What causes differences in population health across states? A comprehensive examination of potential determinants of health
Methods: Following a socioecological model, state-level data were collected on indicators for health outcomes (53 indicators) and five domains of potential health determinants: health systems (26 indicators), health behaviors (35 indicators), socioeconomic factors (40 indicators), the physical and social environment (49 indicators), and public policies/spending (35 indicators). The analysis was restricted to reputable public sources that offered data for at least 45 states, to the most current year with available data, and to indicators that best captured place-based influences at the community/neighborhood level. More than 1100 variables, including covariates, were examined.
Results: Large disparities in health outcomes by state, and regional patterns of poor health (e.g., Deep South), were pervasive across multiple metrics and tracked closely with similar differences in a range of health determinants. Potential explanations for state-level health disparities included not only familiar socioeconomic determinants (e.g., education, income) but also less recognized factors amenable to actionable solutions. State-level health disparities also showed some association with important upstream macrostructural factors, such as public policies and spending priorities.
Conclusions: The health of state residents is shaped by social conditions outside the health sector that influence socioeconomic wellbeing, the physical and social environment, and health behaviors.
Learning Areas:Environmental health sciences
Provision of health care to the public
Public health or related public policy
Social and behavioral sciences
Systems thinking models (conceptual and theoretical models), applications related to public health
Describe differences in health status across states. Identify factors related to health systems, health behaviors, social and economic factors, the physical and social environment, and public policies and spending that may explain differences in population health across states. Discuss how the health status of state residents may be shaped by decisions affecting socioeconomic wellbeing, the physical and social environment, and health behaviors.
Keyword(s): Policy/Policy Development, Epidemiology
Qualified on the content I am responsible for because: I am the lead investigator on the Health of the States project featured in this presentation. I also chaired the National Research Council/Institute of Medicine committee that produced Shorter Lives, Poorer Health, the report about the U.S. health disadvantage that inspired and provided the conceptual framework for this study.
Any relevant financial relationships? No
I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.