Determinants of Health

Determinants of Health

Health is more than medical care

89% of health occurs outside of the clinical space through our genetics, behavior, environment and social circumstances. These factors are known as the social determinants of health. Despite their importance, attempts to integrate the determinants into a single visualization have been limited.

GoInvo identified this gap based on their extensive work as a healthcare design studio and conducted a literature review of sources (World Health Organization and the Kaiser Family Foundation) and face to face interviews with public policy analysts, health IT experts, and clinical professionals. Relying on their experience of mapping complex systems within healthcare, GoInvo created a comprehensive open source visualization of the social determinants of health.

Tap the categories to explore

The Determinants of Health is available as a poster, an installation, a download, and an interactive visualization.

Determinants Compared to Spending

We'd Like Your Feedback

We’ve mapped the most recent available federal, state, and relevant private intervention spending to the determinants of health. Where data is available, we’ve also compared United States performance to a group of comparable countries (OECD countries). Explore the poster and references then send your feedback on this draft tohello@goinvo.com

Note: Intervention spending is money spent to address the problem. It is not total money spent in that area. For example, we list reentry and education program spending for incarcerated individuals and not the total cost of incarceration. Where data is not available it is not displayed.

About GoInvo

GoInvo is a healthcare design company that crafts innovative digital and physical solutions. Our deep expertise in Health IT, Genomics, and Open Source health has delivered results for the National Institutes of Health, Walgreens, Mount Sinai, and Partners Healthcare. Reach out for a custom installation or feedback.

Methodology

Below is a description of the methodology used in creating the Determinants of Health visualization. It is also a record of versioned updates to the methodology and visualization based on continuing research and feedback. Thank you to those who have reached out and helped identify areas to improve.

v1 - 26.Jul.2017

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:

The lists of determinants published from each of the previously mentioned organizations were compiled and compared1 - 8. There was no standard in terms of the number of determinants, hierarchical organization of the determinants, and the naming for the determinants (for example, quality of housing3vs residence quality7). The most thorough publication for the determinants came from the Institute of Medicine report7. Therefore this was the primary source from which the list of 95 determinants within the visualization originated.

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.

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) / 7 = 39.71*Social:(15 + 40) / 2 = 27.5Genetics:(20 + 30) / 2 = 25Medical care:(10 + 10 + 20) / 3 = 13.33Environment:(20 + 7 + 5 + 5.4 + 3 + 10) / 6 = 8.4

*An original miscalculation of 'Behavior' has been rectified. The following values have subsequently been updated.

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:39.71 / 113.94 = 34.85%Social:27.5 / 113.94 = 24.14%Genetics:25 / 113.94 = 21.94%Medical care:13.33 / 113.94 = 11.70%Environment:8.4 / 113.94 = 7.37%Total:34.85 + 24.14 + 21.94 + 11.70 + 7.37 = 100%

The final percentages are as follows.

Behavioral determinants at35%.Social determinants at24%.Genetic determinants at22%.Medical care determinants at12%.Environmental determinants at7%.

v2 - 30.Aug.2017

The following are updated calculations for the relative contributions of each of the determinant categories. The relative contribution of each of the determinant categories to one’s health was found using the values referenced from the six sources listed below.

Each determinant category value is an average based on adding the values from each of the aforementioned sources.

Behavior:(50% [9] + 42% [10] + 40% [11] + 45% [12] + 30% [15]) / 5 = 41.4%Social:(15% [11] + 40% [15]) / 2 = 27.5%Genetics:(20% [9] + 30% [11]) / 2 = 25%Medical care:(10% [9] + 10% [11] + 20% [15]) / 3 = 13.33...%Environment:(20% [9] + 3% [10] + 5% [11] + 3.9% [14] + 10% [15]) / 5 = 8.38%

Additional notes on the determinant category values: For source10, The environmental value of ~3% was based on dividing toxic agent deaths (60,000 deaths. Toxic agents were defined as occupational hazards, environmental pollutants, contaminants of food and water supplies, and components of commercial products) divided by total deaths for that year (2,120,000).

The average values found for each of the determinant categories were each divided by the total determinant value.

Total value:41.4% + 27.5% + 25% + 13.33...% + 8.38% = 115.6133Behavior:41.4% / 115.6133... = 35.81%Social:27.5% / 115.6133... = 23.79%Genetics:25% / 115.6133... = 21.62%Medical care:13.33...% / 115.6133... = 11.53%Environment:8.38% / 115.6133... = 7%

The final percentages are as follows.

Behavioral determinants at36%Social determinants at24%Genetic determinants at22%Medical care determinants at11%(rounded down) Environmental determinants at7%

v3 - 15.Nov.2018

The following is a more detailed explanation of the values used to find the relative contributions of each of the determinant categories.

Each determinant category value is an average based on adding the values from each of the aforementioned sources.

Behavior:(50% [9] + 43% [10] + 40% [11] + 43% [12] + 30% [15]) / 5 = 41.20%Social:(15% [11] + 40% [15]) / 2 = 27.50%Genetics:(20% [9] + 30% [11]) / 2 = 25.00%Medical care:(10% [9] + 10% [11] + 20% [15]) / 3 = 13.33...%Environment:(20% [9] + 3% [10] + 5% [11] + 4% [14] + 10% [15]) / 5 = 8.40%

The environmental value of ~3%10was based on taking toxic agent deaths (60,000, defined as occupational hazards, environmental pollutants, contaminants of food and water supplies, and components of commercial products) and dividing by total deaths for the year of 1990 (2,120,000).

The behavior value of 42%10was based on taking the causes of death in 1990 due to behavior (50%, page 2208) and subtracting deaths caused by microbial & toxic agents (4% + 3%, page 2208) = 43%.

The behavior value of 45%12was based on taking the causes of death in 2000 (48.2%, page 1240), and subtracting deaths caused by microbial & toxic agents (3.1% + 2.3%, page 1240) = 42.8% → 43%.

The environment value of 4%14was based on global risk for burden of disease due to unsafe water, sanitation and hygiene (4%, page V).

The average values found for each of the determinant categories were each divided by the total determinant value.

Total value:41.2% + 27.5% + 25% + 13.33...% + 8.38% = 115.413...Behavior:41.2% / 115.413... = 35.70%Social:27.5% / 115.413... = 23.83%Genetics:25% / 115.413... = 21.66%Medical care:13.33...% / 115.413... = 11.55%Environment:8.4% / 115.413... = 7.28%

The final percentages are unchanged from v2.

Behavioral determinants at36%Social determinants at24%Genetic determinants at22%Medical care determinants at11%(rounded down) Environmental determinants at7%(rounded down)

Additional Change

14.Feb.2018

Race and ethnicity have been removed from the biology section due to a lack of standard objective criteria in the scientific community surrounding the use of genetics to define race and ethnicity. It has been added to the Social Circumstance section due to its continued social importance in describing groups based on similar characteristics. View the following literature for additional detail:

Discrimination can be further subdivided into racial, ethnic, gender, sexuality, and age based discrimination.

Poster images have been updated based on the updated Aug 2017 calculations.

14.Apr.2020

Spanish poster version added, based on the updated Aug 2017 calculations. Translation by Roberto Laureles.

Authors

Contributors

Spanish poster translation byRoberto Laureles