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                                          Volume 4: No. 3, July 2007                                                                                                                                                                                                                                                                                                                                                                                                                                                         
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  Emerging Infectious Diseases Journal
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Volume 4: No. 3, July 2007
                                          ESSAY                                                                                                                                                                                                                                                                                                                                                                                                                                                                              
                                          Changing Times: New Possibilities for Community Health and Well-Being                                                                                                                                                                                                                                                                                                                                                                                                              
 
     Archivo de números en español                                                                                                                                                                                                                                                                                                                                                                                                                                                                                           
                                          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:
               Search PCD                 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
  Emerging Infectious Diseases Journal      * Health care services                                                                                                                                                                                                                                                                                                                                                                                                                                                           
 
  MMWR                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                       
                                          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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    The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions. Use of trade names is for identification only and does not imply endorsement by any of the groups named above.  
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