80 – 90% of Diseases are Caused by Non Biological Factors – Psst… Welcome to the Conversation Health Policy “Experts”


At the US News Healthcare of Tomorrow Conference on Nov. 2, Dr. Pedro J. Greer, the chairman of the department of medicine, family medicine and community health at Florida International University told conference attendees “between 80 and 90 percent of diseases are caused by non-biological factors.”  He explained to attendees “the number one cause of transplants for patients under the age of 50 is fatty liver, and the number one cause of fatty liver is obesity.” There are lower rates of obesity and overweight residents in census tracts with access to healthy and affordable foods. The built environment, location familiarity, and perceptions of safety are highly correlated with dietary habits.


The Office of Disease Prevention and Health Promotion (ODPHP) refers to Social Determinants of Health (SDOH) as “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”


Prior to my role as public policy and government affairs analyst for a Fortune 500 health insurer, I worked in local government as a community policy analyst for an Affordable Care Act (ACA) funded, multi-sector healthy food access initiative.  I was a  public health professional for five years prior to attending graduate school.

The disconnect between health policy and public health is concerning, but it makes sense. Politics direct health policy work. Research and data direct public health work.

Fortunately, the popularity of full-risk capitation and value-based payment models have prompted recent SDOH discussions among Medicaid and other health policy stakeholders. 

Unfortunately, these discussions entail health policy experts enumerating the ways in which they are struggling to define SDOH indicators, collect and analyze standardized SDOH data, understand the geographic component of SDOH, and incorporate SDOH indicators in capitation rate development and value-based payment arrangements.


SDOH indicators and data collection standards already exist.  As a best practice, a prerequisite to taking on a new endeavor should be the completion of a thorough benchmarking and best practices study.

The use of GIS (Geographic Information Systems) software is severely underutilized  in Medicaid and other health policy circles. As a best practice, when hardships identifying geospatial components of a problem arise, utilize geospatial technology. Having used GIS to map various SDOH data points,  I struggle to understand why this is a challenge.

Notably, GIS is useful for health insurers required to meet certain network adequacy standards per the CMS’ Medicaid managed care final rule. GIS is also an effective business development tool.

Innovation — a term health policy experts often use —  requires new ideas and methods.  To that end,  the following organizations (and their affiliates) should have a seat at the table during future SDOH discussions: American Planning Association,  International City/County Management Association, and National Association of Counties.     

Each association has experience with SDOH initiatives and can offer valuable insights.  Through sweeping  authority to direct zoning and other land use policy, local (city and county) government actions inform the “conditions in the environments in which people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.”