Consensus Study Report

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This Project has been funded in whole with federal funds from the Office of Research on Women’s Health, National Institutes of Health, Department of Health and Human Services, under Contract No. HHSN263201800029I, Task Order No. 75N98023F00005. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.

International Standard Book Number-13: 978-0-309-73139-3
International Standard Book Number-10: 0-309-73139-9
Digital Object Identifier: https://doi.org/10.17226/28586
Library of Congress Control Number: 2025931421

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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2025. A new vision for women’s health research: Transformative change at the National Institutes of Health. Washington, DC: The National Academies Press. https://doi.org/10.17226/28586.

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COMMITTEE ON THE ASSESSMENT OF NIH RESEARCH ON WOMEN’S HEALTH

SHEILA P. BURKE (Cochair), Senior Policy Advisor and Chair, Government Relations and Public Policy, Baker Donelson; Adjunct Lecturer, John F. Kennedy School of Government, Harvard University

ALINA SALGANICOFF (Cochair), Senior Vice President and Director, Women’s Health Policy, KFF

NEELUM T. AGGARWAL, Professor, Department of Neurological Sciences, Rush Alzheimer’s Disease Center; Research Director, Rush Heart Center for Women, Rush University Medical Center

VERONICA BARCELONA, Assistant Professor, Columbia University School of Nursing

ALYSSA M. BILINSKI, Peterson Family Assistant Professor of Health Policy, Department of Health Services, Policy & Practice, Department of Biostatistics, School of Public Health, Brown University

CHLOE E. BIRD, Director, Center for Health Equity Research; Sara Murray Jordan Professor of Medicine, Tufts Medical Center; Senior Sociologist, RAND Corporation

SUSAN CHENG, Erika J. Glazer Chair in Cardiovascular Women’s Health and Population Science; Director, Institute for Research on Healthy Aging; Director, Public Health Research; Director, Cardiovascular Population Sciences; Professor, Department of Cardiology, Cedars-Sinai Medical Center

FELINA CORDOVA-MARKS, Assistant Professor, Mel & Enid Zuckerman College of Public Health, University of Arizona

SHERITA H. GOLDEN, Hugh P. McCormick Family Professor of Endocrinology and Metabolism, Department of Medicine, Johns Hopkins University School of Medicine

HOLLY A. INGRAHAM, Herzstein Endowed Professor and Director of University of California, San Francisco IRACDA Scholars Program, School of Medicine, University of California, San Francisco

ROBERT M. KAPLAN, Senior Scholar, Clinical Excellence Research Center, Stanford University School of Medicine

NANCY E. LANE, Distinguished Professor of Medicine and Rheumatology, University of California, Davis Health System

JANE E. SALMON, Collette Kean Research Chair and Director, Lupus and Antiphospholipid Center of Excellence; Hospital for Special Surgery; Professor of Medicine; Associate Dean, Faculty Affairs, Weill Cornell Medicine

CRYSTAL SCHILLER, Associate Professor, Department of Psychiatry; Associate Director, Center for Women’s Mood Disorders, University of North Carolina at Chapel Hill School of Medicine

ANGELES ALVAREZ SECORD, Professor, Division of Gynecologic Oncology, Department of OB/GYN; Director, Gynecologic Oncology Clinical Trials; Associate Director, Clinical Research Gynecologic Oncology Program, Duke Cancer Institute, Duke University Health System

METHODIUS G. TUULI, Chace-Joukowsky Professor and Chair, Department of Obstetrics and Gynecology, The Warren Alpert Medical School of Brown University; Chief of Obstetrics and Gynecology, Women & Infants Hospital

BIANCA D. M. WILSON, Associate Professor, University of California, Los Angeles; Affiliate Faculty Member, the California Center for Population Research

National Academy of Medicine Fellows

2023–2025 Gant/American Board of Obstetrics and Gynecology Fellow

MICHELLE P. DEBBINK, Assistant Professor, Department of Obstetrics & Gynecology, Division of Maternal-Fetal Medicine; Vice Chair, Equity, Diversity, and Inclusion; Associate Program Director, Women’s Health Equity Fellowship, University of Utah

2021–2023 American Board of Emergency Medicine Fellow

TRACY E. MADSEN, Associate Professor, Division of Sex and Gender, Department of Emergency Medicine, The Warren Alpert Medical School of Brown University; Associate Professor, Department of Epidemiology, School of Public Health, Brown University

