Health Equity and the Fallacy of Treating Causes of Population Health as if They Sum to 100%.

• Autores: Nancy Krieger
• Localización: American journal of public health, ISSN 0090-0036, Vol. 107, Nº. 4, 2017, págs. 541-549
• Idioma: inglés
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• Dialnet Métricas: 3 Citas
• Resumen

  • Numerous examples exist in population health of work that erroneously forces the causes of health to sumto 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, County by County," whosemodel 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 deeplyflawed view that causation can be parsed as nature versus nurture. Better approaches exist for tallying risk and monitoring efforts to reach health equity. [ABSTRACT FROM AUTHOR]