Behavioral Determinants in Population Health and Health Disparities Research

Americans spend more than $3.2 trillion on healthcare annually, yet healthcare purchased with that expenditure explains as little as 10% of the variability in life expectancy in the overall population. Health behaviors, in contrast, may explain as much as 50% overall and more than 75% in certain diseases. Of the ten leading causes of death, eight have significant behavioral components. Behavioral determinants of health, which include health-promoting behaviors and health-related risk behaviors, are shaped by biological factors, socioeconomic advantage and disadvantage, and living conditions, neighborhood, geography, and other characteristics of the environment (urban vs. rural, barrio vs. enclave). These determinants, which effect change in health status and outcomes, encompass not only such behaviors as following healthful eating and exercise guidelines, safe sex practices, and vaccination schedules and avoiding alcohol and drug abuse but also encompass considerations of the presence or absence of education, beliefs, social community and relationships, institutions, policies and laws, access to healthcare, and other factors. Therefore, health disparities can flourish in minority and other disenfranchised socioeconomic communities where education, supportive institutions, employment, and access to and support for healthcare are in short supply Accumulating scientific evidence of evolving significant behavioral determinants of health remains a fundamental challenge to public health advancement. Research advances may be expected from the nation's Healthy People metric initiative, international comparisons on selected domains, community-based participatory research, cross-disciplinary and cross-agency engagement, increased attention to detail in outcomes in demographically diverse communities, and increased awareness of sociopolitical and economic context. Meanwhile, long-term public health assaults on some health disparities have shown them to be highly resistant to change, and the lack of social support has undercut progress. Nonetheless, opportunities for intervention at the population level, driven by focused engagement across disciplines and across the public-private-nonprofit-government spectrum, offer exponential impact by, among other efforts, focusing on the multidimensional effects of environment (structural and social determinants), highlighting and diminishing negative determinants, and expanding health equity. Healthcare expenditure does not ensure longevity, meaningful research on behavioral determinants will require cross-disciplinary and cross-boundary efforts, and success can expect to be measured in the expansion of health equity.