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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, it’s 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:
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 one’s 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:
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 it’s 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:
View the references for the above section.
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