Most chronic illnesses affecting adults around the world can be viewed in one of 2 ways: first and most commonly, as a biological cascade of events that must be stopped through medicine and/or surgery, or second, as a disease of social structures and inequities, which requires public health campaigns and policy reform. Should we consider atherosclerosis in an obese 60-year-old to be a process of foam cells and macrophages or of food deserts and sedentary lifestyles? These 2 approaches can be integrated when viewed as a continuous causal pathway, with the social determinants of health leading at the top as the “causes of the causes”1 and with everything else following from it.