Study Staff

AMY GELLER, Study Director

AIMEE MEAD, Program Officer

L. BRIELLE DOJER, Research Associate

MAGGIE ANDERSON, Research Assistant

RACHEL RILEY SORRELL, Senior Program Assistant (until August 2024)

ELLA CASTANIER, Senior Program Assistant (from October 2024)

Y. CRYSTI PARK, Program Coordinator

MISRAK DABI, Senior Finance Business Partner

ROSE MARIE MARTINEZ, Senior Board Director

SHARYL NASS, Senior Board Director

Consultants

HAMAD AL-IBRAHIM, Policy Tech Innovation LLC

JOE ALPER, Independent Consultant

YUDHIJIT BHATTACHARJEE, Independent Consultant

JULIANE KWONG, Cedars-Sinai Medical Center

BENJAMIN RENTON, Brown University School of Public Health

JEN SAUNDERS, Independent Consultant

NANCY SUN, Cedars-Sinai Medical Center

WASAY WARSI, Cedars-Sinai Medical Center

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Reviewers

This Consensus Study Report was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published report as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the study charge. The review comments and draft manuscript remain confidential to protect the integrity of the deliberative process.

We thank the following individuals for their review of this report:

Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the conclusions or recommendations of this report nor did they see the final draft before its release. The review of this report was overseen by SUSAN C. SCRIMSHAW, International Nutrition Foundation, and ERIC B. LARSON, University of Washington School of Medicine. They were responsible for making certain that an independent examination of this report was carried out in accordance with the standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the authoring committee and the National Academies.

Contents

PREFACE

ACRONYMS AND ABBREVIATIONS

KEY TERMS

SUMMARY

1 STATEMENT OF TASK AND APPROACH

Introduction

Urgency of Addressing WHR

Past and Ongoing Efforts in WHR

U.S. Government Actions

Women’s Health at NIH

The Committee’s Approach

Study Process and Report Overview

Concluding Observations

References

2 THE NEED FOR WOMEN’S HEALTH RESEARCH

Introduction

Healthy Women Are Vital to a Healthy Society and Growing Economy

WHR: Still Overlooked, Understudied

Intersecting Barriers to Health Care

Breakthroughs in Women’s Health Benefit Everyone

Female-Specific Biology and Physiology

Synergistic Impact of Biological and Social Factors on Women’s Health

Concluding Observations

References

3 REVIEW OF NATIONAL INSTITUTES OF HEALTH STRUCTURE, POLICIES, AND PROGRAMS

Overview of the National Institutes of Health’s Structure

WHR at NIH

NIH SABV Policy

NIH Research Structure

Concluding Observations

References

4 OVERVIEW OF THE NATIONAL INSTITUTES OF HEALTH INVESTMENT IN WOMEN’S HEALTH RESEARCH

Introduction

Assessing Disease and Condition Funding Levels at NIH

Portfolio Analysis

Summary of NIH Assessments of Funding for WHR

The Committee’s Analysis of NIH Funding for WHR

Concluding Observations

References

5 THE BIOLOGICAL BASIS FOR WOMEN’S HEALTH THROUGH THE LENS OF CHROMOSOMES AND HORMONES

Need for Sex Differences Research

The Female Hormonal Life Course—Implications for Understanding Mental and Physical Health Manifestations

Current Understanding of Female Hormonal Physiology

Hormonal Associations with Mental Health Disorders Across the Life Course

Hormonal Associations with Physical Health Disorders Across the Life Course

Concluding Observations

References

6 WOMEN, HEALTH, AND SOCIETY

Introduction

Structural and Social Determinants of Health

Structural Determinants of Health

SDOH

Resilience

Concluding Observations

References

7 OVERVIEW OF SELECTED WOMEN’S HEALTH CONDITIONS

A Framework for Quantifying Disease Burden to Illustrate WHR Gaps

Exemplar Women’s Health Conditions

Female-Specific Conditions with Increased DALYs Resulting from Disabling Conditions

Female-Specific Conditions with Increased DALYs Resulting from Early Mortality

Female-Specific Conditions with Increased DALYs Resulting from Disabling Conditions and Early Mortality

Differential Effect by Sex and Increased Female DALYs Resulting from Disabling Conditions

