San Francisco Burden of Disease & Injury Study:
Determinants of Health
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About This Site

Why are people living in San Francisco less healthy (or more healthy) than people living elsewhere? Why is health so unevenly distributed among San Franciscans?

This site aims to link what is known about the determinants of health (evidence from the scientific literature) to an objective analysis of the state of San Francisco's Health. It was originally developed as a resource to support the San Francisco Department of Public Health's Prevention Strategic Plan, 2004 - 2008, but it continues to be a useful way to organize information about health.

The determinants page of this site, which can be regarded as the home page for the entire site, has links to many of the major determinants of health.  These are organized within the following categories:

• Social/Environmental/Political
• Behavioral/Individual (Lifestyle)
• Clinical/Physiological

Each determinant (eg, physical inactivity or hypertension or overweight/obesity) has its own "home page" with the same set of links on the right-hand side of all its pages:

Contribution to overall burden of disease in SF
Downstream (health consequences)
Upstream (causes)
• What can be done?
Web resources
MEDLINE strategies

Wherever possible, there are links to expert guidelines, consensus statements, and other key resources, such as the Disease Control Priorities Project. New mortality outcomes (YLL 2004-7, overall, and by ethnicity and sex) are being created (ready by summer 2010), and many of the "Contribution to overall burden of disease in SF" pages will benefit from the recently published The Global Burden of Disease and Risk Factors.

In his classic paper, "Sick Individuals and Sick Populations," Geoffrey Rose makes the point that the "high risk" approach to prevention, carried out in clinical settings, and the "population approach," which seeks to control the causes of incidence, are complementary. This spirit of multiple approaches is reflected in this site. Still, more work needs to be done to find ways to influence the most fundamental, "upstream" determinants of health. As the American Heart Association recently put it, in their Guide for Improving Cardiovascular Health at the Community Level,

A worthy goal is to prevent the onset of risk factors in the first place, referred to as "primordial prevention" or health promotion. This strategy has the potential not only to prevent the first heart attack or stroke in the person at average risk (a population in which large numbers of CVD deaths still occur) but also to avoid the need for intensive and expensive pharmacotherapies to control risk factors such as hypertension, hyperlipidemia, and diabetes, once they become established. The high-risk and the public health strategies mutually enhance each other; the effectiveness of one is compromised when the other is not fully realized as well.

This site is a work in progress. Its primary audience is the makers of health policy. Ultimately, its audience should be all of us who live here.

Background information on this phase of the Burden of Disease & Injury Study

Updated March 7, 2010

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