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Volume 4: No. 3, July 2007
ESSAY
Changing Times: New Possibilities for Community Health and Well-Being
This figure illustrates the Institute of Medicine's (IOM) model of the multiple determinants of health. The model is represented by an inner circle and four outer
circles. Within the innermost circle are
- Innate individual traits: age, sex, race, and biological factors
- The biology of disease
The first circle outside the center circle represents individual behavior;
the next circle represents social, family, and community networks; the next
circle represents living and working conditions; and the outermost circle
represents broad social,a economic, cultural, health, and
environmental conditionsb and policies at the global, national, state, and local levels. The figure includes a note defining living and working
conditions as including the following:
- Psychosocial factors
- Employment status and occupational factors
- Socioeconomic status (income, education, occupation)
- The natural and built environmentsc
- Public health services
- Health care services
a. Social conditions include economic inequality, urbanization, mobility, cultural values, attitudes, and policies related to discrimination and intolerance on the basis of race, gender, and other differences.
b. Other conditions at the national level include major sociopolitical shifts such as recession, war, and governmental collapse.
c. The built environment includes transportation systems, water and sanitation
systems, housing, and other dimensions of urban planning (6).
Figure. The IOM
Model of the multiple determinants of health (6).
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