Health Equity and the Fallacy of Treating Causes of Population Health as if They Sum to 100
Bibliographic Data
| ID | 11032209 |
|---|---|
| Authors | Nancy Krieger (0000-0002-4815-5947, Nancy Krieger is with the Department of Social and Behavioral Sciences, Harvard T. H. Chan School of Public Health, Boston, MA., corresponding author) |
| Year | 2017 |
| Volume | 107 |
| Issue | 4 |
| Pages | 541-549 |
| Publication date | 2017-04-01 |
| Open Access | Yes |
| Type | ARTICLE |
| Venue | American Journal of Public Health (JOURNAL) |
| Journal identifiers | ISSN: 0090-0036 • E-ISSN: 1541-0048 |
| Publisher | American Public Health Association (PUBLISHER • US) |
| DOI | 10.2105/ajph.2017.303655 |
| PMID | 28272952 |
| OpenAlex | W2594014117 |
| Language | EN |
| Citations received | 16 |
| References cited | 33 |
Numerous examples exist in population health of work that erroneously forces the causes of health to sum to 100%. This is surprising. Clear refutations of this error extend back 80 years. Because public health analysis, action, and allocation of resources are ill served by faulty methods, I consider why this error persists. I first review several high-profile examples, including Doll and Peto’s 1981 opus on the causes of cancer and its current interpretations; a 2015 high-publicity article in Science claiming that two thirds of cancer is attributable to chance; and the influential Web site “County Health Rankings & Roadmaps: Building a Culture of Health, County by County,” whose model sums causes of health to equal 100%: physical environment (10%), social and economic factors (40%), clinical care (20%), and health behaviors (30%). Critical analysis of these works and earlier historical debates reveals that underlying the error of forcing causes of health to sum to 100% is the still dominant but deeply flawed view that causation can be parsed as nature versus nurture. Better approaches exist for tallying risk and monitoring efforts to reach health equity
Actuarial science · Causation · Economics · Environmental health · Epistemology · Equity (law) · Fallacy · Health care · Health equity · Political science · Population · Population health · Public health · Publicity · Social determinants of health · Climate Change and Health Impacts · Healthcare cost, quality, practices · Law · Medicine · Public Health Policies and Education
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Precision public health alliances as a model and method for community engagement
Trends in health equity in mortality in the United States, 1969–2019
The Dynamics of Public Health Responsibility
Qualitative modelling of social determinants of health using group model building
The human cost of exploitation
How the Social Environment Gets Under the Skin
The 2022 State of Ohio Families
Krieger Responds
Equity as a Pragmatic Application of Ethics
Growing Economic Inequality Sustains Health Disparities
All Models Are Wrong; Some Are Useful
A pluralistic and socially responsible philosophy of epidemiology field should actively engage with social determinants of health and health disparities
Social determinants of health in the Big Data mode of population health risk calculation
Incorporating Social Determinants of Health into Modelling of Covid-19 and other Infectious Diseases
Epidemiology and the People’s Health
The Mirage of a Space between Nature and Nurture
English men of science
The Case For More Active Policy Attention To Health Promotion
Evidence-Based Public Health
Systems Science Methods in Public Health
The County Health Rankings
The Causes of Cancer
Sick individuals and sick populations
County Health Rankings
People and other Animals
Advancing Efforts to Achieve Health Equity
Mapping and Measuring Social Disparities in Premature Mortality
The Dominant View of Popularization
Sick Individuals and Sick Populations
Estimated Deaths Attributable to Social Factors in the United States
Use and misuse of population attributable fractions
Who and What Is a "Population"? Historical Debates, Current Controversies, and Implications for Understanding "Population Health" and Rectifying Health Inequities
| Citations per year | 1.78 |
|---|---|
| Citation span | 2017 - 2026 (10) |
| Highly cited | No |