A Few Words About Health


The World Health Organization defines health as a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.  Healthy People 2020 tells us that health begins at home by learning self-care, eating well and staying active, not smoking, having recommended immunizations and screenings, and seeing a doctor when we are sick to return us to health.

Health is also influenced by social and economic opportunities, resources available in our homes and communities; the quality of our educational institutions; whether or not we are employed and the reliability of that employment; workplace safety; clean water, food, and air; the nature of our social interactions and relationships.  These conditions explain in part why some people are healthier than others, and why we are not as healthy as we can be.

Social determinants of health

Environments in which people are born, live, learn, work, worship and play influence health.  The conditions in these environments are social, some are physical, and both are “place-based.”  The conditions in which we live can explain why some of us are healthier than others on the Eastern Shore. The following risk conditions shape health beyond lifestyle choice and available medical care.

Social determinants

  • Availability of resources to meet daily needs (e.g., safe housing and local food)
  • Access to educational, economic, and job opportunities
  • Access to health care services
  • Quality of education and job training
  • Availability of community-based resources in support of community living and opportunities for recreational and leisure-time activities
  • Transportation options
  • Public Safety
  • Social support
  • Social norms and attitudes (e.g., discrimination racism, and distrust of government)
  • Exposure to crime, violence, and social disorder (e.g., presence of trash and lack of cooperation in a community)
  • Socioeconomic conditions (e.g., concentrated poverty and the stressful conditions that accompany it)
  • Residential segregation
  • Language/literacy
  • Access to mass media and emerging technologies (e.g., cell phones, the Internet, and social media)
  • Culture

Physical Determinants

  • Natural environment, such as green space (e.g. trees and grass) or weather (e.g., climate change)
  • Built environment, such as buildings, sidewalks, bike lanes, and roads
  • Worksites, schools, and recreational settings
  • Housing and community design
  • Exposure to toxic substances and other physical hazards
  • Physical barriers, especially for people with disabilities
  • Aesthetic elements (e.g., good lighting, trees, and benches

Resources that enhance quality of life can have significant influence on population health outcomes.  Examples include safe and affordable housing, access to education, public safety, availability of healthy foods, local emergency/health services, and environments free of life-threatening toxins.

Health Disparities

Health disparities are preventable differences in the burden of disease, injury, violence or opportunities to achieve optimal health that are experienced by socially disadvantaged populations.  (Source. CDC. Community Health and Program Services (CHAPS): Health Disparities Among Racial/Ethnic Populations. Atlanta: U.S. Department of Health and Human Services; 2008.)

Health disparities result from multiple factors that are mostly explained by the social determinants of health.  The highest level of health requires valuing everyone equally, addressing avoidable inequalities and injustices, and eliminating differences resulting from social, demographic, environmental and geographic factors.