Law in a Social Determinants Strategy: A Public Health Law Research Perspective

Research in social epidemiology over the past three decades has shown convincingly that population health is shaped to a significant degree by fundamental social conditions. The social production of health is sufficiently complex to preclude simple causal attributions, but consistent correlations across populations between health and various measures of social and economic status leave little room for doubt that social arrangements account for an important fraction of population health. Efforts to find the mechanisms of these effects are ongoing, and progress is seen in findings about, for example, the powerful role of stress across the life course.1 Although in the U.S. we tend to hear most about racial/ethnic disparities, these inequities are as much a matter of class as race or ethnicity. Responding to the findings of this social epidemiology is perhaps the true grand challenge of our time in public health. Whether or not it is grand, it is certainly difficult, from both the research and implementation points of view. The efforts of the National Center for HIV/AIDS, Viral Hepatitis, STD, and TB Prevention (NCHHSTP), described in a 2010 white paper,2 represent an extremely valuable contribution to meeting the challenge of health inequities. In this commentary, I offer a public health law researcher's thoughts on practical efforts to address the social determinants of health (SDH), and how law and research on law can best support the effort. I distinguish two relationships between law and social determinants and suggest—via a quick tour through the work of Geoffrey Rose—the importance of integrating law more frequently into behavioral and social health research. Of course, this is epidemiology coming from an attorney, so caveat emptor—let the buyer beware'.