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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 conditions^b 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 environments^c
• 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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