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Clinical medicine and health policy planning find common cause as they seek to define the determinants of health. There is substantial recent interest in the social ecology in which health is embedded. However, biology is where these contributing environmental factors are translated.
I provide a new conceptual framework for the biological determinants of health. The old public health rubric of host, agent, and environment as the features that define the root elements of health is an impoverished scheme, because it does not represent our new appreciation of genetic and aging contributions to phenotypic health. I propose genes, external agency, internal agency, and aging as more operationally helpful determinants that effectively describe the biological experience of the organism.
This scheme has the advantage of differentiating those agencies that are practically approachable, and therefore deserving of increased attention and investment, and those that are currently intractable. (Am J Public Health. 2005;95:389-392. doi:10.2105/AJPH.2003.033324)
ZIMMERMAN'S LAW STATES
"No one notices when things go right." This simple homily underlies the fact that 95% of the US healthcare economy is allocated for direct medical care, and only 5% is allocated to health improvement.1
Aligned with this economic reality is the fact that medical science has devoted almost the entirety of its intellectual and financial capital to the elucidation of disease mechanisms and their relief. The pathogenesis of most illness is now known in great detail, yet the causative features that underlie health remain largely unexplored.
It is commonly acknowledged that the root causes of both disease and health involve multiple agencies. The hierarchical nature of multiple causes, "causes of causes," recognizes that some causes are more proximate or immediate than others.2 The death certificate form in California requests the following information: (1) immediate cause of death, (2) secondary cause of death, and (3) other contributing conditions. McGinnis and Foege examined this "cause of cause" idea in their article "Actual Causes of Death in the United States."3 McGinnis and Foege contrasted the traditional list of causes of death with actual causes, most of which were behavioral and lifestyle in origin.
The summary figure of the determinants of health provided in Healthy People 2010 displays multiple contributing agencies within an interactive matrix formulation (Figure 1).4(p18, Figure 7) However, within the formulation, it...