We know that where we live is inextricably linked to our health and wellbeing. Every neighborhood, every zip code, has different levels of access to quality schools, healthcare, jobs, housing, and transportation. The environments in which we live exert unimaginable force on our lives. So how do we approach community development in a way that not only promotes health and wellbeing, but actively promotes health equity and disrupts racism?

I often find myself reflecting on the interconnected nature of social determinants of health, adverse childhood experiences (ACEs), and distribution of opportunity. If we understand the compounding nature of these forces and infuse that knowledge into community development, I believe we can create environments where everyone has the ability to thrive.

Let’s contextualize these frameworks and how they relate to one another. The Centers for Disease Control and Prevention defines social determinants of health as the conditions in the environments where people are born, live, work, play, worship, and age that influence our health, wellbeing, and quality of life. They can be grouped into five domains: economic stability, education access/quality, healthcare access/quality, neighborhood and built environment, and social and community context. To understand the role that social determinants play in my life, I ask myself questions like:

• How close is the nearest grocery store to where I live? Can I walk there? Does it have healthy and affordable options?
• Do I feel safe in my neighborhood? Am I free from violence? From discrimination?
• Is safe, affordable, and timely transportation available to get me where I need to go?
• Is the place I live affordable? Do I have to sacrifice quality in other areas of my life to afford it?
• Do I have access to quality job opportunities in the area where I live? Is my income sufficient to keep my family stable?

ACEs refer to the household environment in which children grow up. Childhood experiences that are high in stress and instability due to frequent, repeated exposure to trauma, chronic stress, and neglect can lead to poor health outcomes and the early onset of disease. When talking about ACEs, I like to reference the “Pair of ACEs“ framework that demonstrates the relationship between adverse childhood experiences and adverse community environments. The level of resilience to adverse childhood experiences an individual or family may have is rooted in the environment in which they are situated. Due to systemic racism and inequality, many community environments have been intentionally divested, leading to greater challenges in combating the impact of adverse childhood experiences, demonstrating once again the immense force our neighborhoods have.

One way to understand the distribution of opportunity is to consider how circumstances beyond individual control shape access to advancement. Discrimination, racism, sexism, ableism, homophobia, and transphobia are some of the most influential factors beyond the control of the individual that act as the invisible hand of opportunity. When so much of our wellbeing is beyond our control, and the environments in which we live influence the likelihood of positive outcomes, how do we approach community development in a way that combats the compounding pressure of these forces?

I wish I had the answer, but I do have some suggestions as to how community development professionals can intentionally, proactively consider the impact of these forces when investing in communities and endeavor to combat them:

Center the perspectives of those who experience the greatest number of barriers to health and wellbeing. This uplifts the voices of those experiencing the greatest number of compounding oppressive forces. When we design systems and communities in a way that decreases these barriers to our most disenfranchised populations, everyone benefits.

Consider all five domains of the social determinants of health when evaluating community development plans. How are each of the domains uniquely supported? Where are the gaps? What partners are needed to address those gaps?

Understand the causal nature of adverse community environments and the impact they have on adverse childhood experiences. Resilient community environments with equitable distribution of opportunity generate resilient children and families. This promotes intergenerational health and wellbeing, which improves the health of the entire community.

Chandler Esslinger is a public health professional with a background in anti-poverty programming and community-wide initiatives to improve health and wellbeing. Currently, she works to end homelessness in Fargo, North Dakota, by aligning and enhancing local systems and government through evidence-based best practices, trauma-informed care, and racial equity.