Reworking the Social Determinants of Health: Responding to Material‐Semiotic Indeterminacy in Public Health Interventions

Corn dries in the highlands of Guatemala. In the background you can see packaging from USAID nutrition supplements, which has been repurposed into insulation. The Trump administration ended financial support for the supplemental nutrition program abruptly last year, but evidence of the program remains.
Photo by Emily Yates-Doerr


Both public health experts and medical anthropologists are concerned with how health is shaped by environmental forces. This creates an important cross‐disciplinary alliance, yet crucial differences in how the two disciplines tend to evaluate health remain. In this article, I compare public health’s “social determinants of health” framework with anthropological interest in the sociality of health and illness. I draw on ethnographic fieldwork in Guatemala’s highlands, to unpack (1) “the social,” (2) “determinants,” and (3) “of health.” Ultimately, I show how the social determinants framework is deployed in ways that risk undermining its stated health justice goals, and highlight the benefits of an approach that does not know what health is ahead of doing research and which works closely with communities to respond to the effects of its own intervention. The article argues for the need to rework the emphasis on social determinants to make space for health’s material‐semiotic indeterminacy.