Drivers of Health is a one-year research and education project aimed at improving our understanding of the social determinants of health. It is run by the Harvard Global Health Institute, a research driven, university-wide entity that facilitates multidisciplinary, collaborative approaches to tackling global health challenges, and made possible with generous support from the Robert Wood Johnson Foundation, the United States’ largest philanthropic organization devoted to health.
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Principal Investigator Austin Frakt, PhD, is an Adjunct Associate Professor in the Department of Health Policy and Management at the Harvard T.H. Chan School of Public Health. He is also Director of the Partnered Evidence-based Policy Resource Center at the Boston VA Healthcare System, U.S. Department of Veterans Affairs and an Associate Professor with the Department of Health, Law, Policy & Management at the Boston University School of Public Health. Dr. Frakt has substantial experience in studying the quality and costs of care across different populations using both administrative and community-level data. In addition, he routinely writes for the JAMA Forum and is a regular contributor to The New York Times.
Duncan Orlander, BA, is a project coordinator at the Harvard Global Health Institute. He graduated from Northwestern University in 2016 with a bachelor’s degree in Political Science and Global Health. Duncan spent his first year out of college working on a small farm in Concord, Massachusetts exploring his interest in the intersection food systems, environmentalism, and public health.
Kate Raphael, BA, is a research assistant at the Harvard Global Health Institute. She graduated from Yale University in 2018 with a bachelor’s degree in Anthropology where her studies focused on access to health care among historically underserved populations, particularly in the context of the opioid epidemic in Southern Indiana.
Health behaviors encompass a wide range of human behaviors that affect health including: physical activity; diet; sleep; and tobacco, alcohol, and other substance use. Just as one example, reducing exposure to tobacco has been identified as the single biggest way to prevent morbidity, disability, and early death.
Environmental factors — natural and built — have profound effects on our health. Of course, factors like air quality affect our health, evidenced by a study that demonstrated an association between higher levels of air pollutants O3 and PM2.5 and pediatric pneumonia. Environmental conditions even before birth (present during fetal development) can affect health and well-being into adulthood.
Genetics play a role in the development of certain disease. For example, while cancer is not caused by genetics, most cancers have some genetic determinants. The BRCA1 and BRCA2 genes play a role in tumor suppression, and, when mutated, increase the risk of female breast, ovarian, and other cancers.
Racial Identity is closely associated with health outcomes in the US. For example, African-American adults experience much higher levels of mortality than white adults, from all causes. Racial Identity also plays a role in the accumulated stress from discrimination and in the quality of health care received.
Evidence suggests that gender identity plays a role in health and health care. For example, one study found that women with angina pectoris and low socioeconomic status were referred to cardiologists less frequently than men.
Evidence suggests that education has a causal effect in reducing mortality. Among all age groups, every additional year of school is associated with increased self-reported health status.
Income and wealth are associated with health, but through complex pathways. While income and wealth facilitate access to health care, food, and housing, it’s also true that good health facilitates labor force participation, potentially leading to higher income. Several studies suggest that income and resources have profound effects in early life and development, but a much smaller effect on adults.
A wide range of government policies can affect health. For example, in 2007, Australia became the first country to introduce a government-funded human papillomavirus (HPV) vaccination program. For years later, significantly lower levels of HPV were present in the population. As another example, studies show that Medicaid expansion in the US facilitates access to care and improves self-reported health outcomes. Policies outside the health system can affect health too. Those pertaining to deportation of undocumented immigrants and same-sex marriage have been linked to health outcomes, for example.
Medical care is designed to facilitate good health, so both the quality of medical care and access to it influence our health outcomes. One study found that the medically uninsured receive 20% less care after auto accidents and have significantly higher mortality rates than people who are insured.
Occupation is linked to health outcomes, and may both cause health due to the conditions of the job, and be caused by health due to the limitations particular to certain conditions.
Social relationships can affect mental and physical health as well as behaviors and mortality risk. The people we are surrounded by (at an early age, parents, and later in life, peers and romantic partners) strongly influence health through mechanisms of stress, social support, and pressure to engage in or avoid risky behaviors.
Health behaviors encompass a wide range of human behaviors that affect health including: physical activity; diet; sleep; and tobacco, alcohol, and other substance use. Just as one example, reducing exposure to tobacco has been identified as the single biggest way to prevent morbidity, disability, and early death.
Race is closely associated with health outcomes in the US. For example, African-American adults experience much higher levels of mortality than white adults, from all causes. Race also plays a role in the accumulated stress from discrimination and in the quality of health care received.