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Vital Conditions
for Health and
Well-Being

A man with a beard and a little boy on his shoulders.
A woman in a wheelchair with a child drawing on a easel.
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A family is running in a park with a city in the background.

Why do some populations thrive and prosper while others struggle and suffer? The Vital Conditions for Health and Well-Being is a framework that addresses this question in a way that is at once understandable, relatable, and actionable.

Simply put, vital conditions are the properties of places and institutions that we all need all the time to reach our full potential. They include physical necessities like food, water, and humane housing, but also include things that are harder to quantify, like a sense of belonging and agency or civic muscle. Investments in these conditions are necessary to create an equitable, thriving future for ourselves and for generations to come.

A man with a beard and a little boy on his shoulders.
A woman in a wheelchair with a child drawing on a easel.
An older man sitting on a bench holding a cane.
A family is running in a park with a city in the background.

Origins of the Vital Conditions

Over time, different frameworks have attempted to explain the factors that affect a population’s ability to thrive. Some of these frameworks have been greatly influential in shaping our understanding of the ecosystem that produces health and well-being—most notably the social determinants of health framework. The vital conditions are not meant to replace previous frameworks, but rather refine and “evolve” them into a more useful guide for creating measurable systems change.

The concept of vital conditions traces its origin to the Institute of Medicine’s 1988 report The Future of Public Health: “Public health is what we, as a society, do collectively to assure the conditions in which all people can be healthy.”

This statement was an important step forward in our understanding of public health. Specifically, it suggests that public health is best influenced not by direct means (like building more hospitals), but through the indirect means of identifying and improving the underlying conditions that affect health and well-being.

The challenge since then has been to define exactly what these vital conditions are. In 2017, a team led by ReThink Health and the Robert Wood Johnson Foundation came together to fully describe the conditions that are essential to health and well-being. The team sought to build on the social determinants of health by creating a structure that was both comprehensive and succinct.

They aimed to meet the following standards:

  • The conditions should reflect widely held norms and expectations
  • The language should be simple and easy to understand
  • Each condition should align with available measures
  • It should be apparent that each condition is integrally related to the others
Two white rectangles of different heights and widths are positioned closely on a plain white background.
Two white rectangles of different heights and widths are positioned closely on a plain white background.
THRIVING NATURAL WORLD
A white medical cross symbol centered on a light gray background.
A white medical cross symbol centered on a light gray background.
BASIC NEEDS FOR HEALTH + SAFETY
A white chevron or upward-pointing arrow shape on a light gray background.
A white chevron or upward-pointing arrow shape on a light gray background.
HUMANE HOUSING
A white circle with a smaller gray circle in the center, set against a pale background, resembling a simple target or bullseye design.
A white circle with a smaller gray circle in the center, set against a pale background, resembling a simple target or bullseye design.
MEANINGFUL WORK + WEALTH
A large white letter "Q" on a light gray background.
A large white letter "Q" on a light gray background.
LIFELONG LEARNING
A white background with two large, faint, overlapping circles near the bottom of the image.
A white background with two large, faint, overlapping circles near the bottom of the image.
RELIABLE TRANSPORTATION
A white rectangular shape with blurred or faded edges centered on a plain white background.
BELONGING + CIVIC MUSCLE
Two vertical purple rectangles of different heights, side by side, on a light gray background. The rectangle on the right is taller than the one on the left.

Thriving Natural World

Sustainable resources, contact with nature, freedom from hazards

Clean air, water, soil; healthy ecosystems able to sustainably provide necessary resources; accessible natural spaces; freedom from the extreme heat, flooding, wind, radiation, earthquakes, pathogens

A solid blue medical cross symbol on a light gray background.

Basic Needs for Health + Safety

Basic requirements for health and safety

Nutritious food, safe drinking water; fresh air; sufficient sleep; routine physical activity; safe, satisfying sexuality and reproduction; freedom from trauma, violence, addiction and crime; routine care for physical and behavioral health

Teal upward-pointing chevron shape on a light gray background.

Humane Housing

Humane, consistent housing

Adequate space per person; safe structures; affordable costs; diverse neighborhoods (without gentrification, segregation, concentrated poverty); close to work, school, food, recreation, and nature

A solid green circle with a white circular hole in the center, resembling a ring or a doughnut shape, on a light background.

Meaningful Work + Wealth

Rewarding work, careers, and standards of living

Job training/retraining; good-paying and fulfilling jobs; family and community wealth; savings and limited debt

A solid brown letter "Q" with a thick stroke and a circular center on a light background.

Lifelong Learning

Continuous learning, education, and literacy

Continuous development of cognitive, social, emotional abilities; early childhood experiences; elementary, high school, and higher education; career and adult education

A large red rectangle is centered above two smaller red circles on a white background.

Reliable Transportation

Reliable, safe, and accessible transportation

Close to work, school, food, leisure; safe transport; active transport; efficient energy use; few environmental hazards

Two thick magenta horizontal bars are separated by a white space, forming an equal sign on a magenta background.

Belonging + Civic Muscle

Sense of belonging and power to shape a common world

Social support; freedom from stigma, discrimination, oppression; support for civil rights, human rights; arts, culture, and spiritual life; organizing, advocacy, leadership development; civic agency; collective efficacy; civic associations, nonprofit organizations; equitable access to information, communications, technology, and social networking; civic science; transparency; dignified discourse; welcoming, inclusive places; many opportunities for civic engagement (voting, volunteering, public work)

Two white rectangles of different heights and widths are positioned closely on a plain white background.
Thriving Natural World
^
A white medical cross symbol centered on a light gray background.
Basic Needs for Health + Safety
^
A white chevron or upward-pointing arrow shape on a light gray background.
Humane Housing
^
A white circle with a smaller gray circle in the center, set against a pale background, resembling a simple target or bullseye design.
Meaningful Work + Wealth
^
A large white letter "Q" on a light gray background.
Lifelong Learning
^
A white background with two large, faint, overlapping circles near the bottom of the image.
Reliable Transportation
^
A white rectangular shape with blurred or faded edges centered on a plain white background.
Belonging + Civic Muscle
^

How are the vital conditions different from previous models?

