Health is about so much more than health care, or even a person's lifestyle or choices. Much of our health depends on factors that are outside of our skin and which we have little or no direct control over.
Public health experts call these the underlying determinants of health. While the basic concepts are pretty easy to understand, some quotes may help explain it better:
“When it comes to your health, your ZIP code is often more important than your genetic code.”
– Sara Gardner and Dr. Mary Bassett
“If we can’t live in healthy communities, we can’t be healthy.”
"In the long run, housing may be more important to health than hospitals."
Here are four ways to group these determinants (keeping in mind that they overlap):
These are the big picture factors. They include things like income, employment and poverty; education; housing and other land use; racism and other forms of discrimination and stigma; transportation; and, stress, among many other factors.
Many of the most serious health problems we face today are the result of the activities of industries (like polluting air and water, or pumping carbon into the atmosphere) or the products they sell (like alcohol, tobacco, guns, sugary beverages, and ultra-processed foods). We could also call these the corporate determinants of health, since powerful transnational corporations are responsible for the lion's share of this problem.
We tend to take our physical environment for granted, but when things go wrong - whether it's catastrophic climate change, dirty air or water, or harmful chemicals in our food or household products - the effects on our health and well-being can be very serious.
Many people like to put down politics and all things political, but we can't escape the fact that what governments do - or fail to do - matters a lot for our health. Protecting the public's health is one of the core duties of government.