Social Determinants in the United States

Abstract

Abstract This chapter studies the social determinants of health in the United States, focusing on one important but often overlooked social determinant: law. It explains how law influences social determinants and why law should itself be viewed as an important social determinant, one that can both magnify or diminish health disparities. Law can affect population health in numerous ways. Most obviously, laws create, empower, and restrain state, local, and federal public health agencies; regulate the delivery of healthcare; and seek to promote population health by regulating unsafe practices and activities, such as smoking. Health laws, however, are not the only laws that affect health. Laws that affect employment, income inequality, housing, the built environment, and education may also impact health. The chapter then considers some defining features of US law that may play a role in creating or perpetuating health disparities both within the US and between the US and other nations of the Organisation for Economic Cooperation and Development. It also reviews some recent initiatives in the US, many but not all undertaken via law, to address social determinants, and it looks at the barriers that remain to ameliorating social determinants through law, as well as some reasons for optimism.