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By: Ellie Denyszyn

Top 10 Factors of Health in the United States



Updated Top 10

Original Top 10 Factors



Healthcare workers have an overarching goal of helping people and keeping people healthy. Unfortunately, sometimes, we, as healthcare workers, narrow our scope and focus on one particular issue. While this can be beneficial in some cases, the cause is much more significant in most cases. Throughout the semester in population health determinants, students have learned about some overarching issues. At the beginning of the semester, students were asked what they believed were the top 10 factors that contribute to why some are healthier than others in the United States; given now students are much more knowledgeable on what the determinants are, they have been asked to go back and rework the original list.


Orignial Top 10 List


  • Things such as student loans, housing, etc. may take over a household's expendable income, which in turn will impact the level of overall care you have
  • Overall care would include: access to health resources, access to healthy food and water, access to quality transportation, and access to other things that will keep your lifestyle healthy and happy

#10: Expendable Income

  • Fitness, smoking and drinking habits, and diet will all contribute into how the human body transforms and adapts as you age

#9: Lifestyle

  • Practicing unsafe sexual relations may cause STDs, STIs, and unwanted pregnancy
  • Some STDs and STIs are life-threatening and can cause significant compilations down the road

#8: Fornication

  • Inability to speak for yourself may impact how healthcare workers are able to help you
  • Limited literacy could impact the way your question or concern is addressed, which could cause something to be overlooked or misdiagnosed

#7: Literacy

  • Limited access to food will cause delayed growth, loss of muscle, and decreased cognitive function
  • In addition to limited access, access to non-quality food may impact digestion

#6: Access to Food

  • People in service jobs and jobs where they may be chemically exposed to something have a higher risk of contracting a disease
  • Examples include firefighters, who may often inhale smog, and mechanics, who often work with heavy machinery and toxic equipment
  • High-stress jobs may cause depression and other mental illnesses

#5: Job


  • Poor and Rural areas often have less access to care and more opportunities that may comprise one's health
  • Take, for example, Flint, Michigan, and their contaminated water
  • Water pollution in places like Flint or in large cities where there is a lot of air pollution may cause worsened health over a long period

#4: Location

  • In some religions, such as a Jehovah's Witness, medicine and treatments may not be used
  • Avoidance of treatment may lead to worsened conditions or, in some cases death
  • On more of the mental health side, some religions choose to ignore things such as depression, as the person they believe worship can fix all such issues when this is not the case and often leads to worsened mental health

#3: Religion

  • The people you surround yourself with play a significant role in who you are as a person and what you engage in
  • Surrounding yourself with negative behaviors, especially from a young age, such as smoking, heavy drinking, or hard drugs, may play a role in choices made as one grows older

#2: Community

  • Social status and quality of healthcare received typically go hand in hand
  • If you grow up in a poor area, chances are that the local services are not going to be as well funded, which typically leads to decreased care and treatment

#1: Social Status

Updated top 10 list


  • The relationships people form can define one's quality of physical and mental health
  • Typically people develop similar behaviors of those we spend majority of our time with
  • Mental
    • Unhealthy relationships often lead to a decline in mental health
    • Poor mental health can manifest into poor physical health if not treated properly
    • Self isolation and lack of a network can also cause a decline in one's mental health
  • Physical
    • One who surrounds themselves with people engaged in risky behaviors such as drinking, smoking, abusing prescription drugs, and practicing unsafe sex are more likely to engage in said behaviors
    • Risks of which include liver damage, brain damage, cancer, STIs/STDs, addiction, and in some cases death
    • A study shown amongst people with coronary heart disease, those who self isolate are 2.4 times more likely to die due to heart complications as compared to more social adults
    • The same study also concluded those who don’t have frequent social interactions are at higher risk of being diagnosed with a cardiovascular disease, high blood pressure, and cancer amongst other illnesses

#10: Social Network

Social network greatly can impact one's mental health and decision-making and can manifest into physical health given the situation

Social Network (New) and Expendable Income (Old)

The factor of job and employment branches under the factors that contribute to socioeconomic status

Why Did The Factor Change?

