THRIVE Community Health Factors

The 13 community health factors either directly influence health and safety outcomes (e.g., air and
water quality) or directly influence behaviors that in turn affect health and safety outcomes (e.g., the
availability of healthy food affects nutrition). These same factors apply to every community because
the differences between more disenfranchised communities and the more privileged is not that they
suffer from different illnesses and injuries. Rather, for the most part, its the same health problems only more so, with greater frequency and severity. The factors are organized into 3 interrelated
clusters: equitable opportunity, people, and place.
Use the links to the left to navigate to specific factors described below.

EQUITABLE OPPORTUNITY
This cluster refers to the level and equitable distribution of opportunity and resources. Access and
equity affect health in fundamental ways and over a lifetime. The availability of jobs with living
wages, absence of discrimination and racism, and quality education are all important. Underlying
economic conditions play out through a variety of effects1 and poverty is closely associated with poor
health outcomes.2 Economic inequity, racism, and oppression can serve to maintain or widen gaps
in socioeconomic status.3 Individual income alone has been shown to account for nearly one-third of
increased health risks among blacks.4 Further, it has been suggested that other factors such as
segregation make up the additional risk.5,6 Lower education levels are associated with a higher
prevalence of health risk behaviors such as smoking, being overweight, and low physical activity
levels.7 High school graduation rates correlate closely with poor health outcomes.8 The community
health factors in the equitable opportunity cluster are:

racial justice

jobs and local ownership

education

View the references for the above section.

THE PEOPLE
People: This cluster refers to the relationships between people, the level of engagement, and norms,
all of which influence health outcomes. Strong social networks and connections correspond with
significant increases in physical and mental health, academic achievement, and local economic
development, as well as lower rates of homicide, suicide, and alcohol and drug abuse.1,2 For
example, children have been found to be mentally and physically healthier in neighborhoods where
adults talk to each other.3 Social connections also contribute to a community's willingness to take
action for the common good which is associated with lower rates of violence,4 improved food
access,5 and anecdotally with such issues as school improvement, environmental quality, improved
local services, local design and zoning decisions, and increasing economic opportunity. Changes
that benefit the community are more likely to succeed and more likely to last when those who benefit
are involved in the process;6 therefore, active participation by people in the community is important.

Additionally, the behavioral norms within a community, may structure and influence health
behaviors and ones motivation and ability to change those behaviors.7 Norms contribute to many
preventable social problems such as substance abuse, tobacco use, levels of violence, and levels of
physical activity. For example, traditional beliefs about manhood are associated with a variety of
poor health behaviors, including drinking, drug use, and high-risk sexual activity.8 The community
health factors in the people cluster are:

social networks and trust test

participation & willingness to act for the common good

acceptable behaviors and attitudes

View the references for the above section.

THE PLACE
Place: This cluster refers to the physical environment in which people live, work, play, and go to
school. Decisions about place, including look, feel and safety; transportation; open space; product
availability and promotion; and housing can influence physical activity, tobacco use, substance
abuse, injury and violence, and environmental quality. For example, physical activity levels are
influenced by conditions such as enjoyable scenery,1 the proximity of recreational facilities, street
and neighborhood design,2 and transportation design.3 A well-utilized public transit system
contributes to improved environmental quality, lower motor vehicle crashes and pedestrian injury,
less stress, decreased social isolation, increased access to economic opportunities, such as
jobs,4 increased access to needed services such as health and mental health services,5 and access
to food, since low-income households are less likely than more affluent households to have a
car.6 What is sold and how its promoted also plays a role. For example, for each supermarket in an
African American census tract, fruit and vegetable intake has been show to increase by
32%.7 Further, the presence of alcohol distributors in a community is correlated with per capita
consumption. 8 Poor housing contributes to health problems in communities of color9 and is
associated with increased risk for injury, violence, exposure to toxins, molds, viruses, and
pests,10 and psychological stress.11 The community health factors in
the place cluster are:

whats sold & how its promoted

look, feel & safety

parks & open space

getting around

housing

air, water & soil

arts & culture

The determinants of health

Introduction
Many factors combine together to affect the health of individuals and communities. Whether people are healthy
or not, is determined by their circumstances and environment. To a large extent, factors such as where we live,
the state of our environment, genetics, our income and education level, and our relationships with friends and
family all have considerable impacts on health, whereas the more commonly considered factors such as access
and use of health care services often have less of an impact.
The determinants of health include:

the social and economic environment,

the physical environment, and
the persons individual characteristics and behaviours.
The context of peoples lives determine their health, and so blaming individuals for having poor health or
crediting them for good health is inappropriate. Individuals are unlikely to be able to directly control many of the
determinants of health. These determinantsor things that make people healthy or notinclude the above
factors, and many others:
Income and social status - higher income and social status are linked to better health. The greater the gap
between the richest and poorest people, the greater the differences in health.
Education low education levels are linked with poor health, more stress and lower self-confidence.
Physical environment safe water and clean air, healthy workplaces, safe houses, communities and roads all
contribute to good health. Employment and working conditions people in employment are healthier,
particularly those who have more control over their working conditions
Social support networks greater support from families, friends and communities is linked to better health.
Culture - customs and traditions, and the beliefs of the family and community all affect health.
Genetics - inheritance plays a part in determining lifespan, healthiness and the likelihood of developing certain
illnesses. Personal behaviour and coping skills balanced eating, keeping active, smoking, drinking, and how
we deal with lifes stresses and challenges all affect health.
Health services - access and use of services that prevent and treat disease influences health
Gender - Men and women suffer from different types of diseases at different ages.

Evidence base of health determinants

An evidence base about the impact that projects, programmes and policies have had on health is required to carry
out HIA. The best available evidence is used within the appraisal stage of HIA to determine what impacts may
occur (both positive and negative), the size of the impact (if possible) and the distribution of that impact in
different population groups. It is generally assumed that the evidence for health impacts exists, and that
searching and collating will provide the necessary evidence. Unfortunately this is not often the case, and the
evidence of health impacts is often not available. This is because of the long causal pathway between the
implementation of a project/programme/policy and any potential impact on population health, and the many
confounding factors that make the determination of a link difficult. Within the HIA it is important therefore to be
explicit about sources of evidence and to identify missing or incomplete information.
Providing a comprehensive review of the evidence base is not simple. It needs to draw on the best available
evidence that from reviews and research papers, and including qualitative and quantitative evidence. This
information must be supplemented with local and expert knowledge, policy information, and proposal specific
information.
However, there are examples where the best available evidence has been documented, and in some cases
summarised. These are presented below:

Transport
Food and Agriculture
Housing
Waste
Energy
Industry
Urbanization
Water
Radiation
Nutrition and health