89% of health occurs outside of the clinical space through our genetics, behavior, environment and social circumstances. These factors are known as the social determinants of health. Despite their importance, attempts to integrate the determinants into a single visualization have been limited.
GoInvo identified this gap based on their extensive work as a healthcare design studio and conducted a literature review of sources (World Health Organization and the Kaiser Family Foundation) and face to face interviews with public policy analysts, health IT experts, and clinical professionals. Relying on their experience of mapping complex systems within healthcare, GoInvo created a comprehensive open source visualization of the social determinants of health.
Smoking habits, sleep and exercise patterns, sexual activity, and mood levels are all examples of individual behavior, which is a critical determinant for our physical health, mental health, and overall well being. Positive changes to our individual behavior can reduce the risk for developing a variety of diseases, and many public health interventions have already focused on altering dangerous behaviors.
The Determinants of Health is available as a poster, an installation, a download, and an interactive visualization.
GoInvo is a healthcare design company that crafts innovative digital and physical solutions. GoInvo’s deep expertise in Health IT, Genomics, and Open Source health has delivered results for the National Institute of Health, Walgreens, Mount Sinai and Partner Healthcare. Reach out for a custom installation or feedback.
Below is a description of the methodology used in creating the Determinants of Health visualization. It is also a record of versioned updates to the methodology and visualization based on continuing research and feedback. Thank you to those who have reached out and helped identify areas to improve.
The 5 main determinants of health (genetics, medical care, social circumstances, environment, and individual behavior) were chosen due to their consistency across the following 7 out of 8 organizations:
The lists of determinants published from each of the previously mentioned organizations were compiled and compared1 - 8. There was no standard in terms of the number of determinants, hierarchical organization of the determinants, and the naming for the determinants (for example, quality of housing3 vs residence quality7). The most thorough publication for the determinants came from the Institute of Medicine report7. Therefore this was the primary source from which the list of 95 determinants within the visualization originated.
The section below documents our analysis of the data and how we calculated the final impact percentages for the 5 main categories of determinants.
The relative contribution of each of the determinant categories to one’s health was found using the estimated values referenced by the seven primary sources listed below.
Each determinant category was then averaged based on the values from each of the aforementioned sources (the methodology in the primary sources were different depending on the source. The final percentages should therefore be an estimate and not be viewed as absolute numbers).
Behavior: (50 + 38 + 40 + 39 + 36 + 45 + 30) / 7 = 39.71*
Social: (15 + 40) / 2 = 27.5
Genetics: (20 + 30) / 2 = 25
Medical care: (10 + 10 + 20) / 3 = 13.33
Environment: (20 + 7 + 5 + 5.4 + 3 + 10) / 6 = 8.4
*An original miscalculation of 'Behavior' has been rectified. The following values have subsequently been updated.
The ratio for each determinant was then found by taking the average values found for each of the determinant categories and dividing them by the total determinant value.
Behavior: 39.71 / 113.94 = 34.85%
Social: 27.5 / 113.94 = 24.14%
Genetics: 25 / 113.94 = 21.94%
Medical care: 13.33 / 113.94 = 11.70%
Environment: 8.4 / 113.94 = 7.37%
Total: 34.85 + 24.14 + 21.94 + 11.70 + 7.37 = 100%
The final percentages are as follows.
Behavioral determinants at 35%.
Social determinants at 24%.
Genetic determinants at 22%.
Medical care determinants at 12%.
Environmental determinants at 7%.
The following are updated calculations for the relative contributions of each of the determinant categories. The relative contribution of each of the determinant categories to one’s health was found using the values referenced from the six sources listed below.
Each determinant category value is an average based on adding the values from each of the aforementioned sources.
Behavior: (50%  + 42%  + 40%  + 45%  + 30% ) / 5 = 41.4%
Social: (15%  + 40% ) / 2 = 27.5%
Genetics: (20%  + 30% ) / 2 = 25%
Medical care: (10%  + 10%  + 20% ) / 3 = 13.33...%
Environment: (20%  + 3%  + 5%  + 3.9%  + 10% ) / 5 = 8.38%
Additional notes on the determinant category values: For source10, The environmental value of ~3% was based on dividing toxic agent deaths (60,000 deaths. Toxic agents were defined as occupational hazards, environmental pollutants, contaminants of food and water supplies, and components of commercial products) divided by total deaths for that year (2,120,000).
The average values found for each of the determinant categories were each divided by the total determinant value.
Total value: 41.4% + 27.5% + 25% + 13.33...% + 8.38% = 115.6133
Behavior: 41.4% / 115.6133... = 35.81%
Social: 27.5% / 115.6133... = 23.79%
Genetics: 25% / 115.6133... = 21.62%
Medical care: 13.33...% / 115.6133... = 11.53%
Environment: 8.38% / 115.6133... = 7%
The final percentages are as follows.
Behavioral determinants at 36%
Social determinants at 24%
Genetic determinants at 22%
Medical care determinants at 11% (rounded down)
Environmental determinants at 7%
Race and ethnicity have been removed from the biology section due to a lack of standard objective criteria in the scientific community surrounding the use of genetics to define race and ethnicity. It has been added to the Social Circumstance section due to its continued social importance in describing groups based on similar characteristics. View the following literature for additional detail:
Discrimination can be further subdivided into racial, ethnic, gender, sexuality, and age based discrimination.
Poster images have been updated based on the updated Aug 2017 calculations.