What to know
- Non-medical factors and conditions in our environment influence health, well-being, and quality of life.
- They include things like economic stability; our social, community, and built environments; and access to quality health care and education.
- Addressing differences in non-medical factors can advance health equity so everyone has the opportunity for optimal health.
- Action and collaboration across sectors (e.g., public health, transportation, education, housing, health care) and from public, private, and community agencies are needed to address non-medical factors.
Living below 150% of the poverty threshold among all people
Population
All people.
Numerator
People living below 150% the poverty threshold where the poverty level is based on monetary income and does not include noncash benefits, such as food stamps. Poverty thresholds reflect family size and composition and are adjusted each year using the annual average Consumer Price Index level.
Denominator
All people for the same calendar year.
Measure
Prevalence (crude and age-adjusted).
Time Period of Case Definition
Calendar year.
Summary
In 2020, approximately 67.3 million people in the US lived 150% below the poverty level.1 Some racial and ethnic minority groups, people living in rural areas, and people with disabilities have a higher risk of living in poverty.2 Poverty often occurs in concentrated geographic areas and can limit access to educational and employment opportunities, which can perpetuate persistent poverty for families.3 People living in poverty often have reduced access to resources, such as healthcare and healthy foods, which can contribute to a higher risk of developing chronic conditions (e.g., heart disease, stroke, diabetes).24 Addressing poverty will require multipronged approaches.2 Programs and policies, including those that provide financial and food assistance and health coverage to families with lower incomes, can help alleviate some of the negative effects of poverty.24
Notes
Level of income might not reflect all the resources available to individual persons and families for health and health care. Persons who are living at or below the poverty rate might receive health-care services through Medicaid, Medicare, accumulated assets, or other means.
Data Source
American Community Survey (ACS).
Related Objectives or Recommendations
Healthy People 2030 objective: SDOH‑01. Reduce the proportion of people living in poverty.
Related CDI Topic Area
None.
High school completion among adults aged 18-24
Population
Adults aged 18–24.
Numerator
Adults aged 18–24 who have completed 4 years of high school (i.e., completed high school).
Denominator
Adults aged 18–24 for the same calendar year.
Measure
Prevalence (crude).
Time Period of Case Definition
Calendar year.
Summary
In 2021, 11.7% of adults aged 18–24 years did not complete a high school education or equivlent.5 People from low-income families and some racial and ethnic minority groups are less likely to complete high school.67 School resources, such as the number of teachers and size of the school, can also affect a persons’ likelihood of completing high school.78 Not completing high school is linked to a variety of factors that can negatively impact health, including limited employment prospects, low wages, and poverty, and people who do not graduate from high school are at a higher risk of developing chronic conditions (e.g., asthma, diabetes, heart disease, high blood pressure, stroke) and premature mortality.67910 Programs that support students transitioning from middle school to high school and allow students to earn college credit while completing high school can help improve graduation rates.711
Notes
High school education might be completed after age 24.
Data Source
American Community Survey (ACS).
Related Objectives or Recommendations
Healthy People 2030 objective: AH‑08. Increase the proportion of high school students who graduate in 4 years.
Related CDI Topic Area
None.
No broadband internet subscription among households
Population
Households.
Numerator
Households without any type of broadband internet subscription.
Denominator
All households for the same calendar year.
Measure
Prevalence (crude).
Time Period of Case Definition
Current.
Summary
As of 2020, approximately 85% of people in the United States have broadband internet of any type.12 Residents of rural and tribal areas tend to have lower access to broadband.131415 Lack of broadband access can limit educational and economic opportunities, as well as delivery of healthcare services remotely through telehealth services.14 Telehealth services have been shown to reduce chronic disease risk factors and improve the management of chronic disease conditions, like cardiovascular disease, diabetes, and obesity.16 Providing grants or loans to internet service providers, healthcare centers, or local governments to expand availability of and lower the costs associated with broadband is one strategy to increase broadband availability.1415
Notes
None.
Data Source
American Community Survey (ACS).
