What is "determinant" in the social determinants of health? A case seen through multiple lenses

Social determinants of health are a subject of growing interest, yet criticisms have emerged about the way determinants are conceptualized in nursing. A tendency to focus on readily observable living conditions and measurable demographic characteristics can divert attention, it has been said, from the less visible underlying processes which shape social life and health. To illustrate how the analytic perspective determines what becomes visible or invisible as a "determinant" in health, this paper presents a case exemplar. Drawing from news reports and research in real estate economics and urban policy analysis, it explores a single local infectious illness outbreak through a series of progressively more abstract units of inquiry, considering mechanisms of lending and debt financing, housing supply, property valuation, tax policy, change in the structure of the financial industry, and international patterns of migration and capital flow, among other factors, which contributed in various ways to creating unsafe living conditions. An analytic exercise calling attention to dynamism and complexity in social processes, the paper offers a political-economy-based approach that serves as a cautionary note against oversimplification in discussions of health causality.