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Health equity and the fallacy of treating causes of population health as if they sum to 100%

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  • Krieger, N.

Abstract

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 highprofile examples, including Doll and Peto's 1981 opus on the causes of cancer and its current interpretations; a 2015 highpublicity 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, CountybyCounty,"whose model sums causes of health to equal 100%: physical environment (10%), social and economic factors(40%),clinicalcare(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 dominantbutdeeply flawed view that causation can be parsed as nature versus nurture. Better approaches exist for tallying risk and monitoring efforts to reach health equity.

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  • Krieger, N., 2017. "Health equity and the fallacy of treating causes of population health as if they sum to 100%," American Journal of Public Health, American Public Health Association, vol. 107(4), pages 541-549.
    • Handle: RePEc:aph:ajpbhl:10.2105/ajph.2017.303655_0
    DOI: 10.2105/AJPH.2017.303655
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    Cited by:

    1. Rosalind B. King & Regina M. Bures, 2017. "How the Social Environment Gets Under the Skin," Population Research and Policy Review, Springer;Southern Demographic Association (SDA), vol. 36(5), pages 631-637, October.

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