  • The choices one chooses throughout their lifetime will have both short term and long term impacts on their health, these choices and their impacts include;
    • Diet: adults who eat a nutritional diet lower their risks of obesity, cardiovascular disease, diabetes, and certain cancers
    • Sleep habits: getting an inadequate amount of sleep can raise the bodies stress hormones
    • Tobacco use: smoking contributes to between 80 and 90% of all cases of lung cancer development
    • Physical activity: not only does physical activity lower risks of cardiovascular diseases but also is linked to improvement of mental health
    • Use of uncontrolled substance: while manifestations of substances greatly range based on the substance, overall use and abuse of uncontrolled substances lead to decreased brain function and increased mental health issues
    • Hygiene practices: studies have shown that if Americans washed their hands regularly, up to 1 million deaths could be prevented each year
    • Practicing preventive healthcare: overall, practicing preventative care decreases risks developing of all diseases

#9: Lifestyle

It remains on the list because of the significance it has based on choices, and can significantly increase or decrease one's chance of developing a health condition

Lifestyle Choices

Lifestyle choices have a high linkage to preventable diseases and life expectancy

Why Did The Factor Stay The Same?

  • Untreated mental health conditions have physical manifestations
    • Both depression and ADD/ADHD can cause people to feel lazy and unproductive, which can lead to lifestyle choices that cause deteriorating health
      • These“lazy" habits can make it hard for people to perform essential day-to- day functions and often result in people taking the easier route such as eating fast food as compared to making a healthy meal and staying in bed all day
      • While these choices are not inherently wrong, they can cause obesity, high cholesterol, sleep disorders, amongst other conditions
    • Eating disorders also have physical manifestations
      • Anorexia and Bulimia can cause heart problems, lowered metabolism and immune system, anemia, infertility and alopecia
      • Binge eating usually results in obesity
      • Pica can cause lead poisoning (from chewing on pencils), anemia, and constipation
      • Orthorexia leads to overtraining syndrome in addition to the results of anorexia and bulimia

#8: Mental Health Conditions

Fornication is a branch of lifestyle choices and, the negative impacts of practicing unsafe sex, such as STIs/STDs, do not present a large number of long-term consequences as compared to mental health conditions
Mental Health Conditions (New) and Fornication(Old)

Why Did The Factor Change?

  • Exposure to air pollution, often associated with highly industrialized and densely populated areas, can lead to respiratory problems and cardiovascular disease
  • Areas without access to clean water, are at risk of developing waterborne illnesses
  • Communities designed without areas of recreation such as sidewalks, playgrounds, and parks are at higher risk of obesity because it makes it harder for residents to engage in regular exercise
  • If a major disaster impacts a given area, it may be harder for people to find access to clean drinking water as well as food

#7: Environment

Environmentalfactors contribute to a large number of uncontrollable diseases

Enviorment (New) and Literacy (Old)

Literacy is a very broad topic and a subset of quality education

Why Did The Factor Change?

  • As people naturally age, bodily functions begin to slow down, resulting in being at higher risk for developing conditions
  • While there may be few immediate manifestations, over time the accumulation of the environment, lifestyle choices, and genetic predispositions can deteriorate one's health
    • For example a new and infrequent smoker may not experience any health issues but if they continue to smoke throughout life, they increase their risks of developing lung cancer
  • Age can also factor the youth population
    • Children often do not know that what they are experiencing may be a problem, leaving them without help
    • Children who do speak up their concerns are overlooked, and not taken with full seriousness
      • I myself have been a victim to this, and was prescribed an extremely high dosage after continually addressing the concerns with the frequent increase in dosage and the side effects i was experiencing and ended up being hospitalized for an overdose

#6: Age

Age (New) and Access to Food (Old)
Some can argue access to food can be put into both the socioeconomic and environmental categories since access is typically based on income and if there is an ecological factor slowing down food production, such as a drought or another major disaster that prevents adequate access to food. For this significant reason, it was best to scratch the factor entirely and bring in a major non-modifiable factor

Why Did The Factor Change?

  • One’s ability to communicate efficiently with providers can have great impacts (for better or worse) on one's physical health
  • 12% of Americans have proficient skills in health literacy
  • People with limited access to healthcare may struggle with navigating the complex health system, often leading to use unreliable resources
  • People with higher health literacy are better equipped with knowledge and resources they need to navigate their personal health
  • Problems that can arise from being health literate include:
    • Inability effectively communicate health concerns
    • Inability to identify medication labeling, dosing, and side effects
    • Lack of awareness of patient rights
    • Lack of understanding when signing patient documents
    • Misinterpretation of information

#5: Health Literacy

Health Literacy (New) Job (Old)

The factor of job and employment branches under the factors that contribute into socioeconomic status

While a job can contribute to one’s health, jobs tend to have much less of an impact on health as compared to many other factors on this list

(Health) literacy was moved up on the list due to the major impacts it has on a little under 90% of Americans

My original list literacy was included, but it is important to narrow it in on the health aspect of literacy

Why Did The Factor Change?