Related Objectives or Recommendations
Healthy People 2030 objective: HC/HIT‑05. Increase the proportion of adults with broadband internet.
Related CDI Topic Area
None.
Food insecure in the past 12 months among households
Population
US households.
Numerator
Households classified as food insecure17 (including low food security and very low food security) in the past 12 months.
Denominator
All households.
Measure
Prevalence (crude) from a 3-year cycle.
Time Period of Case Definition
Past 12 months.
Summary
In 2021, around 13.5 million US households reported being food insecure at some time during the year.18 People with low income, people with a disability, and some racial/ethnic groups are more likely to experience food insecurity.181920 Limited physical access to healthy foods and transportation options in neighborhoods can also increase a persons’ risk for food insecurity.21 Food insecurity is associated with chronic and acute health problems and health care needs in children,20 and food-insecure adults are at a higher risk of developing several chronic conditions, including coronary heart disease, diabetes, obesity, and cancer. 1922Connecting individuals and families who are food insecure to food and income assistance programs can help to address food insecurity.21
Notes
The questions focus on food inadequacy and insufficiency that result only from inadequate household resources and not from other factors.17
Data Source
Current Population Survey Food Security Supplement (CPS-FSS).
Related Objectives or Recommendations
Healthy People 2030 objective: NWS-01. Reduce household food insecurity and hunger.
Related CDI Topic Area
None.
Unable to pay mortgage, rent or utility bill in the past 12 months among adults
Population
All adults.
Numerator
Adults who were not able to pay mortgage, rent, or utility bill in the past 12 months.
Denominator
All adults.
Measure
Prevalence (crude and age-adjusted).
Time Period of Case Definition
Past 12 months.
Summary
Housing cost burden (spending more than 30% income on housing) is one challenge of housing instability, which also includes housing quality, overcrowding, and moving frequently.2324 In 2019, 37.1 million households were cost burdened.23 People who are renters, people living in urban areas, and some racial and ethnic minority groups are more likely to experience housing cost burden.2526 Living in unaffordable housing is associated with overall poor health and increased risk of disease, including hypertension and cardiovascular disease.2324 Programs that make housing more affordable for both renters and homeowners and housing subsidies that provide financial assistance to pay rent can help improve housing cost burden.2326
Notes
Indicator does not convey a comprehensive measure of housing instability. The indicator does not include housing and neighborhood safety, housing quality, crowding, or residential stability (moving frequently). Data are obtained from the Social Determinants and Health Equity optional module of the Behavioral Risk Factor Surveillance System. States opting to administer this module vary by year.
Data Source
Behavioral Risk Factor Surveillance System (BRFSS).
Related Objectives or Recommendations
Healthy People 2030 objective: SDOH-04. Reduce the proportion of families that spend more than 30 percent of income on housing.
Related CDI Topic Area
None.
Lack of reliable transportation in the past 12 months among adults
Population
All adults.
Numerator
Adults who reported a lack of reliable transportation keeping them from medical appointments, meetings, work, or from getting things needed for daily living in the past 12 months.
Denominator
All adults.
Measure
Prevalence (crude and age-adjusted).
Time Period of Case Definition
Past 12 months.
Summary
Nearly 2% of the U.S. population delayed medical care because they did not have transportation in 2017.27 Lack of available, convenient or reliable transportation can affect a person’s ability to consistently access health care services which can lead to delays in healthcare and medication use that can subsequently impact overall health.2829 In addition, the inability to access reliable transportation to work, schools, and grocery stores is associated with higher rates of unemployment, poverty, and chronic illness.30 People with lower incomes and uninsured people are more likely to experience transportation barriers.2930 Limited public transportation infrastructure in a neighborhood leaves people without access to vehicles lacking in reliable transportation options.30 Offering free or reimbursed public transit or taxi costs, connecting individuals to transportation, and policies that improve the safety and accessibility of sidewalks and bike lanes can help improve transportation access.3031
Notes
Data are obtained from the Social Determinants and Health Equity optional module of the Behavioral Risk Factor Surveillance System. States opting to administer this module vary by year.
