Public Health Institute
of Western Massachusetts

What Influences Health?

Health begins where we live, work, learn, and play — long before we visit the doctor’s office or walk in our local pharmacies. Our health is largely determined by the social, economic, cultural, and physical environments we live in — everything from where we work and live to our level of education and our access to healthy food and water.


These conditions are known as social determinants of health: the social and economic resources — such as housing, education, food access, and transportation — that support health and can determine length and quality of life. Too often, access to these health-determining resources remains outside individuals’ control. Many health inequities experienced by communities of color, low-income individuals, and other vulnerable populations are due to the lack of appropriate distribution of social resources, rooted in a history of discrimination at the individual, institutional, and structural levels. These social and economic factors have a significant impact on individual and community-level health.


Below are several images and models that illustrate factors that influence health.

What is Health Equity?

Health EquiTREE

The tree metaphor is designed to visualize how underlying systems, root causes, social determinants, and health outcomes are integral parts of a health ecosystem. Inequities in health outcomes and social determinants are a direct result of deeply rooted systems of oppression—policies, systems, and environments—and the culture and narratives in which they are steeped. The overlapping network of tree roots is an intentional design element illustrating the complexity of these influences that we must grapple with and embrace through our work to transform our communities.

The Health EquiTREE (2022), illustration by Health Resources in Action for the Massachusetts Community Health and Healthy Aging Funds. https://mahealthfunds.org/resources/

Building a Bridge to Health for All People

Reproduced with permission of the Robert Wood Johnson Foundation, Princeton, N.J.

Determinants of Health

model of the determinants of health. Individual lifestyle factors, social and community networks, living and working conditions, and general socio-economic, cultural and environmental conditions. Source: Dahlgren and Whitehead, 1991
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