The Gulf of Mexico is now the Gulf of America, yet its waters remain as briny as ever. Lake Ontario has been rechristened Lake America, but its autumn winds still howl. These symbolic renames, however, do not change the physical realities they describe. What truly needs a new name, argues a prominent physician and former state health chief, is the concept that has long defined how our surroundings, policies, and choices influence our well-being: the so-called “social determinants of health.”
Dr. Scott Rivkees, a pediatrician and former Florida surgeon general, contends that the term “social determinants of health” has for decades been a fixture in academic and public health circles, yet it remains opaque to the general public. He proposes renaming these factors “America’s determinants of health,” a shift that could crystallize the idea that Americans collectively shape the conditions that determine their health—especially through the ballot box. “We recognize that the individual and collective decisions about our lifestyles—from the food we eat, to the education and healthcare we receive, to where and how we live—are determinants of our health,” Rivkees writes. He adds, “Over the last few years, politics has increasingly shaped these determinants, often in not so favorable ways.”
From Pregnancy to Childhood: The Political Stakes
The determinants of health begin before birth. In the United States, maternal mortality and premature birth rates are among the worst in the industrialized world, a crisis tied to inadequate healthcare access, poor nutrition, and housing instability. Rivkees points to a new and potent determinant: anti-abortion policies in several states. These restrictions, he argues, are driving obstetricians out of red states, creating “healthcare deserts” for pregnant women. This trend is not just a matter of reproductive rights but a public health emergency, as abortion access becomes a pivotal midterm issue.
Early childhood experiences also leave lasting marks. Adverse childhood experiences—rooted in educational, housing, dietary, and healthcare disparities—are linked to higher rates of cardiovascular disease in adulthood. More immediately, the current federal leadership’s undermining of immunization policies has led to falling vaccination rates and the resurgence of vaccine-preventable illnesses. “Vaccine-related determinants of health extend far beyond childhood,” Rivkees notes, pointing to lifelong protections against diseases like hepatitis B.
The Mental Health Crisis and Environmental Threats
Children’s mental health, now recognized as a national crisis, is shaped by societal and economic factors: social media’s corrosive influence, declining face-to-face interaction, and a shortage of pediatric mental health services. Rivkees criticizes elected officials for failing to enact federal regulations on online platforms, a step other countries have taken. “Despite recognizing the perils and impact of these determinants, it is surprising that America’s elected officials have not enacted federal laws regulating online media,” he writes.
Environmental health is another arena where policy choices have direct consequences. While tobacco use has been successfully curbed through public health campaigns, individuals cannot choose the air they breathe or the water they drink. Air and water pollution contribute to asthma and elevated cancer risks, yet federal standards to curb these pollutants are being rolled back. “These rollbacks will predictably harm health,” Rivkees warns.
The Safety Net Under Threat
The United States has long acknowledged the health impacts of poverty and hunger, creating programs like SNAP and Medicaid to mitigate them. Medicaid covers roughly 20% of Americans, and Medicare insures more than 90% of those over 65. But the One Big Beautiful Bill Act of 2025 slashes over $900 billion from Medicaid and about $200 billion from SNAP over the next decade, threatening coverage and food assistance for millions. Rivkees argues these cuts will disproportionately harm rural communities, where the new $50 billion Rural Health Transformation Program—aimed at addressing social determinants—will not offset the closures of more than 20% of rural hospitals. “These budget reductions disproportionately hurt rural America,” he says.
Rivkees’ call to rename these factors as “America’s determinants of health” is not mere semantics. It is a recognition that the conditions we live in, the support government provides, and the health policies we enact all flow from the choices we make—and the leaders we elect. As doctors flood midterm races to counter the administration’s health agenda, the stakes could not be higher. Renaming a body of water does not change its nature; but renaming a concept can reframe how Americans understand their power over their own health.