Differential Effect by Sex and Increased Female DALYs Resulting from Early Mortality

Differential Effect by Sex and Increased Female DALYs Resulting from Disabling Conditions and Early Mortality

Concluding Observations

References

8 A WORKFORCE TO ADVANCE WOMEN’S HEALTH RESEARCH

Extramural Workforce

NIH Extramural Grants to Develop and Support WHR Workforce

Overview of the NIH Program and Intramural Workforce

Gaps in the WHR Workforce

Concluding Observations

References

9 ROADMAP TO PRIORITIZING WOMEN’S HEALTH RESEARCH

Recommendations Overview

Create Pathways to Facilitate and Support Innovative and Transformative WHR

Strengthen Oversight, Prioritization, and Coordination for WHR Across NIH

Expand, Train, Support, and Retain the WHR Workforce

Optimize NIH Programs and Policies to Support WHR

Increase NIH Investment in WHR

Tracking and Accountability

WHR Priorities: Looking Forward

Concluding Observations

References

APPENDIXES

A Committee Analysis of National Institutes of Health Grant Funding for Women’s Health Research: Methodology

B National Institutes of Health Research Career Development Awards (K Awards)

C Public Meeting Agendas

D Committee Member and Staff Biosketches

Preface

More than 30 years after the passage of the landmark National Institutes of Health (NIH) Revitalization Act and the Congressional mandate to NIH to increase its investment and commitment to advancing the state of women’s health research (WHR), Congress asked the National Academies of Sciences, Engineering, and Medicine to assess the status of WHR at NIH. The committee grappled with this broad charge by closely examining NIH’s investments in WHR and workforce development and identifying research gaps and opportunities. In countless ways, NIH has made important advances, including implementing a policy requiring that NIH-funded research consider sex as a biological variable and investing in innovative and breakthrough research that has saved the lives of and improved treatment options for many women. Despite this progress, major gaps remain that must be addressed if our national research enterprise is to significantly drive progress to improve the health and well-being of women in this country.

After reviewing NIH’s investments, structure, and priorities, the committee concluded that the nation needs a bold new approach. The status quo is not enough. Over the past decade, funding on WHR has stagnated and shrunk as a share of the overall NIH budget. Sex differences are not sufficiently studied or reported, and investments in women-specific research fall short. Many WHR training programs and grants have been reduced, and too few researchers have the knowledge base required to make the needed advances in WHR.

The committee was faced with the difficult task of making recommendations for whether and how the structure of NIH should change to

advance this research priority and how to distribute the funding to fill the gaps. After months of careful deliberation, the committee concluded that in addition to doubling the NIH investment in WHR, three major structural elements are needed to address the persistent gaps in research: (1) a new WHR Institute to provide a home for the study of health conditions that predominantly or exclusively affect women and greatly impair the quality of millions of women’s lives, including conditions such as endometriosis, uterine fibroids, the menopause transition, pelvic floor disorder, vulvodynia, and polycystic ovary syndrome, which no Institute or Center (IC) currently prioritizes; (2) a major new interdisciplinary WHR fund, modeled on NIH’s Common Fund, to catalyze interdisciplinary research in women’s health; and (3) a sustained commitment and prioritization by the current ICs to conduct research that examines sex and gender differences and women’s health. The committee also proposes expanding programs to grow the WHR workforce to ensure that it reflects the rich diversity of the research field and the U.S. population.

The committee is composed of experts representing many of the disciplines and medical specialties critical to making needed research advances. A common thread among us is the belief that research can improve women’s health, quality of life, and well-being. We were also cognizant of the importance of ensuring that future research includes an emphasis on the women who are disproportionately marginalized and discriminated against by society and the health system and experience the greatest challenges in achieving the good health and well-being to which we are all entitled. We also recognized the need to broaden the definition of WHR to include those with experiences as girls, women, and females at some point over the life course.

We are grateful for the many contributions of the committee members and their remarkable work on this study conducted under a compressed time frame. It was our pleasure to get to know and work with each of them. Their dedication to women’s health and commitment to the task is unquestioned.

