What is Cummins' emphasis in ecological approaches to public health?

• A. Health outcomes determined solely by individual choices.
• B. Environmental factors do not affect health.
• C. Environmental factors shape health, with emphasis on structural inequalities and environmental injustice.
• D. Geography has no role in health geographies.

Answer: (C)

In ecological approaches to public health, health outcomes arise from how people interact with their environments across multiple levels, not just from individual choices. Cummins emphasizes that environmental factors shape health, and he places special importance on structural inequalities and environmental injustice. This means that where people live, work, and play—pollution levels, housing quality, access to clean water and green space, and exposure to hazards—combine with social and political power to create health disparities. When certain communities bear a heavier burden of environmental risks and have fewer resources or protections, their health outcomes tend to be worse.

So the best choice reflects that health is shaped by environmental contexts and the unequal distribution of those environments, rather than being driven solely by personal behavior, being unaffected by the environment, or being unrelated to geography.