Determinants of Health

An open source visualization of the social determinants of health.

References

1. NCHHSTP Social Determinants of Health. (2014). Retrieved March 14, 2016, from http://www.cdc.gov/nchhstp/socialdeterminants/definitions.html
2. The determinants of health. (n.d.). Retrieved March 14, 2016, from http://www.who.int/hia/evidence/doh/en/
3. Social Determinants of Health. (n.d.). Retrieved March 14, 2016, from https://www.healthypeople.gov/2020/topics-objectives/topic/social-determinants-of-health
4. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity. (n.d.). Retrieved March 14, 2016, from http://kff.org/disparities-policy/issue-brief/beyond-health-care-the-role-of-social-determinants-in-promoting-health-and-health-equity/
5. Schroeder, S. A. (2007). We Can Do Better — Improving the Health of the American People. New England Journal of Medicine N Engl J Med,357(12), 1221-1228.
6. The Relative Contribution of Multiple Determinants to Health Outcomes. (n.d.). Retrieved March 14, 2016, from http://healthaffairs.org/healthpolicybriefs/brief_pdfs/healthpolicybrief_123.pdf
7. Capturing social and behavioral domains and measures in electronic health records: Phase 2. (2014). Washington D.C.: The National Academies Press.
8. Gruszin, S., & Jorm, L. (2010, December). Public Health Classifications Project (Rep.). Retrieved March 15, 2016, from New South Wales Department of Health website: http://www.health.nsw.gov.au/hsnsw/Publications/classifications-project.pdf
9. DHHS, Public Health Service. “Ten Leading Causes of Death in the United States.” Atlanta (GA): Bureau of State Services, July 1980
10. J.M.McGinnis and W.H.Foege. “Actual Causes of Death in the United States.” JAMA 270, No. 18 (1993):2207-12
11. J.M.McGinnis et al, “The Case for More Active Policy Attention to Health Promotion.” Health Affairs 21, no.2 (2002):78-93
12. A.Mokdad et al. “Actual Causes of Death in the United States 2000.” JAMA 291, no.10 (2004):1238-45
13. G.Danaei et al, “The Preventable Cuases of Death in the United States: Comparative Risk Assessment of Dietary, Lifestyle, and Metabolic Risk Factors.” PLoS Medicine 6, no. 4 (2009):e1000058
14. World Health Organization, Global Health Risks: Mortality and Burden of Disease Attributable to Selected Major Risks, Geneva: WHO, 2009
15. B. Booske et al., “Different Perspectives for Assigning Weights to Determinants of Health.” County Health Rankings Working Paper. Madison (WI): University of Wisconsin Population Health Institute, 2010
16. Schneiderman, N., Ironson, G., & Siegel, S. D. (2005). STRESS AND HEALTH: Psychological, Behavioral, and Biological Determinants. Annual Review of Clinical Psychology, 1, 607-628. Retrieved March 16, 2016, from http://www.annualreviews.org/doi/abs/10.1146/annurev.clinpsy.1.102803.144141?url_ver=Z39.88-2003&rfr_dat=cr_pub=pubmed&rfr_id=ori:rid:crossref.org&journalCode=clinpsy

Methodology

The 5 main determinants of health (genetics, medical care, social circumstances, environment, and individual behavior) were chosen due to their consistency across the following 7 out of 8 organizations:

NCHHSTP [1]
WHO [2]
Healthy People [3]
Kaiser Family Foundation [4]
NEJM [5]
Health Affairs [6]
Institute of Medicine [7]
New South Wales Department of Health [8]

The 29 macrodeterminants and 66 microdeterminants below each main category were found by compiling the determinant lists of the previously mentioned organizations.

The section below documents our analysis of the data and how we calculated the final impact percentages for the 5 main categories of determinants.

The relative contribution of each of the determinant categories to one’s health was found using the estimated values referenced by the seven primary sources listed below.

DHHS [9]
JAMA [10, 12]
Health Affairs [11]
PLoS [13]
WHO [14]
U.Wisconsin [15]

Each determinant category was then averaged based on the values from each of the aforementioned sources (the methodology in the primary sources were different depending on the source. The final percentages should therefore be an estimate and not be viewed as absolute numbers).

Behavior: (50 + 38 + 40 + 39 + 36 + 45 + 30) / 6 = 46.33.

Social: (15 + 40) / 2 = 27.5.

Genetics: (20 + 30) / 2 = 25.

Medical care: (10 + 10 + 20) / 3 = 13.33.

Environment: (20 + 7 + 5 + 5.4 + 3 + 10) / 6 = 8.4.

The ratio for each determinant was then found by taking the average values found for each of the determinant categories and dividing them by the total determinant value.

Behavior: 46.33 / 120.56 = 38.43%.

Social: 27.5 / 120.56 = 22.81%.

Genetics: 25 / 120.56 = 20.74%.

Medical care: 13.33 / 120.56 = 11.06%.

Environment: 8.4 / 120.56 = 7%.

Total: 38.43 + 22.81 + 20.74 + 7 + 11.06 = 100.4%.

The final percentages are as follows.

Behavioral determinants at 38%.

Social determinants at 23%.

Genetic determinants at 21%.

Medical care determinants at 11%.

Environmental determinants at 7%.

For guidance integrating the Determinants of Health into your product or service, contact us at [email protected].

License

Health Determinants digital service is Apache 2.0 licensed.

The Health Determinants content and poster is licensed under Creative Commons Attribution v4. If you want to reference this work (in a paper, for example), feel free to use:

Choi, Edwin, and Juhan Sonin. 2019. “Determinants of Health.” GoInvo. https://www. goinvo.com/vision/determinants-of-health/.