Health is shaped far more by daily conditions than by time spent in a doctor's office. The federal Healthy People 2030 plan groups these conditions into five areas: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.
In 2008, a World Health Organization commission concluded that social injustice was killing people on a grand scale. In the US, the link is visible in neighborhoods shaped by redlining and highway construction, which today often have more air pollution, fewer grocery stores and less tree cover. Low-wage jobs without paid sick leave or insurance add to the toll.
The term is sometimes criticized for sounding neutral, as if these conditions arose on their own. Many advocates now use "structural determinants" to point to the laws and policies that created them. Addressing them means housing, wage, transit and environmental policy, not only health care.