What drives health?
By Austin Frakt
What drives health? This is the big and challenging question my team and I are facing on a new, one – year project funded by the Robert Wood Johnson Foundation. This website is devoted to this question, and we invite you to engage with us as we explore it.
This question is important for a number of reasons. First, we should all want to know what makes us healthy so we can make choices in our life. If, for example, the time I spend exercising or selecting my food carefully didn’t meaningfully matter to my health and wellbeing, I would probably choose to spend some of that time in other ways.
Second, this is an important policy question. With vastly more spending on health care in the US compared to other nations, but with no better health outcomes, it’s reasonable to wonder if that spending is worthwhile. Would we be better off investing more in other things, like housing, nutrition, and education? Many believe they know the right answer to this question, but when one examines the evidence base, it’s not clear we have the science to back up any particular view. That’s a problem we need to solve.
In 2012 I encountered this question through the Bipartisan Policy Commission’s infographic (below). In particular, the infographic claims that access to care is responsible for only 10% of our health. In chasing down the source for this figure (and others), I became troubled.
The source is a 1970s – era study by the Centers for Disease Control and Prevention. Already this is troubling as a lot has changed since the 1970s. Even if the infographic’s figures were accurate then, why should we believe they’re accurate now?
The CDC study was based on the opinions of 40 health care experts, a rather weak methodology and focused on mortality, just one facet of health. So, I’m not confident we can even say the figures were accurate in the 1970s.
The more I and colleagues dug into the question of what drives health the more I became convinced that we lack the evidence base to answer it.
That’s what this project is intended to address. The ultimate goal is a research agenda that will get us closer to really understanding what drives health and by how much. It’s a big question that cannot be answered by one study like ours. But we can make progress by recognizing that we don’t know enough to answer it with precision, and then working to fill in the knowledge gaps.