Causes and Causes of Causes of Population Health: A Public Health of Consequence, March 2018

In her classic 1994 article, Nancy Krieger suggested that an ecosocial framework can be useful to integrate our understanding of how biological and social factors influence health and may therefore be an important framework to guide epidemiological theory.1 That article, in turn, rested on earlier work suggesting the importance of multiple causes of health, and subsequently it has been followed by a substantial, and growing, body ofwork that has grappled with the observation that the causes of health are not singular but rather include a broad range of factors at multiple levels of influence. (p. 351) analyzed data from the 2010 to 2014 versions of the Current Population Survey and found that medical outlays redistributed about 1.4% of total income from poorer to richer individuals; put another way, these outlays reduced the median income of the poorest decile by 47.6% as compared with 2.7% in the wealthiest decile, pushing more than seven million people into poverty. Importantly, this article shows that these changes were relatively minimally affected by the Patient Protection and Affordable Care Act (ACA), the signature effort of the Obama administration to improve population health.