Data Source
Behavioral Risk Factor Surveillance System (BRFSS).
Related Objectives or Recommendations
None.
Related CDI Topic Area
None.
Lack of social and emotional support needed among adults
Population
All adults.
Numerator
Adults who report rarely or never getting the social and emotional support needed.
Denominator
All adults.
Measure
Prevalence (crude and age-adjusted).
Time Period of Case Definition
Current.
Summary
Positive relationships and interactions with family, friends, co-workers, and community members can have a protective impact on individual health and well-being, and these relationships can also help mitigate the negative impacts of challenges that people face (e.g., living in an unsafe neighborhood, trouble affording housing or food).32 Past research shows that people with high levels of social isolation (lack of interactions with others or the wider community)33 are at higher risk of developing chronic conditions (e.g., depression, cardiovascular disease, hypertension) and have a higher risk of mortality.34
Notes
Data are obtained from the Social Determinants and Health Equity optional module of the Behavioral Risk Factor Surveillance System. States opting to administer this module vary by year.
Data Source
Behavioral Risk Factor Surveillance System (BRFSS).
Related Objectives or Recommendations
None.
Related CDI Topic Area
None.
Unemployment rate among people aged 16 years and older in the labor force
Population
Population aged 16 years and older in the labor force.
Numerator
Unemployed population aged 16 years and older in the labor force.
Denominator
Population aged 16-64 years in the labor force.
Measure
Prevalence (crude and age-adjusted).
Time Period of Case Definition
Last week or the most recent employment in the past 5 years.
Summary
As of March 2023, the unemployment rate nationally was 3.5%.35 People with a disability and some racial and ethnic minority groups are more likely to experience unemployment.353637 Unemployment is associated with a higher risk of developing chronic conditions (e.g., stroke, heart attacks, heart disease, and arthritis).3839 Several strategies have been implemented to mitigate the negative health impacts of unemployment including temporary financial assistance program and state unemployment benefits.36
Notes
None.
Data Source
American Community Survey (ACS).
Related Objectives or Recommendations
Healthy People 2030 objective: SDOH-02. Increase employment in working-age people.
Related CDI Topic Area
None.
Lack of health insurance among adults aged 18-64
Population
Adults aged 18–64.
Numerator
Adults aged 18–64 who report having no current health insurance coverage.
Denominator
Adults aged 18–64.
Measure
Prevalence (crude and age-adjusted).
Time Period of Case Definition
Current.
Summary
In 2021, approximately 13.5% of U.S. adults aged 18–64 years did not have health insurance.40 People with low income and some racial and ethnic minorities are more likely not to have insurance.40 Without health insurance, people are less likely to receive preventive services which puts them at increased risk for developing diseases or disabilities and death.4142 Federal social assistance programs that provide health coverage to families with lower incomes can help improve health insurance coverage.28
Notes
Since individual persons might move in and out of health insurance, this indicator might underestimate the prevalence of a lack of health insurance.
Data Source
Behavioral Risk Factor Surveillance System (BRFSS).
Related Objectives or Recommendations
Healthy People 2030 objective: AHS‑01. Increase the proportion of people with health insurance.
Related CDI Topic Area
None.
Health insurance coverage in the month before pregnancy among women with a recent live birth
Population
Women who have had a recent live birth.
Numerator
Number of women who reported that they had health insurance coverage during the month before they became pregnant.
Denominator
Number of women who reported that they did or did not have health insurance coverage during the month before they became pregnant.
Measure
Prevalence (crude).
Time Period of Case Definition
One month before the pregnancy resulting in the most recent live birth.
Summary
In 2021, approximately 11.3% of U.S. women aged 18–64 did not have health insurance.40 Lack of health insurance has been associated with decreased access to quality health services before, during, and after pregnancy.43 Young women, racial and ethnic minority women, women with low income, and women who live in rural areas are more likely to experience gaps in their health insurance coverage during pregnancy and post-partum.43444546 Continuous access to health insurance and care is especially important for recently pregnant women with chronic medical conditions, such as diabetes or hypertension.47 Removing barriers to obtaining health insurance for women who lack coverage could improve timeliness of prenatal care and the health of women and their infants.
