![]() ![]() This report makes frequent reference to a number of terms with meanings that vary depending on the context and the community of users. In addition to actors in communities, the report examines other elements that address the structures, policies, and norms needed to promote health equity. By showcasing many creative, forward-looking, and bold community-led solutions for achieving health equity, this report aims to provide a new narrative about health in the United States. Therefore, this report focuses on the promise of communities to create opportunities for their members to achieve their full health potential. People are heavily influenced by the communities they work and live in, and the diverse actors that make up the community ecosystem can be powerful producers of health and well-being. Community assets can be built, leveraged, and modified to create a context to achieve health equity. These factors are not intractable, and inequities in these factors can be mitigated by policies and community action in powerful ways (see Chapter 3 for a discussion of the evidence). The historic and ongoing interplay of structures, policies, norms, and demographic/geographic patterns shapes the life of every individual across the country. Community-wide and national problems like poverty, unemployment, poor education, inadequate housing, poor public transportation, exposure to violence, and neighborhood deterioration (social or physical) are among the factors that shape people's health, and they do so in unequal ways, thus contributing to health inequities. People inhabit environments shaped by policies, forces, and actions that influence their individual choices and behaviors over a lifetime and over generations. Although the life of a person is clearly more complex than that of a fish, this metaphor illustrates the futility of only addressing individual behaviors without considering the context. If the bowl in which a fish lives is dirty, or the glass is cracked and the water is leaking, the fish will never reach its full health potential, despite any individual effort. To put this more simply, Keyes and Galea (2016) describe the relationship between an individual and the conditions in which one lives using the metaphor of a fishbowl. Understanding the social determinants of health requires a shift toward a more “upstream” perspective-that is, the conditions that constitute the context in which an individual's behaviors are shaped. In the United States, health equity and equal opportunity are inextricably linked, and the burdens of disease and poor health and the benefits of wellness and good health are inequitably distributed among groups of people.Īlthough biology, genetics, and individual behaviors play a role in these differences, many health outcomes are more substantially affected by social, economic, and environmental factors. ![]()
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