What Impacts Health
What Shapes Health and Equity
Many factors contribute to health and the conditions that shape how long and how well people live.
Safe housing, jobs that pay a living wage and well-resourced schools are among the factors, often called the social determinants of health, that make up a healthy community. How these conditions are created, distributed and maintained determines the opportunity for everyone to thrive. Written and unwritten societal rules – and how they are applied – shape conditions for healthy communities. Rules may be written in the form of policies and laws, or unwritten, in the form of worldviews and norms. Together, power and rules are the structural determinants of health.
People with power create, reinforce and modify these rules for their benefit. People and groups who hold power influence society’s rules and determine whether they are applied equitably. When power is concentrated in the hands of a few, it advantages their shared interests and often disadvantages interests aligned with good health for all individuals, groups, communities and even entire regions of the country. How well we include everyone in setting agendas, making decisions and sharing resources determines how well society’s rules shape daily living conditions will promote and preserve health for all. Everyone should have a say in creating society’s rules and in determining how they are applied.
We can structure our communities so that everyone realizes health and well-being. We can work across our differences and build solidarity by understanding the root causes of our problems and addressing them together. People created the rules and thus the conditions we live in today. We can change the rules to allow every community the opportunity to thrive today and in our future.
Structural racism: How rules and power can hold unfair conditions in place
Community conditions that support health and well-being are often distributed unfairly. These patterns harm racialized groups, women, queer communities and people with less income and wealth. Society's rules and the unwillingness of those with power to change them often hold these unfair conditions in place, structuring racism, sexism and classism into the fabric of our communities.
Structural racism is embedded in society’s unwritten rules through a worldview that white people are superior. It is also reinforced through governance and institutional practices that apply regulations in an unequal manner across communities. Structural racism is also present in society’s written rules. Policies and laws, such as voter registration laws, can make it difficult for people who experience structural racism to have a say in the decisions that affect them. These rules, set and applied by people who have power, unevenly affect living conditions and create patterns of disadvantage for racialized people and in communities where society has decided to disinvest. Such patterns of disadvantage also show up through under-resourced schools, unsafe housing and limited access to health care, and make it impossible to establish the conditions people need to be healthy.