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The Last Straw! A board game on the social determinants of health

The Last Straw! is a board game and participatory education tool focused on the social determinants of health.

The game has three objectives:

  1. to promote discussion about the social determinants of health
  2. to help players build empathy with marginalized people and gain an awareness of their own location on the socio-economic spectrum
  3. to encourage learning in a fun and supportive environment

The game can be played with almost any number of players, from a small group of four or five to a group of 25. Key to the game is the role of the facilitator or “Game Master,” as this person must ensure that the examples and discussions are appropriate for the playing audience. Training manual and videos are available to help the Game Master prepare to host.

In this character-based game, each player develops a profile that includes his or her gender, socio-economic status and race, and receives “vitality chips” based on his or her profile. Chips are gained and lost based on scenarios and “community events,” and the character with the most vitality chips at the end of the game is the winner.

The game was developed 10 years ago, as a graduate student project, by Kate Rossiter and Kate Reeve; it has been refined and updated frequently based on feedback and evaluation data, and has won awards from the University of Toronto, Health Nexus, and Community-Campus Partnerships for Health. Kate Rossiter continues to work in the areas of public health, bioethics, and theatre at Wilfrid Laurier University.

Use this resource to

  • Facilitate discussion and engage critical thinking about the social determinants of health with your public health colleagues, students and other stakeholders
  • Engage community decision makers around the importance of policy and program decisions that address the social determinants of health
  • Help increase understanding within marginalized groups of the importance of the structural determinants when exploring opportunities for social change and empowerment

The game is available for a fee ($100)

Training Videos:

Rossiter, K. & Reeve, K. (2008).  The Last Straw!: A Tool for Participatory Education About the Social Determinants of Health.  Progress in Community Health Partnerships: Research, Education, and Action, Volume 2, Issue 2, Summer 2008, pp. 137-144.  Retrieved from:

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