Making the Invisible Causes of Population Health Visible

Making the Invisible Causes of Population Health Visible: A Public Health Consequence, August 2018 by MD, DrPH, and DrPH, MS was published in July of 2018 in the American Journal of Public Health (AJPH). Below is an excerpt:

As we continue to promote causal thinking in population health, we note that the causes that affect population health are, in some respects, well enumerated. In the United States, we know that heart disease is the leading cause of death, followed by cancer and then chronic lower respiratory disease. And yet, as we have argued frequently in these columns, these causes of death (or, conversely, their absence, which leads to good health) are simply one way of looking at the production of health. Another way, which has equal validity, would be to suggest focusing on the behaviors that contribute to these causes of health, leading us to focus on smoking, toxic substances, the use of firearms, and obesity as the causes of death. Yet another approach would tackle the more foundational drivers of population health, which would focus on the contributions of low education, poverty, and spatial racial residential segregation as the causes of health and disease.

None of these approaches are wrong—all are correct. Indeed, although, for example, low education sets one on a trajectory that will include a poor living environment, limited opportunities for exercise, and, subsequent, obesity, all of these ultimately manifest as cardiovascular disease, and it is cardiovascular disease that compromises health. Therefore, an understanding of health requires an understanding of the complex causal architecture that creates health in the first place and structured thinking about how we can grapple with these complex causes to improving health.

One of the challenges we face with this reckoning, however, is that it is unusual for one discipline to engage with all of these factors; this leads to fragmented knowledge and limits our full grasp of the factors that contribute to health. In that regard, throughout its history AJPH has played an important role in shaping our thinking about the full range of factors that shape health, highlighting forces from the biologic to the macrosocial that contribute to population health. Three articles in this issue highlight forces that we see discussed infrequently in the health literature, reminding us of their centrality in the creation of population health.

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Date: 2018