We would especially like to extend our deepest appreciation to the study staff. Amy Geller worked tirelessly to get us to completion. We benefited greatly from her nimble leadership and superb research and project management skills. She was skillfully supported by an exceptional, creative, and tirelessly dedicated study team—Aimee Mead, L. Brielle Dojer, Maggie Anderson, and Rachel Riley. This report would not have been possible without their dedicated effort and meticulous attention to detail. We would be remiss if we did not also extend our thanks to Rose Marie Martinez, who played a quiet but critical role in shepherding this report through its many stages. We also thank Crysti Park, Aisha Bhimla, Zarah Batulan, Elizabeth Boyle, Nicholas Murdock, and Dara Ancona for their additional support. We thank the National Academies and Health and Medicine Division

communications staff, including Amber McLaughlin. This project received valuable assistance from Megan Lowry (Office of News and Public Information); Misrak Dabi (Office of the Chief Financial Officer); and Monica Feit, Samantha Chao, Leslie Sim, Taryn Young, and Lori Brenig (Health and Medicine Division Executive Office). We received important research assistance from Rebecca Morgan and Will Anderson (National Academies Research Center).

We also greatly benefited from the participation of two National Academy of Medicine Fellows, Michelle Debbink, 2023–2025 Gant/American Board of Obstetrics and Gynecology Fellow, and Tracy Madsen, 2021–2023 American Board of Emergency Medicine Fellow, who provided meaningful input to our deliberations and contributions to preparing this report. We also appreciate the insightful comments of the reviewers. This report is undoubtedly stronger because of their careful review.

Several consultants made critical contributions to this report. In particular, we would like to thank Hamad Al-Ibrahim, who devised a state-of-the-art, artificial intelligence–informed approach to analyze the research and funding investment that NIH has supported over the past decade. Nancy Sun provided essential data preparation and analytics, and we were further supported in this area by Juliane Kwong and Wasay Warsi. Joe Alper, Yudhijit Bhattacharjee, and Jennifer Saunders provided helpful background for and editing of the report. We also thank Benajmin Renton for his research support.

We also want to extend our heartful appreciation to the legion of scientists, clinicians, and advocates who shared their expertise and insights with us in open sessions and in writing. Their passion for generating research to improve women’s health inspired us. We are especially grateful to the many women who candidly shared their sometimes very painful personal health experiences. Their perspectives enriched this study and movingly illustrated to us why NIH’s work is so vital and why we as a nation must do more to improve women’s lives. The following speakers provided their research, expertise, and perspectives at our information-gathering meetings: Madina Agénor, Victoria L. Bae-Jump, Lisa Barroilhet, Irina Burd, William Catherino, Evelina Cebotari, Janine Austin Clayton, Christos Coutifaris, Kristina M. Deligiannidis, Amanda Dennis, Angela Doyinsola, C. Neill Epperson, Lori Frank, Karen Freund, Jamie Hart, Irene Headen, Reshma Jagsi, Beth Y. Karlan, Kristin Kramer, Erica E. Marsh, Carolyn Mazure, Margaret M. McCarthy, Michele McGuirl, Lindsey Miltenberger, Eliseo J. Pérez-Stable, Tory Eisenlohr-Moul, Karen L. Parker, Vivian Pinn, Nancy Praskievicz, Karen Reue, Ayanna Robinson, George Santangelo, Jake Scholl, Danny J. Schust, Tara Schwetz, Carolyn W. Swenson, Sarah Temkin, Marina Volkov, Vivian Ota Wong, Steven Young, and Christopher M. Zahn. We also thank the following individuals who provided technical review of

sections of the report: Nancy Praskievicz, Jake Scholl, Evelina Cebotari, Kristin Kramer, and Stephanie Constant (NIH); Danny J. Schust (Duke University); and Christos Coutifaris (University of Pennsylvania).

We offer our thanks to committee members’ executive assistants and support staff, without whom scheduling meetings and conference calls would have been nearly impossible: Hannah Bagley, Kathy Farnum, Duane Haneckow, Lamia Pierre, Tamala Knox, Kathleen Prutting, Bryana Castillo Sanchez, Lidiana Sanvar, and Kisha Young.

Finally, the committee would like to thank the NIH Office of Research on Women’s Health, the study sponsor, for its support of this work.

