What is Health?

The WHO defines health as a state of complete physical, mental, and social well-being; not merely the absence of disease or infirmity.

Health is determined by many things:

  1. Social and economic factors
  2. Physical environment
  3. Health care
  4. Health behaviors
  5. Genes and biology

The 2017 Massachusetts State Health Assessment illustrates that genes, biology, and health care represent only a small percent of what makes us healthy (20%). Social and economic factors have a much greater impact (40%).


What makes us healthy?
Image courtesy of MDPH

Social Determinants of Health

Social determinants of health are economic and social conditions that influence the health of people and communities. These conditions are shaped by the amount of money, power, and resources that people have access to. Oftentimes, they are also influenced by policies, institutions, and systems created by people with access to money, power, and resources.

The result is not everyone experiences the same opportunities for good health. Where you live, work, and play is a strong dictator of your health and well-being (individual, family, or community).

Before moving on, see if you can list economic and social conditions that can influence health.

The following are some examples:

  • Access to good schools and affordable professional education
  • Being able to find and keep a job
  • The type of work a person does
  • Access to public transportation
  • Having enough food, or being able to buy nutritious food
  • Stable housing
  • A safe community that has open spaces, parks, and other recreational areas
  • Social supports
  • Freedom from discrimination and bias



The Massachusetts Department of Public Health (MDPH) has grouped social determinants of health into six categories:

  1. Built Environment
  2. Education
  3. Employment
  4. Housing
  5. Social Environment
  6. Violence


MA Six Social Determinants of Health Categories
Source: 2017 Massachusetts State Health Assessment

By identifying and prioritizing these categories, MDPH is aiming to transform inequitable policies, cultural norms, and structural barriers so that all people will have the same opportunity to be healthy, regardless of race, ethnicity, income, ability, sexual orientation, gender identity, age, or zip code.

Public Health 3.0

Public Health 3.0: A Call to Action to Create a 21st Century Public Health Infrastructure (PH 3.0) is a report that addresses the need to focus on the social determinants of health as a way of creating lasting health improvements for everyone. PH 3.0 is a new model that calls for local public health agencies to move beyond traditional roles and to engage multiple sectors and community partners to generate collective impact and achieve health equity.

Important Quotes

"We have made great strides in the last several years to expand health care coverage and access to medical care and preventive services, but these successes have not yet brought everyone in America to an equitable level of improved health. Today, a person's zip code is a stronger determinant of health than their genetic code.......In order to solve the fundamental challenges of population health, we must address the full range of factors that influence a person's overall health and well-being."

 "Public health is what we do together as a society to ensure the conditions in which everyone can be healthy......When we build a complete infrastructure of healthy communities, we can begin to close the gaps in health due to race or ethnicity, gender identity or sexual orientation, zip code or income."

-- Karen B. DeSalvo, Assistant Secretary for Health (acting), U.S. Department of Health and Human Services, PH 3.0