Notes
Because the income threshold for pregnancy-eligibility Medicaid is greater than other eligibility based on income, many persons who are uninsured before pregnancy, may be covered by Medicaid during pregnancy. Since individual persons might move in and out of health insurance, this indicator might underestimate the prevalence of a lack of health insurance.
Data Source
Pregnancy Risk Assessment Monitoring System (PRAMS).
Related Objectives or Recommendations
Healthy People 2030 objective: AHS‑01. Increase the proportion of people with health insurance.
Related CDI Topic Area
Maternal Health.
Health insurance coverage after pregnancy among women with a recent live birth
Population
Women who have had a recent live birth.
Numerator
Women who reported that they had health insurance coverage now (at the time the survey was completed).
Denominator
Women who reported that they did or did not have health insurance coverage now.
Measure
Prevalence (crude).
Time Period of Case Definition
Two to six months after the most recent live birth
Summary
In 2021, approximately 11.3% of U.S. women aged 18–64 did not have health insurance.40 Lack of health insurance has been associated with decreased access to quality health services before, during and after pregnancy.43 Young women, racial and ethnic minority women, women with low income, and women who live in rural areas are more likely to experience gaps in their health insurance coverage during pregnancy and post-partum.43444546 Continuous access to health insurance and care is especially important for recently pregnant women, or those who have recently given birth, with chronic medical conditions, such as diabetes or hypertension.47 Removing barriers to health insurance in the year after pregnancy could improve the health of women and their infants.
Notes
Currently, states are required to extend Medicaid coverage for 60 days after the end of pregnancy. Strategies for states to extend Medicaid coverage beyond 60 days in the postpartum period include state plan amendments and 1115 demonstration waivers. Since individual persons might move in and out of health insurance, this indicator might underestimate the prevalence of a lack of health insurance.
Data Source
Pregnancy Risk Assessment Monitoring System (PRAMS).
Related Objectives or Recommendations
Healthy People 2030 objective: AHS‑01. Increase the proportion of people with health insurance.
Related CDI Topic Area
Maternal Health.
Routine checkup within the past year among adults
Population
Adults aged 18–64.
Numerator
Adults who report having been to a doctor for a routine checkup (e.g., a general physical exam, not an exam for a specific injury, illness, condition) in the previous year.
Denominator
All adults.
Measure
Annual prevalence (crude and age-adjusted).
Time Period of Case Definition
Previous year.
Summary
In 2021, three-fourths of U.S. adults (73.6%) visited a doctor for a routine checkup in the past year.48 Uninsured adults, adults with lower incomes, and some racial and ethnic groups are less likely to get a routine checkup.4849 Regular checkups includes receiving recommended vaccinations, screenings, and blood tests in addition to checking blood pressure, weight, and cholesterol with the purpose of maintaining wellness.5051 Obtaining regular checkups can reduce morbidity and premature mortality from chronic conditions (e.g., cardiovascular disease, cancer, chronic lower respiratory diseases, and diabetes).5051 Federal and state programs that provide health coverage to adults with lower incomes can help improve routine checkups among adults.49
Notes
None.
Data Source
Behavioral Risk Factor Surveillance System (BRFSS).
Related Objectives or Recommendations
None.
Related CDI Topic Area
None.
- Poverty Status in the Past 12 Months, American Community Survey 2016-2020. United States Census Bureau; 2021.
- Healthy People 2030. Poverty. U.S. Department of Health and Human Services. Accessed April 3, 2023.
- U.S. Department of Agriculture, Economic Research Service. Rural Poverty & Well-Being. U.S. Department of Agriculture; 2022. Updated November 29, 2022. Accessed April 27, 2023.
- Khullar D, Chokshi DA. Health, income, & poverty: where we are & what could help. Health Affairs Health Policy Brief. 2018. doi:
- Educational Attainment, American Community Survey 1-Year Estimates Subject Tables. United States Census Bureau; 2021. Accessed April 27, 2023.
