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Hi Dave -

What is the progress in knowing what % of health outcomes are attributable to the four broad domains representing the multiple determinants of health? What's the basis of the percentages you used in this blog post?

I agree with the principles and broad perspectives but am curious about the evolving science.

Helene, thank you for the thoughtful and important question. As you imply, the science is less than we would want, which is the reason for the commentary I wrote in JAMA last fall with John Mullahy calling for an expanded approach to comparative effectiveness research (http://jama.ama-assn.org/content/304/8/901.extract). For the County Health Rankings, we use a combination of existing evidence and expert opinion, this is summarized on the Rankings website in a working paper(http://www.countyhealthrankings.org/sites/default/files/differentPerspectivesForAssigningWeightsToDeterminantsOfHealth.pdf). With regard to behaviors and SES, the recent work of Paula Lantz and colleagues (http://www.improvingpopulationhealth.org/blog/2010/11/individual_responsibility.html) is about the best available.

Thanks for reading and please keep commenting!

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