10 Framing Recommendations


Explain the social determinants of health using the Foundation of Community Health metaphor.

The Goal & The Challenge

When the goal is… to talk to other sectors about the “social determinants of health” that exist within their respective spheres of responsibility and influence…

The challenge is… they aren’t likely to recognize this phrase, or more important, to understand the concept behind it. Professionals in other sectors are mostly unaccustomed to thinking about the social determinants of health. Like most Americans, they assume health outcomes are shaped primarily by individuals’ lifestyle choices.

Before Framing

When You Say… everyone should be aware of how the social determinants of health shape population outcomes. We can all play a part in promoting initiatives that support the health of all members of the community.

They Think… Public health professionals can think about health, but that’s not what we do. Besides, to be healthier as a society, we all really just need to take better care of ourselves.

Framing can help

Framing can help other sectors understand health in more proactive, holistic, and structural terms. The Foundation metaphor conveys that the many different issues tied to a community’s health are also connected to one another, which urges professionals in all sectors to see that they must work together to achieve shared success.

An effective reframe would look something like this:

The health of our community is like a building—it depends on a strong and stable foundation. Every sector contributes to laying that foundation, and we all depend on its durability to prop us up. Factors like steady employment, quality education, and safe housing form the base of a functioning society by supporting vibrant communities, strong economies, and long-lasting good health for everyone.

Remember, the reframe isn’t a ready-made talking point. It’s a sample iteration that models the framing recommendation in action.

More Examples

Housing Sector

An effective reframe would look something like this:
Safe and healthy homes are part of the foundation of community health. We can work with housing professionals to strengthen that foundation—for example, by promoting regular home inspections as a way to deal with environmental triggers like mold and dust.


In communications with the housing sector, be sure to use the metaphor, well… metaphorically. In other words, avoid mixing it with literal references to a building’s foundation or other aspects of an actual construction project, which could cause confusion.

Education Sector

An effective reframe would look something like this:
Students’ experiences in the classroom, as well as things like test scores and graduation rates, are built on what happens outside of school. Partnerships between education and public health make sense if we’re going to lay a foundation of community health that supports the academic performance and general well-being of our students too.


Education professionals often focus on the needs of their student population, and struggle to see how student well-being is tied to the well-being of the community as a whole. Communicators need to be clear that well-being isn’t just built inside the four walls of the school. The Foundation metaphor explains how community factors support or undermine health outcomes for everyone.

Health Systems Sector

An effective reframe would look something like this:
The starting point for improving community wellness is addressing the foundational social factors that really hold up health. Positive outcomes rest on top of basic supports like stable places to live; safe and reliable ways to get around; and dependable, fairly compensated work.


Help the health systems sector see how environments can actively promote good health. Compared with other sectors, these professionals are more familiar with the phrase “social determinants of health,” but they associate it exclusively with risk factors and harmful environments that influence health in a negative way.

Business Sector

An effective reframe would look something like this:
Businesses depend on healthy communities in order to thrive, and they have an important role to play in shoring up a strong foundation that supports good health for everyone. Providing things like fair pay, a safe work environment, and sick leave lifts up healthy workers and their families, which is good for business too.


When business professionals hear the phrase “social determinants of health,” they think about government regulation and fears of overreach. The Foundation metaphor helps them understand how public health initiatives build a healthy workforce and consumer base.