BLOG

As largely unpreventable contributors to health disparities, social determinants of health (SDOH) are a concern throughout the world. The seventh edition of Schneider's Introduction to Public Health, a classic textbook in public health education programs, delivers a new perspective on the critical role of SDOH in shaping public health. The authors have woven expert insights and examples to help public health students recognize these influences and respond to them.

"We wanted to make sure that there is a clear understanding for the instructor and student that a lot of what happens in terms of our health outcomes are not necessarily under the control of the individual,” said Andy Moralez, PhD, MPH, CHES, a public health educator who wrote much of the book content focused on SDOH.  “Where you grow up — sometimes your ZIP code alone — is just as predictive of your health as the behaviors you engage in."  

The new edition of Schneider’s Introduction to Public Health fosters greater understanding of SDOH and seeks to prepare the next generation of public health professionals to address the complex challenges faced by many communities today. 

Public health faculty can access instructor resources and sample content here.

Jones & Bartlett Learning spoke with each author of the revised and updated text to learn more about their areas of expertise and their contributions to the book content.

This article spotlights the reasons why SDOH is a significant new emphasis in the text; other articles in this series will explore content on climate change and pandemic response and help faculty align the new book to required competencies.

Shifting the Narrative to Encompass Social, Economic & Environmental Influences

The seventh edition of Schneider's Introduction to Public Health charts a fresh path for teaching foundational principles of public health, and an expanded focus on SDOH and cultural determinants of health is a notable change in the content approach. (Get an overview of the seventh edition in this article.)

Moralez and coauthors Jessica Kruger, PhD, MCHES, and C. Eduardo Siqueira, ScD, MD, MPH, sought to ensure that students and instructors understand that health outcomes are not solely determined by individual behaviors but are heavily influenced by broader social context. 

The authors developed the outline for the seventh edition to reflect more recent thinking on public health, with greater attention to the external factors that contribute to health. This approach aligns with current public health research recognizing the impact of social, economic, and environmental factors on health outcomes, Moralez said.

SDOH are described as the environmental conditions in which people are born, live, work, and age. The Centers for Disease Control and Prevention and World Health Organization classify SDOH in the five domains shown in the image below.

The revised textbook also introduces a life course perspective that encourages students to think about health from conception to death.

Moralez described this approach as teaching students to recognize moments that are transitional in terms of health, such as birth, housing situations, parental health, access to healthcare, and educational opportunities.

By examining health across the lifespan, students can better understand how early life experiences and social conditions shape long-term health outcomes, he said. 

Expanding the View of What Threatens Public Health

In comparison to previous editions of Schneider’s Introduction to Public Health, the new authors encourage a broader view of threats to public health. Public health efforts should expand beyond individual behaviors to the systemic factors that create health disparities, they contend.

"No one in public health would argue that tobacco use, sedentary lifestyle, dietary practices and alcohol use are not critical issues,” Moralez said. “But in my opinion the biggest public health enemy of our health is probably poverty and lack of resources. It’s where we grow up and who we are raised by and influenced by, and who we are modeling ourselves after.”

The authors share what Moralez described as “upstream thinking” to drive this point home. Using the analogy of a river, the book encourages future public health professionals to look to points of origin more often than they look downstream at results. 

“We added metaphors and stories to the text that were not in the previous editions, to help students contextualize what we're getting at,” he said.

The authors’ decision to broaden educational viewpoints on SDOH reflects the growing body of evidence showing that health equity can be advanced by addressing social, economic and environmental factors that influence health. For example, ongoing data analysis by the Kaiser Family Foundation shows that racism and discrimination negatively impact health and well-being. Across the most studied measures of SDOH, Black, Hispanic, American Indiana/Alaska Natives and Native Hawaiian/Pacific Islander people “fare far worse compared to White people,” the research shows.

Gaining a Broader Understanding of What Contributes to Health Outcomes

Moralez said he hopes that students who read the seventh edition of Schneider’s Introduction to Public Health take away a broader understanding of the causes of health outcomes. The authors of the text urge students to apply what they learn in the classroom to their own lives and communities. By recognizing the impact of SDOH, students can develop a more empathetic and comprehensive approach to public health, Moralez said.

“I think that due to the way we’ve modified this edition and made new additions, it will be more applicable to real life,” he said. “I hope students start to think about their own lives and the lives of others in terms of a kind of temporal life course to understand why we've included the impact of adverse childhood experiences as a critical determinant of health.”

Moralez emphasized that adverse childhood experiences (ACEs) are critical determinants of health and should be included in discussions and learnings about SDOH. Although ACEs fall into the category of mental health, which is traditionally viewed through a psychological lens, Moralez said it should also be considered from a community perspective, thus bringing it into the sphere of public health.

“We have to accept the fact that we did not all start off at zero,” he said. “Whether we have family wealth or we're living in poverty, the housing conditions that we were born into … nobody chose those conditions.”

Moralez also hopes the book will foster in students a greater understanding of themselves and others. “I hope it will help them recognize that whether we're talking about situations of drug addiction or adverse mental health conditions, or the obesity epidemic, we should take a wider perspective that considers why and how we get to where we are.”

Request a review copy of the new Schneider’s Introduction to Public Health here.