Social Determinants of Health

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


In Baltimore 24.2% of people live below the poverty line (23,850 for a family of four) compared to 9.9% of people in Maryland.

Social Determinants

Place Matters

“Place” refers to more than just the physical environment but also the social and economic conditions. The environment a person grows up in and lives in has a huge influence on his or her health and quality of life.

This map developed by the Baltimore City Health Department shows information on social determinants of health across the Baltimore neighborhoods.

Explore the map and factors that affect how Baltimore residents live, learn, work, and play. Find your Neighborhood Health Profile.

Find your Neighborhood Health Profile.

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. Exposure to ACEs and adversity such as poverty or racism over a prolonged period of time is often toxic and will make a child vulnerable to disrupted social, emotional and neurodevelopment. 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 11,010 violent crimes in 2017





Violent crime rate: 1,780 per 100,000 people compared to 472 per 100,000 people in Maryland (2.77 times higher).