| Summary: | Health of individuals and populations is now understood to be strongly influenced by social conditions and structures, yet health policy remains focused on addressing individual medical and behavioural factors instead of the more fundamental social factors that determine health. Without policies that address the social causes of health, there is a risk of not only imposing interventions that are ineffective, but also missing opportunities to adopt broader societal interventions that could produce significant health benefits for populations. For small-scale agricultural producers, one way to improve the social determinants of health is through certification systems that use production standards, monitoring, certification and labelling to identify and reward items produced under exemplary social conditions. This thesis examines the effects of Fair Trade certification, one of the most established product certification systems, on producers in order to understand its effectiveness as a market-based tool for improving the health of populations. A meta-study of the Fair Trade literature finds evidence that Fair Trade certification positively affects producer health through three main processes: improvement of material conditions (physical capital); better education (human capital); and more extended and robust social networks (social capital). Yet the research design of the reviewed studies limits the ability to conclude that benefits are the effects of certification and not associated with prior cooperative organization resulting in the adoption of certification. These shortcomings in research design were addressed through a case study of Fair Trade certified coffee producers in Rwanda. Given the importance of social structure for health outcomes, the study tested the relative importance of Fair Trade certification versus cooperative organization for producer-level social capital. Regression analyses of farmer survey data and interview responses indicate that both Fair Trade certification and cooperative organization are associated with dimensions of social capital. It seems that prior social organization matters more than certification, and how much more depends on a farmer’s particular experience of his/her producer organization. The research suggests that government and non-governmental organizations may help ensure positive effects of Fair Trade certification on the social determinants of health of producers through interventions that strengthen cooperative producer organizations.
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