In the previous chapter, we examined how national policies can shape and constrain men's and women's choices in a myriad of ways, many of which can affect their health. Here we narrow the context to focus on state and community polices and characteristics that can also affect men's and women's choices and in turn their health. This level of influence over people's lives is one level lower on our conceptualized constrained choice diagram (Figure 2.2), and hence the impact of state and local policies on individual choice may in many respects be more apparent than that of national policies.

Although this chapter focuses on the health effects of state and local policies, these policies are neither created nor function in a vacuum. In most but not all areas, local, state, and national governments each control some dimension of policy, including funding. The extent to which local resources and problems are a function of multiple levels of governmental decision making varies across countries, and it is generally greater in those with a decentralized federal system that gives more control to states or provinces. In the United States at least, there is considerable variation in both state and local policies ranging from those regarding air quality and land use to those on aspects of the social safety net, policing, and transportation. Together these policies shape the social and built environments of the states and communities in which we live and work.