ArticleAmerican journal of public health2017
Health Equity and the Fallacy of Treating Causes of Population Health as if They Sum to 100.
Article in American journal of public health, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 27 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
27 citing papers in PubMed.
- On the Unfairness of the 'Fair-share Principle' for Health Research.Public health ethics · 2026Article
- Precision public health alliances as a model and method for community engagement.Frontiers in public health · 2025Article
- Black cancer patients navigating a health-care system of racial discrimination.Journal of the National Cancer Institute · 2024Article
- Factors Associated With Racial and Ethnic Disparities in Locally Advanced Rectal Cancer Outcomes.JAMA network open · 2024Article
- Reuniting philosophy and science to advance cancer research.Biological reviews of the Cambridge Philosophical Society · 2023Article
- Pursuing a Cross-Sector Approach to Advance Child Health Equity.Pediatric clinics of North America · 2023Review
- Contrasted life trajectories: reconstituting the main population exposomes in French Guiana.Frontiers in public health · 2023Review
- Racial disparities in breast cancer preclinical and clinical models.Breast cancer research : BCR · 2022Review
- Qualitative modelling of social determinants of health using group model building: the case of debt, poverty, and health.International journal for equity in health · 2022Article
- Trends in health equity in mortality in the United States, 1969-2019.SSM - population health · 2021Article
- Contribution of causal factors to disease burden: how to interpret attributable fractions.Breathe (Sheffield, England) · 2021Article
- The association between social needs and chronic conditions in a large, urban primary care population.Preventive medicine · 2021Article
- Incorporating Social Determinants of Health into Modelling of COVID-19 and other Infectious Diseases: A Baseline Socio-economic Compartmental Model.Social science & medicine (1982) · 2021Article
- Pivoting from decomposing correlates to developing solutions: An evidence-based agenda to address drivers of health.Health services research · 2020Article
- Social Risks Among Primary Care Patients in a Large Urban Health System.American journal of preventive medicine · 2020Article
- Art, Anti-Racism and Health Equity: "Don't Ask Me Why, Ask Me How!"Ethnicity & disease · 2020Article
- Lost in the Black Belt South: health outcomes and transportation infrastructure.Environmental monitoring and assessment · 2019Article
- Contributions of Health Care to Longevity: A Review of 4 Estimation Methods.Annals of family medicine · 2019Review
- Stem cell replication, somatic mutations and role of randomness in the development of cancer.European journal of epidemiology · 2019Review
- "Centering the Margins": Moving Equity to the Center of Men's Health Research.American journal of men's health · 2018Article
Corrections and comments
- Commented on by
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- Erratum issuedERRATUM.2017
Authors and funding
1 author.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Numerous examples exist in population health of work that erroneously forces the causes of health to sum to 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 high-profile examples, including Doll and Peto's 1981 opus on the causes of cancer and its current interpretations; a 2015 high-publicity 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," whose model 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 deeply flawed view that causation can be parsed as nature versus nurture. Better approaches exist for tallying risk and monitoring efforts to reach health equity.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.