It is our hope that the road map the committee has laid out in this report will not only guide Congress and NIH but also inspire a new generation of researchers to embrace the challenge and address the urgent need to make new scientific breakthroughs to improve women’s lives. This journey began at NIH over 30 years ago, and we believe this is the time to renew and expand this commitment with transformative change. To quote the late Nancy Adler, a leading researcher and passionate advocate for WHR, “to invest in the health of women is to invest in the well-being and progress of society.”¹

Alina Salganicoff and Sheila Burke, Cochairs
Committee on the Assessment of NIH Research on Women’s Health

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¹ Institute of Medicine. 2010. Women’s Health Research: Progress, Pitfalls, and Promise. Washington, DC: The National Academies Press. https://doi.org/10.17226/12908.

Acronyms and Abbreviations

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Key Terms

The committee strived to use language that is respectful, accurate, and maximally inclusive. This relies on attempting to reflect preferences for how individuals and groups wish to be addressed, but there is not always consensus on preferred terms, and these preferences may evolve. These terms are defined for the purposes of this report and adapted or informed by other National Academies of Sciences, Engineering, and Medicine reports and other reports.¹

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¹ Canadian Institutes of Health Research. 2022. National women’s health research initiative. https://cihr-irsc.gc.ca/e/53095.html (accessed August 27, 2024); Jones, C. P. 2002. Confronting institutionalized racism. Phylon (1960-), 50(1/2), 7–22; NASEM. 2024. Advancing research on chronic conditions in women. Washington, DC: The National Academies Press; NASEM. 2023. Federal policy to advance racial, ethnic, and tribal health equity. Washington, DC: The National Academies Press; NASEM. 2022. Measuring sex, gender identity, and sexual orientation. Washington, DC: The National Academies Press; NASEM. 2020. Understanding the wellbeing of LGBTQI+ populations. Washington, DC: The National Academies Press; NASEM. 2022. Measuring sex, gender identity, and sexual orientation. Washington, DC: The National Academies Press; NIH Office of Equity, Diversity, and Inclusion. n.d. Terms and definitions. https://www.edi.nih.gov/people/sep/lgbti/safezone/terminology (accessed July 12, 2024); ORWH. n.d. Sex and gender. https://orwh.od.nih.gov/sex-gender (accessed July 12, 2024); SGMRO. 2024. About SGMRO. https://dpcpsi.nih.gov/sgmro (accessed August 20, 2024); WHO. n.d. Gender and health. https://www.who.int/health-topics/gender/strengthening-health-sector-response-to-gender-based-violence-in-humanitarian-emergencies#tab=tab_1 (accessed July 30, 2024).

Women’s Health Research Terms

Female: An individual (human or animal) whose sex traits (see definition of “sex”) include features typically associated with or assigned as female; females typically have any of the following organs or characteristics:

• External genitalia including a vulva, vagina, and/or clitoris; or
• Internal sex organs and gonads including a cervix, uterus, fallopian tubes, or ovaries; or
• Sex chromosome complement that consists of a predominantly X configuration (typically two X chromosomes) in the absence of an active Sry gene.

Human females can include individuals who were assigned female at birth and identify as women, men, nonbinary, transgender, genderfluid, and/or Two-Spirit. This definition should not be conflated with the definition of women; though most women are assigned female at birth, many are not. Furthermore, the definition is not proscriptive, exhaustive, or immutable, as indicated in the definition of sex.

Women: The terms “female” and “woman” are used differently according to context and perspective, which may cause confusion. In this report, the definition of women goes beyond the sex and gender binary and includes all people who identify as a woman or girl, solely or in addition to other gender identities and regardless of biological sex traits. This inclusive definition recognizes individuals who have been or may be affected by a set of biological and/or social variables that influence women differently than men across the life course.

Women’s health: Includes physical, biological, reproductive, psychological, emotional, and cultural/spiritual health and wellness across the life course, for more than those identifying as women or girls. It includes the experiences and needs of all people who identify as a woman, girl, female, nonbinary, transgender (men or women), genderfluid, or Two-Spirit or were assigned female at birth.

Women’s health research: The scientific study of the range of and variability in women’s health as defined and the mechanisms and outcomes in disease and non-disease states across the life course. It considers both sex and gender and how these affect women’s health and well-being, disease risk, pathophysiology, symptoms, diagnosis, and treatment. This work also addresses interacting concerns related to women’s bodies and roles and social and structural determinants and systems.

