Background: In the United States, street address and zip code are surprisingly good predictors of health. Why? Because the social, economic, and physical environments in which we live powerfully shape our life chances and wellbeing - for better and worse.

Where we live is not simply a matter of personal preference. It has a profound impact on financial security, school quality, job opportunities, safety, as well as access to goods and services. Unfortunately, racial segregation and past housing and loan discrimination have helped create inequities in neighborhood quality and the distribution of wealth and health.

Among other things, communities with lower income and educational levels tend to have higher rates of asthma, obesity, diabetes, heart disease, and child poverty. They are also more likely to have substandard housing, underfunded schools, poor access to grocery stores and supermarkets, and to be located near toxic industries and other sources of pollution.

On the other hand, well-off neighborhoods include many resources that help protect and sustain individual and group health: safe streets, well-maintained public spaces, good schools, libraries and other amenities, community programs, clean air, and good access to jobs and healthy food options.

Several overlapping factors play an important role in shaping health directly and indirectly:

Physical environment. Built space, infrastructure, and environmental quality all have a direct impact on our wellbeing. Old, substandard housing is more likely to have peeling paint, exposing families to dangerous lead levels, as well as pests and mold, which increase the risk of infectious disease and respiratory ailments like asthma. Geographic access to jobs, services and safe places to exercise and play shapes behaviors, choices and economic opportunities. Proximity to polluting industries, waste, freeways, and other hazards affects the air we breathe, the water we drink and the land we live on. Noise pollution also affects our anxiety and stress levels, which increase our risk for chronic illness.

Economic environment. Wealth, employment and economic mobility are important to foster good health, now and in the future. High housing costs threaten food and financial security, while concentrated poverty and a lack of good jobs lead to crime and disinvestment. On the flip side, home ownership brings financial security; attracts public and private investment in businesses, schools and infrastructure; and also promotes neighborhood cohesion - all of which are beneficial to health. Job training and access to good jobs with benefits, decent pay and career ladders help families avoid falling into financial disaster and reduces their risk for premature death and chronic disease.

Social environment. Communities that have strong social networks and foster social inclusion are healthier. Isolation and lack of support not only contribute to illness, they disempower individuals and communities. Neighborhoods where residents gather and help one another can foster belonging, affirmation and increased civic participation. They also have a bigger voice: organized groups can better advocate for their needs, reduce crime and increase safety, and bring health-promoting resources and services into their environment.

Resources and services. Our access to grocery stores and supermarkets, reliable transportation, clean parks, safe streets, community programs and institutional services reflect larger structural patterns of opportunity and advantage in society. Nevertheless, they impact our ability to make healthy choices, to gain skills and knowledge, to get adequate health care, fire protection and police protection, to avoid injury and live relatively unencumbered by fear, and fundamentally, to ensure that our basic needs are met and that we have a future to look forward to.

Together, these elements determine our health in subtle and obvious ways. Ensuring that every community is the healthiest it can be requires community organizing, political will, and public investment. Strategies to revitalize neglected areas, clean up environmental hazards, improve schools and foster economic development and wealth are critical they but must include and respond to the needs of residents, who more often than not are painfully aware of what is wanting in their communities.