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Background (HIA) Toolkit

What do these pictures have in common? Answer: Decisions made in each of the areas (transportation, development, accessibility to healthy foods, education, etc.) have an effect on our health.
Hold mouse over the image for the answer

It has long been believed that our individual behavior (i.e. eating a well balanced diet, exercise, not smoking) and access to health care are the most important steps in achieving and maintaining good health. While these factors are important to our health, we are learning that there are a combination of other factors that are equally, if not more, important to our health. These factors are known as social determinants of health.

Not everyone has equal access to safe neighborhoods, recreation areas and working conditions, quality education and housing, affordable and convenient transportation and health care, and/or strong family and social support, etc. Individuals and communities that have limited access to these social determinants of health have higher rates of illness, disease, and death than individuals and communities with greater access to these determinants. This difference in health status due to unequal access to resources is known as health inequity. Health inequities are a result of social and economic policies that are unequal and unjust. Health inequities can be avoided through legislation that offers equal opportunity and access to resources for all groups of people.

Social Determinants of Health

  • Socioeconomic status
  • Discrimination
  • Housing
  • Physical environment
  • Food security
  • Child development
  • Culture
  • Social Support
  • Healthcare services
  • Transportation
  • Working conditions
  • Democratic participation


Lantz P. M, House J. S., Lepkowski J. M., Williams D. R., Mero R. P., Chen J. Socioeconomic factors, health behaviors, and mortality. JAMA. 1998; 279: 1703-1708

Diez Roux AV, Merkin SS, Arnett D, Chambless L, Massing M, Nieto FJ, Sorlie P, Szklo M, Tyroler HA, Watson RL. Neighborhood of residence and incidence of coronary heart disease. N Engl J Med. 2001; 345(2):134-6

Marmot MG, Smith GD. Socio-economic differential in health. J Health Psychol. 1997; 2(3): 283-296

Last Updated: 11-26-2013

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