I use the in-class discussions of the “social determinants of health” to discuss difference, considering how racism is implicated in health outcomes. I start by introducing the social determinants of health, using the WHO Healthy People 2030 as an outline: https://health.gov/healthypeople/objectives-and-data/social-determinants-health.

Once this concept has been introduced, we use an adapted version of lesson 6 and lesson 7 in “Type 2 Diabetes: A complex disease of gene and environment interactions” https://gsoutreach.gs.washington.edu/files/gem_diabetes_final615.pdf to breakdown type 2 diabetes as a multifactorial trait, considering how social determinants of health combine to influence the type of food people have access to, exploring how those determinants, sometimes more than genetic components and personal behavior choices, influence health outcomes for individuals.

To illustrate this point, we draw on place-based data, using GIS health data to discuss the association between rates of obesity, to rates of type 2 diabetes, to (importantly) geographic regions defined as a food desert. I have found the CDC to be a good source for this data. To bring this discussion more local, I rely heavily on a study by Drewnowski et al., 2019, that illustrates place-based measures of SES and property values, in comparison to soda and salad consumption. We delineate the difference between “choice” and “availability” in this discussion, considering how there are factors that may influence where someone is able to live, and based on their geographic location alone, their access to “health” (healthy food, preventative care, reactive care, etc.) may vary based on this location. https://www.sciencedirect.com/science/article/pii/S2352827318301113.

Drawing on historical resources, I really like to discuss the Hunger Winter, as a striking example of how social determinants of health can continue to impact subsequent generations. With a background in Public Health Genetics, I love being able to inject some conversations about epigenetics into class, as a mechanism for understanding how the social determinants of health have such a strong bearing on health outcomes. A favorite resource I use for this part of the discussion is a TedTalk by Annie Murphy Paul. This recording helps bridge our diabetes unit with our perinatal nutrition unit. https://www.ted.com/talks/annie_murphy_paul_what_we_learn_before_we_re_born