Press Release

Embargoed Until Contact

August 21, 2014

Sue Ducat
Director of Communications
(301) 841-9962


The Relative Contribution of Multiple Determinants to Health Outcomes


Bethesda, MD --A new Health Policy Brief from Health Affairs and the Robert Wood Johnson Foundation examines factors that can contribute to health status. In the United States, less than 9 percent of health expenditures go to disease prevention, and there is little support for social services, such as programs for older adults, housing, and employment programs. This brief focuses on "multiple determinant" studies that seek to quantify the relative influence of some of these factors on health. It is part of a larger project, supported by the Robert Wood Johnson Foundation, which aims to create a structure for conducting analyses that demonstrate the value of investments in nonclinical primary prevention and their impact on health care costs.


Topics covered in this brief include:


  • What's the background? As the brief explains, the literature on health determinants, which has grown over the past several decades, highlights five major categories: genetics, behavior, social circumstances, environmental and physical influences, and medical care. Since this is a relatively new area of inquiry, topics and approaches continue to evolve.  
  • What's the research? There have been several approaches to health outcomes research, which are outlined and summarized in a comprehensive table that is part of the brief. Comparisons of health outcomes have tried to measure impact, calculating a range of estimates to assess the contribution of health determinants. Multiple determinants have been found to act in concert with one another; other research has found that a small number of modifiable risk factors (tobacco, diet, and exercise) can have a large impact on mortality reduction and disease burden. The brief highlights some key research efforts and notes that many of the findings recommend the need for both individual and population-based interventions in order to make a lasting effect on behavior change and relevant health incomes.


  • What's the policy? The brief describes the effect of the "health in all policies" (HiAP) approach, which looks for the health ramifications of policies in all sectors, including those not directly related to health--for example, transportation, education, agriculture, and housing. The Affordable Care Act (ACA) provides, as an Institute of Medicine report notes, "an unprecedented shift the focus of health experts, policy makers, and the public beyond health care delivery to the broader array of factors that play a role in shaping health outcomes." 
About Health Affairs

Health Affairs is the leading journal at the intersection of health, health care, and policy. Published by Project HOPE, the peer-reviewed journal appears each month in print, with additional Web First papers published periodically and health policy briefs published twice monthly at Read daily perspectives on Health Affairs Blog. Download weekly Narrative Matters podcasts on iTunes.