- Freudenberg N, Ruglis J. Reframing school dropout as a public health issue. Prev Chronic Dis. 2007; 4(4):A107.
- Healthy People 2030. High School Graduation. U.S. Department of Health and Human Services. Accessed April 4, 2023.
- Rumberger RW. Why students drop out of school and what can be done. University of California Los Angeles: The Civil Rights Project; 2001.
- Krueger PM, Tran MK, Hummer RA, Chang VW. Mortality attributable to low levels of education in the United States. PLoS One. 2015;10(7):e0131809. doi:
- Vaughn MG, Salas-Wright CP, Maynard BR. Dropping out of school and chronic disease in the United States. J Public Health. 2014; 22, 265–270. doi:
- Wilson SJ, Tanner-Smith EE. Dropout prevention and intervention programs for improving school completion among school-aged children and youth: A systematic review. JSSWR. 2013; 4(4), 357–372. doi:
- Types of Computers and Internet Subscriptions, American Community Survey 5-Year Estimates Subject Tables. United States Census Bureau; 2020. Accessed April 27, 2023.
- 2019 Broadband Deployment Report. Federal Communications Commission, 2019. Accessed April 27, 2023.
- Bauerly BC, McCord RF, Hulkower R, Pepin D. Broadband access as a public health issue: the role of law in expanding broadband access and connecting underserved communities for better health outcomes. J Law Med Ethics. 2019;47(2_suppl): 39–42. doi:
- Broadband Initiatives for Unserved and Underserved Areas. County Health Rankings and Roadmaps; 2021. Accessed April 27, 2023.
- Division for Heart Disease and Stroke Prevention. Telehealth Interventions to Improve Chronic Disease. Centers for Disease Control and Prevention. Updated May 11, 2020. Accessed April 4, 2023. /dhdsp/pubs/telehealth.htm#table1
- Healthy People 2030. Reduce Household Food Insecurity and Hunger — NWS-01 Data Methodology and Measurement. US Department of Health and Human Services. Accessed April 5, 2023.
- U.S. Department of Agriculture, Economic Research Service. Key Statistics & Graphics. U.S. Department of Agriculture; 2022. Updated October 17, 2022. Accessed April 27, 2023.
- Hernandez DC, Reesor LM, Murillo R. Food insecurity and adult overweight/obesity: gender and race/ethnic disparities. Appetite. 2017;117:373-378. doi:
- Thomas MMC, Miller DP, Morrissey TW. Food insecurity and child health. Pediatrics. 2019;144(4):e20190397. doi:
- U.S Department of Health and Human Services. Food Insecurity. Healthy People 2030. Accessed April 4, 2023.
- Gregory CA, Coleman-Jensen A. Food Insecurity, Chronic Disease, and Health Among Working-Age Adults. U.S. Department of Agriculture; 2017.
- Healthy People 2030. Housing Instability. U.S Department of Health and Human Services. Accessed April 4, 2023.
- Pollack CE, Griffin BA, Lynch J. Housing affordability and health among homeowners and renters. Am J Prev Med. 2010;39(6):515-21. doi:
- United States Census Bureau. Renters More Likely Than Homeowners to Spend More Than 30% of Income on Housing in Almost All Counties. United States Census Bureau; 2022.
- Hess C, Colburn G, Crowder K, Allen R. Racial disparity in exposure to housing cost burden in the United States: 1980-2017. Hous Stud. 2022;37(10):1821-1841. doi:
- Wolfe MK, McDonald NC, Holmes GM. Transportation barriers to health care in the United States: findings from the National Health Interview Survey, 1997-2017. Am J Public Health. 2020 Jun;110(6):815-822. doi:
- Healthy People 2030. Access to Health Services. U.S. Department of Health and Human Services. Accessed April 5, 2023.
- Syed ST, Gerber BS, Sharp LK. Traveling towards disease: transportation barriers to health care access. J Community Health. 2013;38(5):976-93. doi:
- United States Department of Transportation. Expanding Access. United States Department of Transportation; 2022.
- Starbird LE, DiMaina C, Sun CA, Han HR. A systematic review of interventions to minimize transportation barriers among people with chronic diseases. J Community Health. 2019;44(2):400-411. doi:
- Healthy People 2030. Social and Community Context. U.S. Department of Health and Human Services. Accessed April5, 2023.
- Healthy People 2030. Social Cohesion. U.S. Department of Health and Human Services. April 5, 2023.
- Leigh-Hunt N, Bagguley D, Bash K, Turner V, Turnbull S, Valtorta N. An overview of systematic reviews on the public health consequences of social isolation and loneliness. Public Health. 2017;152:157-171. doi:
- U.S. Department of Labor, Bureau of Labor Statistics. Employment Situation News Release. U.S. Department of Labor; 2023.
- Healthy People 2030. Employment. U.S. Department of Health and Human Services. April 5, 2023.
- National Center on Birth Defects and Developmental Disabilities. Common Barriers to Participation Experienced by People with Disabilities. Centers for Disease Control and Prevention. Accessed April 5, 2023. /ncbddd/disabilityandhealth/disability-barriers.html
- Robert Wood Johnson Foundation. How Does Employment — or Unemployment — Affect Health? Health Policy Snapshot. Robert Wood Johnson Foundation; 2013.
- Avendano M, Berkman LF. Labor markets, employment policies, and health. In: Berkman LF, Kawachi I, Glymour MM, eds. Social Epidemiology. 2nd edition. Oxford Academic; 2014; 182–233. doi:
- Cohen RA, Cha AE, Terlizzi EP, Martinez ME. Health Insurance Coverage: Early Release of Estimates from the National Health Interview Survey, 2021. National Center for Health Statistics; 2022. /nchs/data/nhis/earlyrelease/insur202205.pdf
- Fox JB, Shaw FE. Relationship of income and health care coverage to receipt of recommended clinical preventive services by adults – United States, 2011-2012. MMWR Morb Mortal Wkly Rep. 2014;63(31):666-70.
- Q, Bierman AS, Meyers D. Few americans receive all high-priority, appropriate clinical preventive services. Health Affairs. 2018; 37(6). doi:
- Daw JR, Kolenic GE, Dalton VK, et al. Racial and ethnic disparities in perinatal insurance coverage. Obstet Gynecol. 2020;135(4):917-924. doi:
- Interrante JD, Admon LK, Carroll C, Henning-Smith C, Chastain P, Kozhimannil KB. Association of health insurance, geography, and race and ethnicity with disparities in receipt of recommended postpartum care in the US. JAMA Health Forum. 2022;3(10):e223292. doi:
- Admon LK, Daw JR, Winkelman TNA, et al. Insurance coverage and perinatal health care use among low-income women in the US, 2015-2017. JAMA Netw Open. 2021; 4(1):e2034549. doi:
- D’Angelo DV, Williams L, Harrison L, Ahluwalia IB. Health status and health insurance coverage of women with live-born infants: an opportunity for preventive services after pregnancy. Matern Child Health J. 2012;16 Suppl 2(0 2):222-30. doi:
- American College of Obstetricians and Gynecologists, Society for Maternal-Fetal Medicine. Obstetric care consensus No. 8: interpregnancy care. Obstet Gynecol. 2019;133(1):e51-e72.
- BRFSS Web Enabled Tool. Centers for Disease Control and Prevention. Accessed April 5, 2023.
- Ayanian JZ, Weissman JS, Schneider EC, Ginsburg JA, Zaslavsky AM. Unmet health needs of uninsured adults in the United States. JAMA. 2000;284(16):2061–2069. doi:
- Gamble S, Mawokomatanda T, Xu F, Chowdhury PP, Pierannunzi C, Flegel D. Surveillance for certain health behaviors and conditions among states and selected local areas – Behavioral Risk Factor Surveillance System, United States, 2013 and 2014. MMWR Surveill Summ. 2017;66(16):1-144. doi:
- Jin J. Routine checkups for adults. JAMA. 2022;327(14):1410. doi: