The social determinants of health are the conditions in which people are born, live, work, learn and play. These conditions are shaped by the distribution of money, power and resources, and they drive health inequities.

Examples of social determinants include:

• Safe housing
• Employment opportunities
• Quality education
• Access to nutritious food
• Socioeconomic conditions
• Exposure to violence
• Experiencing racism and other forms of discrimination

Health disparities in Baltimore are the direct result of a long history of inequality and systemic racism. Systemic inequalities in housing, education and policing are drivers of the deeply concerning disparities in our city today.

Supporting communities to develop and maintain social and physical environments that promote health and well-being is essential in order to reduce health inequities.

Percent of people living below the poverty line

ACEs and Toxic Stress

Experiencing trauma as a child can have lifelong consequences. A growing body of research indicates that Adverse Childhood Experiences (ACEs) and toxic stress contribute to negative physical and behavioral health outcomes.

Everyone responds instinctively when exposed to stressful situations. Humans have evolved to have a strong fight or flight response (survival response) to stressful experiences. When individuals are exposed to stressful situations for prolonged periods of time, such as living in a dangerous neighborhood, living with an abusive adult or experiencing racism, their neurobiological defense system is constantly activated. This can lead to what is known as “toxic stress.”

Experiencing toxic stress, especially in childhood, impacts brain and physical development and has negative effects on learning, behavior and health.

Experiencing toxic stress, especially in childhood, impacts brain and physical development and has negative effects on learning, behavior and health. This can negatively impact their health across a lifetime. Experiencing six or more ACEs may reduce life expectancy by 20 years.

In Baltimore 42 percent of adults have experienced three or more ACEs within the home, compared to 24 percent statewide. This directly contributes to the health disparities and social inequity we see in our city.

Baltimore City had 1028 overdoses in 2020