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Social Determinants of Health

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From:
Melissa Raven <[log in to unmask]>
Reply To:
Social Determinants of Health <[log in to unmask]>
Date:
Tue, 8 Jul 2008 00:37:09 +0930
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Hi everyone

I keep coming across citations of McGinnis & Foege's classic 1993 paper:

McGinnis JM, Foege WH. Actual causes of death in the United States. JAMA 
1993 Nov 10;270(18):2207-12. http://www.ncbi.nlm.nih.gov/pubmed/15010446

There is also a follow-up paper:

Mokdad AH, Marks JS, Stroup DF, Gerberding JL. Actual causes of death in the 
United States, 2000. JAMA. 2004 Mar 10;291(10):1238-45. 
http://www.ncbi.nlm.nih.gov/pubmed/15010446

The first paper in particular seems to be very influential - according to 
Google Scholar, it has been cited by 1673 academic publications. Most often 
what is cited is the claim that 40% of deaths are caused by preventable 
behaviors - the usual suspects: smoking, bad diet and lack of exercise, 
alcohol..

It is generally cited by people on the lifestyle bandwagon (who usually do 
not mention that McGinnis & Foege stated that social determinants are also 
important), but it is also sometimes cited by people with a social 
determinants orientation, usually in relation to the point McGinnis & Foege 
made about the disproportionate allocation of health resources to treatment 
rather than prevention. Disappointingly, in the latter cases, there is 
usually no critical discussion of the 40% lifestyle claim.

Can anyone point me to a good critique of the methodology, assumptions, 
interpretation etc.?

Thanks

Melissa

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