Report Publish Date: March 2023
This issue brief describes the main findings from the What Shapes Health and Well-Being survey of 5,450 state and local leaders.
More than 9 in 10 leaders surveyed believed people’s choices about diet, exercise, and smoking affect their health and well-being. Nearly 9 in 10 believed the healthcare they get plays a role. Nearly 8 in 10 believed the place where people live matters to their health.
Many leaders believed addressing health care inequities and coordinating across health care, social services, and public health, as well as other steps, would improve people’s opportunities to be healthy, but far fewer had confidence their organization would take these steps.
The biggest barrier to helping residents have opportunities to be healthy, according to those surveyed, is not having enough funding, staffing, or services.
The authors wanted to know how state and local leaders understand and talk about the social determinants of health.
“Because leaders are in a unique position to advance programs and policies that improve health and well-being for all, understanding their views on what shapes health and well-being is key to improving population health,” the authors write.
The authors surveyed 5,450 leaders from nine sectors between October 2020 and March 2022. The leaders came from city councils, nonprofits and faith groups, city and state agencies, large employers, universities, economic and community development organizations, and other groups.
“Despite perceived barriers, leaders want to advance health equity, enable meaningful collaboration with residents, facilitate cross-sector collaboration, and promote equitable allocation of resources.”
—Emily Hoe, Nyna Williams, and Martha Kovac, Mathematica
Many leaders lacked confidence in their organization’s ability to effectively take action. The authors recommend tools like the Assessment for Advancing Community Transformation Tool to help state and local leaders work toward change.
Social determinants of health (SDOHs)—the conditions in which people are born, live, learn, work, play, worship, and age—are vital levers in efforts to advance health equity (Artiga and Hinton 2018; Braveman et al. 2017; Marmot and Allen 2014). Research suggests that SDOHs such as socioeconomic status, education, employment, and social support networks account for 30 to 55 percent of health outcomes (World Health Organization n.d.). Despite a strong evidence base on how SDOHs can increase or limit people’s opportunities to be healthy, few studies have explored how state and local leaders (hereafter “leaders”) view, understand, and talk about these concepts. Because leaders are in a unique position to advance programs and policies that improve health and well-being for all, understanding their views on what shapes health and well-being is key to improving population health.
To better understand the views and knowledge of people in positions of influence in state and local communities, RWJF partnered with Mathematica to field a nationally representative survey of leaders in the United States. These leaders represent influential people in local communities, businesses, and state-level organizations whose views and actions can affect the health of the community. We sampled leaders from 50 states, 325 cities, and nine sectors to take part in this study.
Mathematica, March 2023
Exhibit 2. Factors that affect people’s health and well-being Page 3
Exhibit 3. Factors that are important for residents to have access to Page 4
This study and report was conducted and created by the following:
