Fig. 4.

Connections and consequences of social determinants of health in the context of COVID-19 risk. We propose that social determinants of health are the root causes of health disparities at the population level. Upstream social determinants contribute to midstream factors, such as environmental conditions and occupational factors, which in turn mediate the effects of social determinants of health on downstream health outcomes, including obesity and diabetes, among others. Finally, excess downstream COVID-19 risk is proposed to result from the upstream and midstream factors. Examples of each determinant and their contribution to COVID-19 risk are presented.