Novel Approach to Racial Inequities in Uterine Fibroids.” American Journal of Public Health 111(1):104–9. doi:
• Zota, Ami R., and Bhavna Shamasunder. 2017. “The Environmental Injustice of Beauty: Framing Chemical Exposures from Beauty Products as a Health Disparities Concern.” American Journal of Obstetrics and Gynecology217(4):418.e1-418.e6.