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The impact of vital conditions on community health

Written by Ruth Thomas-Squance, PhD, MPH on December 7, 2021

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“It was the best of times, it was the worst of times, it was the age of wisdom, it was the age of foolishness…” —Charles Dickens, “A Tale of Two Cities”

Written over 160 years ago, these words feel tailor-made for our lived experience wrought by the SARS-CoV-2 virus and the COVID-19 pandemic. As the virus swept through the U.S. and we grappled to adapt our systems to the challenges it created, the links among our health, our housing and our economic status became inescapable.

The conditions in which people are born, grow, live, work and age have been termed “the social determinants of health.” More recently, the field is adopting a holistic framework, called “vital conditions for well-being,” which emphasizes the multifaceted nature of our systems that combine to influence community health. These factors include clean air, humane housing, employment status and access to healthy foods.

The differential distribution of those factors across communities has a huge impact on community health and gives rise to observed differences in life expectancy that can be measured across areas sometimes just a few miles apart. The COVID-19 pandemic did not create the disparities in housing, transportation or healthy food access, but it certainly exposed and exacerbated them.

These vital conditions have become a focal point as sectors seek to promote their commitments to advancing racial equity. In addition, there is increasing movement to gather perspectives from multiple sectors to bear on the solutions needed to address these complex, cross-sector challenges.

Health equity has become a top priority for many health care organizations in light of national mobilization around racial justice, combined with the stark disparities in health outcomes based on race and ethnicity revealed during the COVID-19 pandemic. In seeking to deliver equitable care, the health care sector has become increasingly aware of the multitude of factors that impact community health outside of the clinical delivery system. This so-called move “upstream” has led to new, less traditional cross-sector partnerships—for example, investments in housing and other community infrastructure or career and workforce development. We can also appreciate the power and intersectionality that creation of the spaces that welcome us are as important for healing as medicine.

Beyond the health care sector, there have also been calls to extend investments for community health to other for-profit enterprises. These investments are not just the right thing to do, but vital to sustaining resilient, healthy and equitable communities for the health of the economy.

As we seek to redress patterns of disinvestment that have deprived too many of our communities, often along racial and ethnic lines, how can we think about the infrastructure that supports health and well-being? What role can we imagine for those shaping our built environment? While we continue to make advances in the quality of buildings internally, we can challenge the expansion to consider the broader role of the built environment for influencing the vital conditions. We can consider what type of infrastructure (grocery stores, affordable housing, child care, transportation), its geographic location and who has access to it.

In this reimagining, we can also create paths that move us from considering sustainability and energy efficiency “boutique” to recognizing they are essential tools in driving systemic change for health equity across our nation and beyond. In affordable housing situations, energy and water efficiency can make the difference to a food budget that impacts health and empowers communities, often those in areas substantially impacted by natural disasters to contribute to climate solutions. Furthermore. we have opportunities to take inclusive approaches that center residents in this process.

This post was originally published by the U.S. Green Building Council (USGBC) in preparation for the USGBC Pacific region communities, Bridging Occupant and Community Health.

Join the summit on Dec. 7-8th, 2021 to explore how the health of individuals relates to community and the important role the building industry plays in supporting health and wellness for all.


Ruth Thomas-Squance, PhD, MPH, is Senior Director of Field Building at the Build Healthy Places Network where she ensures delivery of high quality activities and content in line with the organization’s national Field Building Strategy.