Health factors: what decides outcomes?

Posted on 28 January 2019

Health factors: what decides outcomes?

Growing up, when I saw the doctor I always saw them as a fountain of knowledge and the saviour of my health. When I went to medical school I felt a great sense of responsibility in carrying that trust which patients gave me in return for guiding them through their ailments and admittedly had a lot of pride in becoming a ’saviour’. A small but key component of my time at medical school really got me questioning this, though. During our 2 weeks of learning about Public Health we were taught about the health factors that determine outcomes, which are summarised in this famous diagram:

Dahlgren and Whitehead 1991 model of the determinants of health

A few years later with a couple of years as a fully-fledged doctor under my belt I wasn’t able to shake the feeling that no matter how much we try in hospital the best we manage is to control symptoms but never really deal with root causes of illness. So I looked into data on the relative contribution of these health factors to outcomes:

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Let’s take a real look at each of the health factors. Environmental (roads, housing, etc.) and socioeconomic (employment and education) factors are not in the job remit of doctors and actually, although they may be difficult to change, they are mostly determined by you, the individual. So that’s half of health factors out of my control as a doctor and on to you guys. Health behaviours are something I want to help with, but are ultimately down to you, the patient. Genes and biology none of us can control…or can we?

We have recently come to understand a phenomenon called epigenetics. Yes, our genes do not change but how they are expressed does change in response to environmental factors such as nutrition, drugs, temperature and radiation; all of which you have control over. Moreover, there is increasing interest in the role of the microbiome in disease. The microbiome is the 10s of trillions of bacteria in and around our bodies that support our cells in functioning. Most of these are located in the gut and more and more imbalances are being associated with chronic illness. What you eat therefore has a massive role to play here. So yes, genes and biology can be altered but mainly by you, not your doc.

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That leaves me, your lovely neighbourhood doctor, only able to contribute 10% to your health outcomes, frustrating for me given I spent six years at medschool. 90% of it is on you, folks. But this needn’t be the burden it sounds like. Think about just how much control you as individual have over your health outcomes. Your health really is about you and your day-to-day lifestyle and there are so many things you can do to optimise it. Yes, no one can do your health for you because so much of it is determined by you; but there is help available. I opened Hippocrates’ Lounge to help patients optimise their whole lifestyle for health and so I can contribute to at least 50% of it rather than only 10%. It’s time to take ownership of your health, because it is and will always be about you.