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Recent national policy adoptions of the social determinants of health approach present enormous challenges to practitioners designing health promotion programs aimed at eliminating health disparities. This chapter provides a framework for understanding the social determinant rationale embedded in Healthy People 2020 and introduces the concept of place as an important consideration.

This chapter presents a conceptual explanation of social determinant thinking and describes the potential impact for traditional health promotion activities that target the at-risk populations.

Two major resources, the Health Impact Assessment Toolkit and the HHS Disparities Action Plan, have emerged as frameworks for developing a health in all policies approach that will enable health practitioners to enhance their social determinant interventions.

Current social determinant approaches and models need to be strategically tailored to interventions aiming to reduce health disparities. Additional research focusing on how these approaches are integrated within the existing health promotion program frameworks is required.

Very few health practitioners have had the opportunity to integrate a social determinant approach that emphasizes the concept of place and explores the consequences of using a health in all policies approach. This chapter serves as a practical introduction and outlines the major challenges.

The tipping point for the inclusion of social determinants of health in addressing health disparities occurred with the publication of Healthy People 2020. As this innovation begins to diffuse throughout the country, health practitioners will benefit by reviews and applications of the new rationale and model.

This chapter analyses and discusses local government health promotion in Norway.

Institutional theory indicates that political and administrative jurisdictions are path dependent in their policy formation and implementation. By using data from different sources this assumption is analysed and discussed according to health promotion in Norwegian municipalities. The main methodology is cross tabulations, bivariate correlations and regression is carried out to supplement analyses.

Municipalities are path dependent in their health promotion policies. They acknowledge and prioritize health behaviour independent of experienced socio-economic challenges, municipal capacity as size and income, and local government political profile. Competence devoted to health promotion can create changes in policies.

The rhetoric on determinants and social determinants in particular is new in Norway. Rhetoric on, and interventions, that highlight the social determinants of health need to be coordinated.

The chapter presents new knowledge on Norwegian local government health promotion and how this is implemented in relation to the challenges experienced.

Late nephrology referral, a problem currently identified across many high income countries, has been associated with reduced opportunities for delaying or halting the progression of chronic kidney disease (CKD), delayed dialysis initiation, reduced choice in treatment modality, increased morbidity and hospitalization, and premature death. Despite a recent finding that the progression of CKD nearly always presents warning signs, and despite the fact that all Canadians are entitled to receive medically necessary health care free at the point of patient entry, each year in the province of British Columbia (BC) a substantial number of people with CKD experience late or no referral to nephrology care prior to requiring renal replacement therapy. A subset of these CKD patients experience no referral and “crash” onto dialysis (experience an acute or emergent start). Existing research has not fully explored the range of potential health determinants that may affect the timing of nephrology referral. This paper adopts a “determinants of health” framework and assesses the impact of a variety of indicators on patients’ physical health, demographics, socioeconomic status, social support, geographic and health system characteristics. Using a late referral definition of <3 months and data on BC patients who began dialysis between April 2000 and March 2003, multiple regression analysis indicates that the following determinants have an independent effect on the timing of referral: cause of end-stage renal disease (p=<0.0001); age (p=<0.0001); race/ethnicity (p=0.0019); English ability (p=0.0158); marital status (p=0.0202); proximity to care (p=0.0118); and, “age by first language” (p=0.0244).

Urban green space can be viewed as a preventative public health measure. Nature contributes to health through disease prevention, disease management, and well-being (physical, mental, and social) promotion. Those contributions are based on improvement in health determinants. Nature and green spaces have been related to more physical activity, restoration and less stress, more social capital, and ecosystem services such as better air quality, less traffic noise, less heat island effects, more biodiversity, among others. Nature, vegetation, and green spaces have also been associated with better mental health, immune system, metabolic system, pregnancy outcomes, reduced cardiovascular disease, and premature mortality. This chapter presents the connections between nature and health, describing how nature impacts key health determinants, how those health determinants are associated with health outcomes (i.e. diseases, injuries, deaths), and provides examples of urban nature interventions that have been related to public health.

The Models of Child Health Appraised (MOCHA) project recognises that child health policy is determined to a great extent by national culture; thus, exploring and understanding the cultural influences on national policies are essential to fully appraise the models of primary care. Cultures are created by the population who adopt national rituals, beliefs and code systems and are unique to each country. To understand the effects of culture on public policy, and the resulting primary care services, we explored the socio-cultural background of four components of policy-making: content, actors, contexts and processes. Responses from the MOCHA Country Agents about recent key national concerns and debates about child health and policy were analysed to identify the key factors as determinants of policy. These included awareness, contextual change, freedom, history, lifestyle, religion, societal activation and tolerance. To understand the influence of these factors on policy, we identified important internal and external structural determinants, which we grouped into those identified within the structure of health care policy (internal), and those which are only indirectly correlated with the policy environment (external). An important child-focused cultural determinant of policy is the national attitude to child abuse. We focused on the role of primary care in preventing and identifying abuse of children and young people, and treating its consequences, which can last a lifetime.

