Obesity Epidemiology

17Social Determinants ofObesityGary G. Bennett, Kathleen Y. Wolin,and Dustin T. DuncanIntroductionOver 2000 years ago, the philosopher Aristotle issued a simple, yet prescient thesis, writing,“Society is something in nature that precedes the individual.” Aristotle’s notion isone that is particularly salient today. In an era characterized by an explosion of researchinto fundamental biological systems, we are seeing a parallel surge of interest in understandingthe social determinants of health. Myriad recent reports from the Institute ofMedicine, World Health Organization, United Nations, and other organizations haveemphasized the importance of more frequently considering social determinants as fundamentalinfluences on health and disease. The reader is directed to reviews providingthe theoretical bases of the social determinants perspective. 1 Briefly, however, the socialdeterminants approach requires attention to “the causes of the causes,” moving beyondthe individual to explore potential determinants occurring at multiple levels. While socialdeterminants clearly include factors reflecting sociodemographic (e.g., gender, nativity,race/ethnicity, socioeconomic position [SEP]) and psychosocial (e.g., stress, occupationaldemands, purely psychological constructs such as depression and anxiety) characteristics,they also include more upstream factors, including neighborhood characteristics,social structures, and the social environment. Certainly, one of the more important socialdeterminants of health in most societies is the level of economic development; in mostsocieties, greater development is associated with increased longevity, and reductions inthe prevalence of infectious disease. For most conditions, patterns of disease distributioncannot be fully explained by focusing solely on individual behaviors and healthpractices; health behaviors, rather, are heavily influenced by the broader social contextin which they occur. The challenge of the social determinants perspective then, bothfor epidemiological investigation and ultimately for intervention, is that while the moreupstream social determinants undeniably pattern individual-level behavior, the ubiquityin and variability of social determinants challenges their empirical assessment. This isparticularly the case when one considers social determinants in a global context, as manysuch determinants are influenced by globalization, and the increasing inequities betweenindustrialized and nonindustrialized nations.The social determinants perspective is one that is particularly well suited to obesityresearch, conducted both in the United States and in most of the industrialized world.342