More Thoughts on Schools, Hospitals and Health

Yesterday's writeup of my notes about social determinants of health from the annual conference of the Association of Health Care Journalists focused a lot on the graphical sin of using circles (which tend to show equality) in an area where equality does not exist.

Just as important is the realization that when it comes to developing a recipe for promoting health, you cannot leave any of the important ingredients out--no matter if it is just a quarter of a teaspoon (a small amount) or a pound of something (a large amount).

So, while schools/general education may be more important than hospitals/health services in coming up with a recipe for promoting the overall health of a population, you cannot ignore the contribution of health services.

I was first introduced to this idea of how various factors relate to each other in David Bloom's class at the Harvard School of Public Health--although, being a health economist, he didn't talk about cooking and recipes. He talked about addition and multiplication.

More specifically, he told the class of future public health experts that they would eventually have to decide whether to think of health as a multiplicative process or an additive one. If additive, then the various factors that contribute to the health of a population (however you rank them) simply add up to whatever sum--and if one of those factors is zero, well, that's not fatal because the others will make up for it.

On the other hand, if achieving health is a multiplicative process, then any factor along the line whose value is zero ends up negating the whole effect.

As in 2 + 1 + 3 + 2 = 8

But 2 x 0 x 3 x 2 = 0

Changing a single one of the factors to zero negates the contribution of every other factor.