Many in Generation Z are concerned about health, nutrition, and lifestyle. They are sensitive to the social determinants of health, represented through concerns about access to health care, viable and affordable housing, poverty, and unemployment. They are also concerned about food choices, their environmental footprint, and the way food is produced. There is similarly high awareness about the importance of nutrition for health. Despite engaging in physical exercise, Generation Z is also exposed to the risks associated with obesity and sedentary lifestyle.

A crucial contemporary public health issue is the construction and contestation of the relevance of the natural world to human health.

Taking a critical approach, this chapter examines how the natural environment as a health determinant is positioned in relation to the ‘social’ within social theory generally and social epidemiological studies of health, illness and disease specifically.

– This study shows how current constructions of social and natural environmental health drivers contour social approaches to the study of health and proposes an integrated social-ecological approach for generating new contributions of social epidemiology to research on environmentally driven health injuries.

– The research breaks ground for further social scientific studies of health and the environment and in particular substantiates the call for an extended notion of the ‘environment’ using ecological principles. Methodologically, the interdisciplinary reach of this research draws attention to the tensions that arise when working across the medical, natural and social sciences.

Epidemiology is often described as “the basic science of public health” (Savitz, Poole & Miller, 1999; Syme & Yen, 2000). This description suggests both a close association with public health practice, and the separation of “pure” scientific knowledge from its application in the messy social world. Although the attainability of absolute objectivity is rarely claimed, epidemiologists are routinely encouraged to “persist in their efforts to substitute evidence for faith in scientific reasoning” (Stolley, 1985, p. 38) and reminded that “public health decision makers gain little from impassioned scholars who go beyond advancing and explaining the science to promoting a specific public health agenda” (Savitz et al., 1999, p. 1160). Epidemiology produces authoritative data that are transformed into evidence which informs public health. Those data are authoritative because epidemiology is regarded as a neutral scientific enterprise. Because its claims are grounded in science, epidemiological knowledge is deemed to have “a special technical status and hence is not contestable in the same way as are say, religion or ethics” (Lock, 1988, p. 6). Despite the veneer of universality afforded by its scientific pedigree, epidemiology is not a static or monolithic discipline. Epidemiological truth claims are embodied in several shifting paradigms that span the life of the discipline. Public health knowledges and practices, competing claims internal and external to epidemiology, and structural conditions (such as current political economies, material technologies, and institutions) provide important contexts in which certain kinds of epidemiological knowledge are more likely to emerge.

This chapter presents an organizational learning approach to understanding the objectives and challenges of an National Health Service (NHS) Sustainable Development agenda, which involves the integration of social, ecological and economic concerns into organizational functioning, for example the construction and management of buildings, design and delivery of services, and employment of staff.

The approach is used to frame an empirical analysis of 11 Projects conducted by NHS organizations aiming to advance this agenda during a particularly active phase in the mid to late 2000s. The approach helps identify the assumptions of organizational purpose, strategy and practice inherent in proposals for Sustainable Development and expose the challenges these are likely to pose. This framing helps articulate a vision and identify the actor groups, and their guiding assumptions, which need to be engaged if progress is to be made.

The vision of Sustainable Development being promoted was predominantly one of an NHS contributing to the economic and social determinants of health through its procurement, service development and employment activities. Contributions to environmental determinants only took place where financial gains to the NHS organizations themselves made activities, such as investment in renewable energy, viable in the short-term. Within most Projects strategic tools able to predict and measure benefits had to be developed on-the-job and most received help from external agencies to do this work.

Rather than expecting individual NHS organizations to progress this agenda alone, others involved in the shaping of collective assumptions of the NHS' purpose and strategies for growth must be engaged in what can be viewed as a social process of learning.

The COVID-19 pandemic has impacted every community across the globe, but the global COVID-19 data show that the United States remains the most affected country where well over 666,000 people died, and approximately 40 million citizens became ill due to the virus' spread by mid-2021 (CDC, 2021). It is also noteworthy that extreme racial disparities in rates of COVID-19 cases and deaths are high in the United States, specifically among African American population. This situation is particularly evident among African American population in Alabama's Black Belt. Subsequently, COVID-19, racial disparities, and health inequalities have become central to the national and regional conversation. This chapter examines the associations between COVID-19, social determinants of health, and the systematic health disparity in African American population in Alabama's Black Belt region using Geographic Information Systems and the concept of uneven spatial development. Understanding the relationship between COVID-19 and these disparities within a spatial context vital to developing pathways to overcome the pandemic's effects and combat the systemic discrimination in this region. The derived policy recommendation could apply to other regions experiencing social inequality and health disparity.