Upshot extra: social determinants of health

Our lifestyle, our genes, and the environment, and many other things outside the health system affect our health. By how much exactly? Good estimates are lacking, but there are some things we know. My Upshot post, published yesterday, takes one dive into this, focusing on education.

There have been prior efforts to assess the contributions of various factors to health. The following bit of history didn’t fit into the piece:

Some widely cited figures derive from work done by the Centers for Disease Control and Prevention in the in the mid-1970s. Based on the opinions of 40 health care professionals, the C.D.C. estimated how much lifestyle, human biology (genetics), the environment, and the health system affect mortality. It concluded that the health system played only a small role, about 10 percent. This statistic has been used since to argue that we obtain very little value for all our spending on health care.

The C.D.C. credited lifestyle (like smoking, exercise, and eating habits) for nearly half the responsibility for early deaths. Human biology and the environment received 26 percent and 16 percent of the blame, respectively.

A lot has changed in health care, as well as in the rest of society, the environment, and the economy, since the 1970s. Even if the figures published by the C.D.C. were correct then (and it’s not clear they were), there’s no good reason to believe they’re correct now. More recent studies show that in the latter half of the 20th century, 40-50 percent of longevity gains were due to the health system — far above the 10 percent C.D.C. figure.

In addition, the C.D.C.’s work in the 1970s focused on mortality, but health is a lot broader than that. Another limitation: some important determinants of health don’t fall neatly into the categories “lifestyle, “biology,” or “environment.”

And one of those is education. See my post for more.


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