Sexual Orientation, Gender Identity and Expression, and Sex Characteristics Terms

Sex: A multidimensional construct that refers to a person’s biological status, based on a cluster of anatomical and physiological traits that include external genitalia, secondary sex characteristics, gonads, chromosomes, and hormones. It is typically categorized as male, female, or intersex and determined at birth. Some notable characteristics about sex include

• Usually assigned as female or male;
• Most often defined at birth based on visual inspection of external genitalia;
• Sex traits are usually assumed to be unambiguous, but may not be;
• Sex traits are usually assumed to correspond to the same sex, but may not;
• Some sex traits can change or be altered over time.

Intersex: People whose sex traits do not all correspond to a single sex.

Gender: A multidimensional construct that links gender identity, gender expression, and social and cultural expectations about status, characteristics, and behavior that are associated with sex traits. It influences how people perceive themselves and each other, how they act and interact, and the distribution of power and resources in society. Gender identity is not confined to a binary (girl/woman, boy/man), nor is it static; it exists along a continuum and can change over time. There is considerable diversity in how individuals and groups understand, experience, and express gender through the roles they take on, the expectations placed on them, relations with others, and the complex ways that gender is institutionalized in society.

Gender identity refers to a person’s deeply felt, internal, and individual experience of gender, which may or may not correspond to their physiology or designated sex at birth.

Gender identities include

• “Cisgender” (“cis”) refers to a person whose current gender identity aligns with the sex they were assigned at birth.
• “Transgender” (“trans”; not “transgendered”) refers to a person whose current gender identity differs from the sex assigned at birth.
• “Nonbinary” is often used to describe a gender identity that is neither exclusively man nor woman (i.e., outside the gender binary).
• “Genderqueer” describes a person who does not follow gender norms.

• “Genderfluid” refers to a person who does not identify with a fixed gender.
• “Two-Spirit” is a placeholder term for specific gender and sexual orientation identities that are centered in Indigenous tribal worldviews, practices, and knowledges.

Gender binary refers to the concept that there are only two genders, male and female, and that everyone must be one or the other. The concept is also often misused to assert that gender is biologically determined and reinforces the idea that men and women are opposites and have different roles in society.

Gender expression is how an individual signals their gender to others through behavior and appearances (e.g., clothing, appearance, mannerisms). This may be conscious or subconscious and may or may not reflect their gender identity or sexual orientation.

Sexual orientation is a multidimensional construct encompassing emotional, romantic, and sexual attraction, identity, and behavior. Categories of sexual orientation include heterosexual (straight), lesbian/gay (homosexual), bisexual, queer, pansexual, and questioning.

• “Heterosexual” (“straight”) refers to people whose attraction and behavior are oriented toward people of a different, usually binary, gender.
• “Lesbian/Gay” (“homosexual”) refers to people whose attraction and behavior are oriented toward people of the same, usually binary, gender.
• “Bisexual” refers to people whose attraction and behavior are oriented toward people of both the same and different genders.
• “Queer” is an umbrella term for belonging to the LGBTQIA+ community and also used to refer to a person whose attraction and behavior are oriented toward people of more than one gender.
• “Pansexual” refers to people whose attraction and behavior are oriented toward people of any gender.
• “Questioning” refers to someone who is uncertain about sexual orientation and identity.

Sexual and gender minorities (SGM): SGM populations include but are not limited to individuals who identify as lesbian, gay, bisexual, asexual, transgender, Two-Spirit, queer, and/or intersex. Individuals with same-sex or -gender attractions or behaviors and those with a difference in sex development are also included. These populations also encompass those who do not self-identify with one of these terms but whose sexual orientation, gender identity

or expression, or reproductive development is characterized by nonbinary constructs of sexual orientation, gender, and/or sex.

Social and Structural Determinants of Health

Social determinants of health (SDOH): The conditions and environments in which people live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks. SDOH can both promote and harm health. For the purposes of this report, SDOH are organized by the Healthy People 2030 domains: economic stability, education access and quality, health care access and quality, neighborhood and built environment, and social and community context.

Structural determinants of health: Macrolevel factors, such as institutional practices, governance processes, and social norms, that shape the distribution or maldistribution of SDOH, including housing, income, employment, exposure to environmental toxins, and interpersonal discrimination, across and within social groups. Structural determinants of health, also referred to as the “determinants of the determinants of health,” include structural racism and other structural inequities and thus impact not only population health but also health equity.

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