The Relative Contribution of Multiple Determinants to Health Outcomes

Families play in public park.

Five major categories of health determinants are highlighted: genetics, behavior, social circumstances, environmental and physical influences, and medical care.

The last several decades have seen a growing interest in what defines and shapes health. Despite having the highest per capita health spending, the United States lags behind many other countries in many health indicators, and glaring health disparities remain. The United States devotes a small share of its health expenditures (less than 9 percent) toward disease prevention.

One theme gaining strength in the research literature posits that many benefits from the extremely high health care spending in the United States are undermined by the nation’s very low investments in social services, broadly defined to include support services for older adults, survivor benefits, disability and sickness benefits, family supports, housing programs, employment programs, unemployment benefits, and other social policy issues.

Furthermore, there is an increasing awareness that other nonclinical factors such as education and income have a major impact on health. To understand and address these issues, researchers have focused on understanding the factors that affect people’s health, commonly referred to as health determinants. The goal of this research is to effectively design interventions and create policy choices that value health for all people and that address not only the more obvious, direct determinants of health but also the structural and societal issues that may be causing persistent health disparities. A better understanding of what influences health outcomes will ultimately lead to better policies and allow for more effective use of limited resources—directly on health and otherwise.

In this issue brief the researchers focus on multiple determinant studies that seek to quantify the relative influence of the major categories of determinants on health (in contrast to the extensive body of research that examines single classes of determinants in detail). This brief is part of a larger project, under a grant from the Robert Wood Johnson Foundation, which aims to create a structure for conducting analyses that demonstrate the value of investments in nonclinical primary prevention and their impact on health care costs.

A foundation for this structure is provided by a high-level representation of the process by which an investment in primary prevention acts through the determinants of health to produce impacts on health, costs, and other outcomes of interest to various stakeholder groups. Central to this representation is an understanding of the relative contribution of the determinants of health to health outcomes and costs. Where possible, they aim to simplify this construct per David Kindig’s assertion in his blog "Population Health: If It’s Everything, Is it Nothing?" to prioritize and focus on a smaller number of specific determinants that are known, a priori, to be important.



Media Contacts

Sue Ducat

Health Affairs 301-841-9962

Additional Media Contact: Melissa Blair

Robert Wood Johnson Foundation 609-627-5937