When people think of health, they often think of doctor’s offices and vitamins, not power and place. The truth is, health happens in community, school, and the places people spend their time. The current day differences in health outcomes between different neighborhoods did not evolve by chance or by the choice of the residents. Rather, the differences can be traced to intentional processes and policies designed to exclude some people based on race, sexual orientation, immigration status, age, disability status, and religion from the benefits of full membership in our society.
The Framework for Health Equity (see below), developed by the Bay Area Regional Health Inequities Initiative (BARHII), helps explain how health happens and what we need to do to ensure health happens for everyone. The right side of the framework shows that our health is influenced by a combination of our access to health care, our genetics, and our personal choices. This is known as the medical model and research shows that health care and genetics are responsible for less than 30 percent of our health outcomes – our chances of developing diabetes, and so on.
The other 70 percent or more lies with the social, political, and economic environments that shape the choices we make. These are called the social determinants of health and their influence on health can be explained by the socio-ecological model, or the left side of the diagram below. Our values, beliefs and attitudes as a society influence our institutions, such as our schools or our financial system. These systems, and the rules and practices they enact and promote, in turn determine where business owners are permitted to open liquor stores, which parks are well-maintained, who gets a prime loan to buy a house, and so on. In other words, they determine the distribution of resources and opportunities and who has access to them. And to be healthy, one has to have opportunities to make healthy choices – to be able to afford healthy food and housing, good jobs that sustain a family, quality schools, breath air free of pollution, and so on. No amount of health care coverage will compensate for people who don’t have access to these essential opportunities for health.
That is why Building Healthy Communities place-based investments prioritize working with residents, the public sector, and other stakeholders to transform 14 communities by changing the policies and systems that shape them.
To learn more about the interplay between the Framework and how the work is being prioritized and implemented on the ground, check out our Drivers of Change.