Structural Determinants of Health

The COVID-19 pandemic has made the underlying health disparities that exist in the United States more apparent. The traditional biomedical model places the responsibility of these disparities on the choices that an individual makes. The model assumes that one’s smoking, eating and exercising habits are based on personal choice. Therefore, the prevalence of morbidities such as high blood pressure, obesity and diabetes is the result of an individual’s poor decisions. This course will explore how the conditions under which individuals live, work, play and pray impact their health outcomes. Collectively these conditions are referred to as the Social Determinants of Health (SDoH) and often they reveal the systemic inequalities that disproportionately affect marginalized communities. This course will also call upon the need for a paradigm shift from the “Social” Determinants of Health to the “Structural” Determinants of Health. This shift is in recognition that it is the underlying structures (laws, material infrastructure) that impact health outcomes. The development of the SDoH has challenged health care providers to look beyond the biomedical model that stresses an individual’s behavior as the main predictor of adverse health conditions. Instead the SDoH focuses on an “upstream” approach that examines the underlying systemic and racial inequalities that impact communities of color and their health outcomes. An analysis that focuses upstream reveals that government policies and social structure are at the core of health disparities. Through the lens of New York City and its health systems, this course will cover a wide range of topics related to race and health, including: racial inequalities in housing and homelessness, biases in medical institutions, and the unconscious bias that lead providers to have racialized perception of an individual’s pain tolerance. In addition to exposing these inequalities the course will also provide innovative solutions that seek to mitigate these barriers including: home visiting programs, medical respite programs for homeless patients and food as medicine in health care systems. Students will demonstrate their knowledge through individual writing, and class discussion. The course revolves around important readings, lectures, and podcasts that illustrates how one’s class position and the color of one’s skin can influence the access to healthcare one has as well as their experie