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What determines our health…Five Health Determinants

In my last blog I had talked about how we are paying more for our healthcare but paying more does not seem to be helping. It is certainly not helping us become healthier or lead longer lives. In fact, recent reports indicate that life expectancy has fallen in the United States.

If our investments are not getting the desired results then we need to look hard to figure out what else to do. Do we need to do something better? Should we look at what  we are not doing? Do we need to look at what determines our Health , the Five Health Determinants.

What should we do? What can we do? The Five Health Determinants

I asked myself a basic question. What is Healthcare? What determines that we have good Healthcare? That are we doing well. What are we improving.

According to McGovern, Miller and Hughes-Cromwick in their article in Health Affairs in Aug 2014, there are five major categories of health determinants:

  • Genetics
  • Behavior
  • So­cial Circumstances
  • Environmental and Physi­cal influences
  • Medical Care.

The paper highlights a couple of important points.

It summarizes findings from 10 studies. All of them show that Behaviors and Social circumstances have the same, if not larger impact on health. They have an impact larger than the other three determinants, Environment and Physical influences, Medical Care and Genetics put together.

Think about that! Behaviors and Social circumstances have the largest impact on our health!

This paper also notes that Behavior change is one of the most difficult things to accomplish.

What health determinant  has our attention?

Next, I tried to establish how much attention we are paying, relatively speaking to each of these five determinants of health. I thought that the money spent on each of these ‘categories‘ would be a good proxy for attention. I looked into this.

Determinants of Health

I did not find any studies (yet… though I am sure they are out there) that quantify investments on these five determinants. However, anecdotal information based on my conversations with healthcare practitioners, both doctors and administrators, seems to indicate that most of our investment dollars are spent on medical care, on just One of the Five determinants.

Let me take a step back and put this picture back together.

We are paying more for our healthcare. It is not helping us become healthier or lead longer lives. Don’t get me wrong. Modern medicine is almost miraculous. The gains that advances in medical care have delivered have slowed or plateaued. We can do more.

Relative importance of Health Determinants
Relative importance of Health Determinants

There are five ‘Categories’ that affect our health. We are focused on just one of them. Medical Care. That’s where we invest most of our money.

How does this help…

All this points to something. Doesn’t it?

What about the other four determinants? Genetics, Behavior, So­cial Circumstances, Environmental and Physi­cal influences. Can we do something about them? Is there any evidence that working on these other determinants  will help with better outcomes?

As it turns out, there is. I will talk about Blue Zones in a forthcoming blog…

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