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context; education; and economic stability. The fol-
lowing examples illustrate the nexus between the un-
equal distribution of the social determinants of 
health and health disparities: 
(A) The built environment influences resi-
dents’ level of physical activity. Neighborhoods 
with high levels of poverty are significantly less 
likely to have places where children can be 
physically active, such as parks, green spaces, 
and bike paths and lanes. Neighborhoods and 
communities can provide opportunities for phys-
ical activity and support active lifestyles 
through accessible and safe parks and open 
spaces and through land use policy, zoning, and 
healthy community design. 
(B) Emotional and physical health and 
well-being are directly impacted by perceived 
levels of safety, such as unlit streets at night. 
Community members have expressed that safety 
is not only a barrier to accessing programs and 
services that increase quality of life but they 
are also not able to access physical activity in 
their community through the built environment. 
(C) In many workplace environments, toxic 
chemicals have lasting detrimental effects on 
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employees’ health. The hazardous compounds 
found in most nail salon products affect the 
respiratory system, reproductive system, and 
central nervous system, and also cause kidney 
and liver damage. Recognizing the importance 
of addressing occupational hazards as a matter 
of public health, especially for Asian-American 
women who constitute 40 percent of nail salon 
technicians—with Vietnamese-American women 
accounting for 37 percent of this—the White 
House Initiative on Asian American Pacific Is-
landers has created an interagency working 
group to coordinate efforts by the Environ-
mental Protection Agency, Occupational and 
Safety Health Administration, Food and Drug 
Administration, and other Federal agencies to 
create programming, draft regulations, and con-
duct more outreach on educating workers on 
health and safety issues. 
(D) Historical and institutional discrimina-
tion against certain racial groups in the United 
States has shaped the way in which social and 
economic resources and exposure to health pro-
moting environments are distributed. Income, 
education, occupation, neighborhood conditions, 
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schools, workplaces, the use of and health and 
social services, and experiences with the crimi-
nal justice system are all highly patterned by 
race, with racial minorities (compared to 
Whites) experiencing more that is health harm-
ing. Finding ways to uncouple the link between 
race and access to resources and healthy envi-
ronments is a principal means of reducing 
health disparities. Additionally, the anticipation 
of racism itself causes higher psychological and 
cardiovascular stress levels that are linked to 
poor health outcomes. Remedying discrimina-
tory practices at the individual and systemic 
levels will likely reduce health disparities caused 
by this unequal distribution of stress. 
(E) Poor health among Native Americans 
has largely been driven by post-colonial oppres-
sion and historical trauma. The expropriation of 
native lands and territories to the American 
state had severe consequences on Native Amer-
ican health. This resulted in the deprivation of 
traditional food sources—and nutrients—for 
Native Americans and also the destruction of 
traditional economies and community organiza-
tion. Today, Native Americans have twice the 
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rate of diabetes than non-Hispanic Whites. Rec-
ognition of the origins of the diabetes as having 
a social and community context, rather than 
just individual responsibility and genetic pre-
disposition, will shape better policy to provide 
food security. 
(F) In the context of prisons, overcrowding 
has led to the deterioration of the physical and 
mental health of individuals after they leave 
prison. In particular, the mass incarceration of 
African-American males as a result of unequal 
contact with and treatment in the criminal jus-
tice system has contributed to an overburdening 
of certain infectious diseases within the African- 
American community. As a social institution, 
incarceration amplifies existing adverse health 
conditions by concentrating diseases and harm 
health behaviors such as tobacco use, drug use, 
and violence. 
(G) Educational attainment is the strong-
est predictor of adult mortality. It is a basic 
component of socioeconomic status by shaping 
earning potential to access resources that pro-
mote health. People with more education are 
less likely to report that they are in poor health, 
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and are also less likely to have diabetes and 
other chronic diseases. 
(H) Similarly, reading ability is a strong 
predictor of adult health status and is often 
correlated with other child health issues, such 
as developmental problems, vision and hearing 
impairments, and frequent school absence due 
to illness. 
(I) Individuals with lower levels of edu-
cational attainment are much more likely to re-
port to be current smokers. In 2011, smoking 
prevalence was 45.3 percent among adults with 
a GED diploma, 34.6 percent with nine to 11 
years of education, and 23.8 percent with a 
high school diploma, while dropping signifi-
cantly to 9.3 percent among adults with an un-
dergraduate college degree and 5.0 percent with 
a postgraduate college degree. 
(J) Social class differences account for a 
large part of health disparities. For example, 
children living in poverty experience poorer 
housing conditions, increased exposure to in-
door allergens and toxins (such as pesticides, 
lead, mercury, radon, air pollution, and carcino-
gens), and more psychological stress. These ex-
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