• More about that “what makes us healthy” infographic

    I’ve already established that the Bipartisan Policy Center’s infographic was sourced with a citation to nowhere, raising doubts about the accuracy of the figures in it. I was not satisfied, and Adrianna McIntyre of Project Millennial wasn’t either. She did her own internet sleuthing. She began not with the BPC’s citation, but her own lecture slides archive.

    And then I remembered that I probably still had my lecture slides. I did! On the slide in question, the lecturer put “Source: Adapted from CDC, 1979; IOM, 1988; and PHS, 1993.”

    After puttering around the internet, I think the first is a reference to Healthy People: The Surgeon General’s Report on Health Promotion and Disease Prevention, the second a reference to The Future of Public Health, and finally, the third to The Core Function Project, (gated).

    She also found a 2001 IOM report which says,

    An Institute of Medicine Committee on Health and Behavior: Research, Practice, and Policy was convened in 1998 to update the 1982 Health and Behavior report … the committee encountered limitations as to what it was able to address. [It] became clear that there are inadequate data to evaluate fully the cost-effectiveness of behavioral and psychosocial interventions in comparison with other ways of promoting health … Comparing behavioral and psychosocial interventions with other ways of promoting health on the basis of cost-effectiveness requires additional research.


    • If there is any research that supports the notion that health care accounts for only 10% of health or death or something it is far older than the BPC’s 2007 citation to nowhere suggests. Perhaps it dates from as long ago as 1979, or maybe 1988, or possibly 1993. Those are two- and three-decade old sources, which themselves likely reference even older research. Even if any of that does support a 10% figure, I don’t think we need to accept that as accurate today.
    • As recently as 2001, the IOM was unable to speculate on the cost-effectiveness health care vs. behavioral interventions.
    • It is still possible a credible source for BPC’s figures is out there. Neither I nor Adrianna have read every word of the documents we have cited. To be fair, some of them are unavailable or are cited so vaguely by what we have found that we can’t read them. Maybe you can find something out there that we haven’t noticed.

    How much does health care contribute to health? I’m not sure anyone knows, but I have a stack of papers to go through that some say supports an estimate of 50%.


    • There have been huge advances in clinical care in the last 30 years. Thirty years ago if you went to a hospital having a heart attack you’d get morphine and they’d watch you have your heart attack. If you survived, you’d likely be a cripple for the rest of your life, no climbing stairs, etc.Today there would be intelligent intervention, your chances of survival being much better, and if you were so inclined, in a few months you’d be back playing tennis. One could think of many such successes; joint replacements, insulin pumps.

      What eve the estimate of HC’s contribution it has to be recent, not 20-30 years old.

    • 2 things:
      -2001 is not recent, so saying “as recent as 2001” immediatly discredits you
      -someone else commented on your last post said it – GOOGLE IT!!!
      i did a quick google search, 2 minutes later, I found this: http://www.tbf.org/uploadedFiles/BostonParadoxReport.pdf
      after skimming for 5 i found the data they obviously took this from. boston foundation even put it into a convenient bar graph on page 17.

      talk about not doing your homework…

      • The chart on p. 17 says “Source: New England Healthcare Institute”. That’s another citation to nowhere. Please Google it and find the underlying studies.

        Also, it’s the same chart as on page 28 of . Only there it cites a different source (to nowhere). See http://theincidentaleconomist.com/wordpress/oh-come-on-this-just-wont-do/ .

        Relative to 1979, 1988, or 1993 (the dates of the other reports I mention), 2001 is more recent.

        I feel like I’ve done plenty of homework. Still finding no studies to back up the claim. Why don’t the folks pushing the 10% idea do some good scholarship and point to some actual studies that explain how they came up with the numbers? That’s what I do, in every post in which I cite numbers and data.

        Nice try. You can check your snark at the door next time.

      • Following your link, I find the same document Mr. Frakt referred to yesterday, so it wasn’t necessary and must now be embarrassing to have written this comment. As for arguing about whether 2001 is recent, may I say, “Oh come on! This just won’t do.”

    • My real concern with the infographic is how the environment is completely ignored in the “spent” graphic. Environment includes everything from sidewalks to grocery stores to smokestack scrubbers to playgrounds. To indicate that we don’t spend anything on environment, or that it’s only a piece of “other” is disingenuous. the infographic ends up distracting from what is an otherwise very good report.

    • Thanks for exploring this.

      One of the more useful resources on this I’ve found is a working paper by Dave Kindig’s group putting together their methodology for the County Health Rankings. They end up deciding on weighting clinical care as 20% in their final model:


    • Percentage of money spent is not a great metric here. A gym membership doesn’t cost as much as cancer treatment or trauma care after an accident.