  • Certain individuals may be born with genetic differences that increase their likelihood of developing particular health conditions, including heart disease, cancer, or diabetes.
  • Genes can impact the way an individual's body responds to a given medicine, which could impact the effectiveness or longevity the medicine
  • Some individuals develop rare genetic disorders that have a predisposing impact on their health
  • Genetics can also play a role in the production and regulation of hormones if their is a genetic mutation it can cause there to be a lack of certain hormone production, or the hormone not being produced at all
    • For example if one has a mutation in the GH1 gene, they will not produce the growth hormone which will result in short stature and lack of muscle growth
  • Genetics also play into fat distribution and how easy it is for one to gain or lose weight

#4: Genetics

Location is a subset of environment, which is another factor on the updated list

Genetics (New) and Location (Old)

Location is a somewhat controllable factor; being that genetics is nonmodifiable, location should not be as highly factored

Why Did The Factor Change?

  • Lots of diseases and illnesses and labeled as either a male or female disease, which results in underdiagnosed from those whose genders are not associated with a given disease
    • Osteoporosis is considered a "female disease," which often leads male patients undiagnosed and untreated
  • Woman are at higher risk of developing certain conditions because the female body has smaller parts as compared to a male
    • Woman are more likely to get a UTI because the urethra is 1.5 inches as compared to the male urethra which is 8 inches long
    • Woman are more likely to develop CVD because the blood vessels are smaller. This is also why strokes are more common in women; blockages happen more easily in the female body
  • Just as with race; there is still sexual bias in the healthcare system
    • Woman are labeled as more emotional and dramatic, which sometimes leads to serious health concerns being overlooked

#3: Biological Sex

Biological sex impacts everyone regardless of their beliefs

Based of the US census and realistic judgement, between 5-7% of the US population will deny some form of healthcare due to religious beliefs or affiliation

Religious bias is much harder to judge unless one is openly discussing their religion

Religion can factor into the care one may or may not receive but it does not hold enough significance to remain on the list

Biological Sex (New) and Religion (Old)

Why Did The Factor Change?

  • Particular races may be more susceptible to developing certain conditions
    • White adults are at the highest risk of developing skin cancer
  • Unfortunately, in the United States, there is still a plethora of racial bias and discrimination
    • This often leads to people of African, Asian, and Middle Eastern descent getting significantly worse treatment
    • People of color are more likely to develop mental health issues due to racial bias
      • Black adults are 23% more likely to develop a serious mental disorder as compared to white adults
    • Racism has been linked to low birth weight and high blood pressure
  • White adults are the most likely to have health insurance
    • Lack of health insurance can create a barrier on what treatments can be afforded, leaving some suffering from treatable conditions

#2: Race

Racial disparities contribute to a large number of deaths, illnesses, and injuries that could have been detected earlier if people of color received the same treatment as others. We can see these racial disparities in cases such as maternal mortality. For every 100,000, black mothers contribute to around 55 of pregnancy-related deaths as opposed to white moms, which contribute to 19 deaths. In addition, the community is a big part of the environment and social network.
Race (New) and Community (Old)

Why Did The Factor Change?

  • Socioeconomic status is determined by a variety of factors including;social status, income, education level, job, and access to resources
  • Higher socioeconomic status is often associated with better access to healthcare
    • Individuals typically have insurance, which allows them to seek medical treatment without dealing with the burden of costly out of pocket medical expenses
  • Individuals with higher socioeconomic status often have engage in healthier behaviors because they are more educated on the risks of unhealthy behaviors, some of these behaviors include
    • Substance abuse
    • Overeating
    • Unsafe sex
    • Violating social rules
  • Jobs of people with lower socioeconomic status are typically more physically demanding, which often means higher risk of dealing with hazardous materials and a higher risk of workplace injury
    • Jobs of people with higher socioeconomic status have better health insurance

#1: Socioeconomic Status

Socioeconomic Status (New) Social Status (Old)

Social status is very hard to measure unless you are a highly influential person, socioeconomic status can be based on actual data from the areas that contribute to it

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Socioeconomic status also includes factors beyond one's ranking on the social pyramid making it a much more complex and easier to analyze

Why Did The Factor Change?

