Understanding Determinants of Health, One Course at a Time

By Brianna Vargas, IGHS master's student

Brianna Vargas

Growing up in Pomona, California—a low-income neighborhood on the outskirts of Los Angeles county inhabited predominantly by people of color—I saw firsthand how poverty, trauma, interpersonal violence, and other social determinants can have an impact on human health and happiness. As a child, I did not have the language to explain these phenomena, but I understood and would often witness people engaging in victim blaming. Hearing this was frustrating because I knew that the deep intersections between social determinants and health were much more complex than most people understood. I realized early on that I wanted to help all people in their endeavors to be healthy and happy, and I understood that such a complex task would encompass addressing these larger structural issues.

With courses like Socio-Cultural and Behavioral Determinants of Health and an elective Women’s Health and Empowerment in the winter quarter of the Institute for Global Health Sciences (IGHS) master’s program, I knew this quarter would be my favorite. Not much can beat the feeling of reading Michael Marmot or Paul Farmer to learn about ideas like structural violence, which Farmer et al. explain in Structural Violence and Clinical Medicine as the “social arrangements that put individuals and populations in harm’s way… they are embedded in the political and economic organization of our social world; they are violent because they cause injury to people (typically, not those responsible for perpetuating such inequalities).”

These are truths that I witnessed in my hometown. Take for example, how the built environment shaped the resources available to us: in my neighborhood the nearest places (within walking distance) to buy food were McDonald’s and a liquor store. My family and I would often drive to a grocery store a few miles away, but what about our neighbors with multiple children in households that did not have cars? This food desert contributed to a lot of food insecurity and concurrent health issues for folks in our neighborhood. Food insecurity, poor living and working conditions, stress, violence, and laws and policies that perpetuate structural violence all take a toll on an individual’s ability to lead a healthy life.

When examining HIV disparities in our courses, we see that these and similar factors have direct impact on disease course, treatment, mental health, and adherence. The empowerment of individuals is central to the social determinants of health and can be achieved through inclusion in society and fulfilment of human rights. According to the World Health Organization, health is “a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity.” This definition was established in 1948, and it rings increasingly true for us today in a world where global health professionals strive to reach health equity.

Every day in the master’s program, I gain the knowledge and tools necessary to comprehend—on a more meaningful level—my past, present, and future experiences. I am lucky enough to engage in these moments alongside likeminded and amazing individuals in my cohort. The conversations we have, both inside and outside the classroom, teach me different perspectives and how to be a strong advocate for vulnerable populations, including my own Latinx community. Through these courses and continued engagement, I have learned that we cannot let frustration, anger, and grief regarding the current national and global political climate thwart our efforts to bring positive change. Instead, we must sit with those feelings and allow them to motivate and inspire us to take meaningful action.

We are exploring often-upsetting evidence and challenges, such as:

  • One-quarter of girls in the global South live in extreme poverty.
  • In this region, suicide is the #1 killer of girls, followed by maternal mortality.
  • 75% of HIV positive African youth are girls.

We are also learning that we can create opportunities with these communities for improvement in the lives of millions:

  • Additional years in school can delay childbearing and decrease risk of HIV transmission in girls and women.
  • One additional year of secondary school is associated with a 15-25% wage boost.
  • Breaking intergenerational cycles of poverty will lead to healthier and better-educated future generations.

Developing countries, vulnerable populations, displaced individuals: these are not just terms we read about, they are real places and human beings throughout the world who have the same desires and rights to health, safety, and happiness. The IGHS master’s curriculum has placed clear emphasis on our ability to advance our careers and become leaders in the rapidly growing and interdisciplinary world of global health. We are tasked with doing the meaningful work and influencing decisions that will end structural violence and improve the health of many. We are the future of global health.