The vital conditions are an evolution, not a replacement, of the social determinants model that has been prevalent since its emergence in the early 2000s.

The World Health Organization (WHO) defines the social determinants of health as “the conditions in which people are born, grow, work, live, and age, and the wider set of forces and systems shaping the conditions of daily life.”

  • This framework has greatly enriched our understanding of the non-medical factors that contribute to health and well-being. However, as the WHO and others worked to specify exactly what these social determinants are, the result was a proliferation of lists that attempted to catalog all of the factors that influence health and well-being
  • This complexity creates some significant limitations. New and prospective stewards (not to mention the general public) are often overwhelmed by the abundance of information. Additionally, with so many different lists and a seemingly endless number of proposed determinants, it can be difficult to build consensus and align around specific courses of action.
  • The vital conditions framework focuses on building consensus around a relatively short list of easily understood and easily relatable factors. Stewards now have a model that is much easier to communicate and that facilitates the creation of effective and measurable plans of action.
Play

Vital Conditions vs. Urgent Services

A man with a beard and a little boy on his shoulders.
An older woman and a young girl looking out a window.
A man with dreadlocks standing on a street.
A woman in a wheelchair reading a book.
A group of people holding hands on a couch.

The vital conditions framework enables several important shifts in the way that people think about health and well-being. One of the most important is recognizing the shortcomings of over-reliance on urgent services.

Urgent services are broadly defined as all of the services that anyone under adversity would need to temporarily regain or restore their health and well-being. These include everything from urgent care clinics to food pantries and homeless shelters.

Urgent services are necessary for a safe, healthy, and thriving community. However, existing ways of thinking about health and well-being often lead to over-investing in urgent services and under-investing in vital conditions.

This creates a negative cycle in which the lack of vital conditions creates excess demand for and reliance on these urgent services. Community leaders and institutions in turn often become hyper-focused on providing more urgent services to meet the demand. It is easy to see how this cycle can perpetuate an over-emphasis on urgent services and obscure the need for identifying and improving root causes.

The truth is that no amount of urgent services can ever produce thriving. The vital conditions model provides a framework for communities to break out of this negative cycle and create a better system that supports thriving for all.

A man with a beard and a little boy on his shoulders.
An older woman and a young girl looking out a window.
A man with dreadlocks standing on a street.
A woman in a wheelchair reading a book.
A group of people holding hands on a couch.

What is a Well-Being Portfolio?

The importance of vital conditions becomes even easier to see when combined alongside urgent services in a full well-being portfolio. In times of crisis, urgent services are lifesaving and life-altering. But urgent services cannot produce the experience of thriving. The path to thriving goes through vital conditions. They shape the choices, opportunities, and challenges that we encounter throughout our lives, from birth to death and across generations.

When vital conditions are disrupted or denied, people struggle and suffer, driving demand for urgent services, which in turn diverts even more resources from vital conditions. The best way to escape this downward spiral is through a balanced portfolio of investments in both vital conditions and urgent services.

When stewards from all walks of life are able to negotiate investment priorities across the well-being portfolio, the experience reliably opens space for honest exchange about the legacies we want to pass on to future generations and what it takes for everyone to thrive together—no exceptions.

Federal Plan Uses the Vital Conditions Framework

In November 2022, the federal government released its interagency plan for Equitable Long-Term Recovery and Resilience (ELTTR). With commitments over time from more than 47 federal agencies, this landmark plan outlines a whole-of-government approach to unlock America’s full potential for all people and places to thrive together. It orients federal action around vital conditions that are essential for all people and places to thrive.

“Adopting this framework is a major step in reflecting the reality of people’s lives, as well as the interdependence of government agency missions to make real and lasting improvements in population health,” said Rippel President and CEO Becky Payne, former Lead, Federal Interagency Workgroup for Equitable Long-Term Recovery and Resilience at the U.S. Department of Health and Human Services. Read her full statement.

As of February 2025, the ELTRR is no longer available on the Office of Disease Prevention and Health Promotion website. Please click here to view an archived version of the original web page featuring the ELTRR. Download the Plan and its recommendations below:

Federal Plan for Equitable Long-Term Recovery and Resilience (ELTRR):
Cover of a report titled "Federal Plan for Equitable Long-Term Recovery and Resilience," dated 1/20/22, with colorful geometric shapes and the slogan "All People and Places Thriving, No Exceptions.

Discover More Users Of the Vital Conditions Framework

An increasing number of organizations are embracing the vital conditions framework to drive meaningful change. Explore these organizations and their work.

Explore More Users

Explore More Resources

Vital Conditions Graphics Library

Tools and Publications

Webinars and Videos

  • Watch a ReThink Health Toolbox webinar that offers an introduction to the vital conditions framework
  • Watch this explainer video on the vital conditions for health and well-being produced by Healthy Communities Delaware
  • In this video, Build Healthy Places Network’s Co-Executive Director, Ruth Thomas-Squance speaks with Bobby Milstein from The Rippel Foundation on how public health practitioners can expand on the vital conditions framework

Explore additional resources and connect with fellow stewards through: