Then, Now, Next: Unpacking the Shifting Trajectory of Social Determinants of Health

This paper examines the evolving trajectory of the Social Determinants of Health (SDOH), tracing their development from early observational studies to contemporary, interdisciplinary frameworks that emphasize structural inequities and relational dynamics. It explores foundational milestones such as the Whitehall studies, the Heckler Report, and the World Health Organization’s conceptual models, which positioned SDOH as key drivers of population health. The paper highlights how upstream determinants—such as governance, policy, and socioeconomic systems—influence downstream health outcomes through mechanisms of social stratification and unequal access to resources. While SDOH are increasingly applied in clinical and educational settings, significant challenges persist, including underinvestment in community systems, fragmented care models, and political rollbacks of equity-centered policies. The paper critiques deterministic and deficit-focused framings of SDOH and underscores a shift toward more relational, context-sensitive, and agency-oriented approaches, reflected in the emerging concept of “social dynamics of health.” It highlights the importance of experiential education, competency-based curricula, and digital innovations in driving systemic transformation. Emphasis is placed on reimagining SDOH pedagogy and expanding interdisciplinary, data-driven research to bridge the gap between knowledge and practice. Amid shifting political landscapes, sustaining health equity efforts requires embracing adaptive, participatory models that acknowledge power, community agency, and structural change.