My future career path is pharmaceutical sales. Learning about the determinants of health can impact what communities and people I should be directing my sales towards. An example of this using the upstream approach is if I work for a pharmaceutical company developing a medication used to manage cholesterol levels. Instead of highlighting only its effects on lowering cholesterol, I can eduacte healthcare providers on the importance of an lifestyle modification. This can include things such as such as diet and exercise, alongside the medication. By providing comprehensive information, I will be not only promoting the product but also teaching others about the tools that can be used to have a more overall holistic approach. An additional example using cultural competence is if I was working for a company that was creating a new medication for a mental health condition. Given my understanding of cultural competence I can tailor my approach based on cultural nuances. This could include providing materials in numerous languages as well as using simple wording and clarifying what something is when talking about something that people do not have adequate health literacy may not understand.

Reflecting on the Implications

  1. American Psychiatry Association. (2020, December). What is a substance use disorder?. Psychiatry.org - What Is a Substance Use Disorder? https://www.psychiatry.org/patients-families/addiction-substance-use-disorders/what-is-a-substance-use-disorder
  2. Centers for Disease Control and Prevention. (2022, June 15). Hygiene fast facts. https://www.cdc.gov/hygiene/fast-facts.html#:~:text=Hand%20Hygiene&text=Researchers%20estimate%20that%20if%20everyone,a%20year%20could%20be%20prevented.&text=A%20large%20percentage%20of%20foodborne,foodborne%20illness%20and%20other%20infections.
  3. Center for Disease Control and Prevention. (2022, September 8). Poor nutrition. Centers for Disease Control and Prevention. https://www.cdc.gov/chronicdisease/resources/publications/factsheets/nutrition.htm#:~:text=Adults%20who%20eat%20a%20healthy,these%20conditions%20and%20avoid%20complications.
  4. Center for Disease Control and Prevention. (2023, May 19). Understanding health literacy. Centers for Disease Control and Prevention. https://www.cdc.gov/healthliteracy/learn/Understanding.html#:~:text=Health%20literacy%20can%20help%20us,health%20problems%20when%20they%20arise.&text=They%20aren%27t%20familiar%20with,affect%20their%20health%20and%20safety.
  5. Jia, X., Zhu, H., Sun, G., Meng, H., & Zhao, Y. (2021). Socioeconomic status and risk-taking behavior among Chinese adolescents: The mediating role of Psychological Capital and self-control. Frontiers in Psychology, 12. https://doi.org/10.3389/fpsyg.2021.760968
  6. NIDA. 2021, April 12. What are the physical health consequences of tobacco use?. Retrieved from https://nida.nih.gov/publications/research-reports/tobacco-nicotine-e-cigarettes/what-are-physical-health-consequences-tobacco-use on 2023, November 3
  7. Mental Health America. (n.d.). Racism and mental health. https://mhanational.org/racism-and-mental-health
  8. Public Religion Research Institutete. (2022, June 2). The 2020 Census of American Religion. PRRI. https://www.prri.org/research/2020-census-of-american-religion/
  9. Umberson, D., & Karas Montez, J. (2010). Social Relationships and Health: A flashpoint for health policy. Journal of Health and Social Behavior. https://doi.org/10.1177/0022146510383501
  10. United Health Group. (2020). County Health Literacy Levels. Health Literacy Key to Better Health Outcomes. United Health Group. Retrieved October 31, 2023, from https://www.unitedhealthgroup.com/newsroom/research-reports/posts/health-literacy-research-462863.html.
  11. US Department of Health and Human Services. (n.d.). Discrimination. Discrimination - Healthy People 2030. https://health.gov/healthypeople/priority-areas/social-determinants-health/literature-summaries/discrimination
  12. Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved November 6, 2023, from https://health.gov/healthypeople/objectives-and-data/social-determinants-health
  13. Vogel, L. (2019). Life expectancy grows with supply of Primary Care Doctors. Canadian Medical Association Journal, 191(12). https://doi.org/10.1503/cmaj.109-5729
  14. Wein, H. (2018, April 4). The benefits of slumber. National Institutes of Health. https://newsinhealth.nih.gov/2013/04/benefits-slumber#:~:text=“Sleep%20affects%20almost%20every%20tissue,obesity%2C%20heart%20disease%20and%20infections.