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  • Washington Highlights

    AAMC Center for Health Justice Responds to the NCCIH Request for Information on Determinants of Health


    Philip Alberti, Founding Director, AAMC Center for Health Justice
    Daria Grayer, Director, Regulation and Policy
    Heather Pierce, Senior Director, Science Policy & Regulatory Counsel
    For Media Inquiries

    On June 17, the AAMC Center for Health Justice (CHJ) responded to a request for information (RFI) from the National Center for Complementary and Integrative Health (NCCIH) on defining a set of key determinants that address “whole person health,” defined as factors that can influence health either positively or negatively and that encompass the full continuum of biological, behavioral, social, and environmental domain. These key determinants could then be used in research or patient care. While the RFI requested submission of the determinants only, the CHJ also submitted a letter, providing the NCCIH with additional context for its response as well as recommendations on how feedback to the RFI could be considered by the NCCIH.

    To inform the list of determinants submitted to the NCCIH, the CHJ invited its community partner network, the AAMC Collaborative for Health Equity: Act, Research, Generate Evidence (CHARGE), as well as all AAMC employees to complete a short questionnaire on the factors and social determinants they believed have the greatest impact on health, including determinants that are neglected or under-addressed in research or policymaking. There were several notable outcomes from the questionnaire:

    Factors That Impact Social Determinants of Health

    60% of the 67 respondents reported neighborhood and public safety as a key determinant. Education, economic stability, and food security were listed as other key determinants (57%, 37%, and 37% of the respondents, respectively).

    Commonly Referenced Determinants That Have a Significant Impact on Health or the Progression of Disease

    81% of respondents selected economic stability as a determinant that significantly impacts health, while 75% selected racism and discrimination and 69% selected neighborhood and environment.

    Other Determinants That Are Neglected or Under-Addressed in Research or Policymaking

    Many respondents who provided determinants reported mental health (46%), social isolation (27%), policing and incarceration (27%), and climate change (22%) as determinants that are neglected or under-addressed in research or policymaking.

    In its concluding remarks, the CHJ highlighted the apparent variation in how respondents interpreted meanings associated with certain factors and determinants and how these definitional challenges could produce new or exacerbate existing inequities. The CHJ also recommended robust interagency coordination to ensure a “whole-of-government approach,” expanding this initiative beyond the NIH-NCCIH to other agencies doing this work such as the Office of Management and Budget’s current efforts to revise its Standards for Maintaining, Collecting, and Presenting Federal Data on Race and Ethnicity (refer to Washington Highlights, Oct. 28, 2016). Ultimately, the CHJ encouraged the use of community engagement as the bedrock for the development of the NCCIH’s research strategy and “Common Data Elements Measurement Tool” to ensure it is easily accessed, utilized, and understood by all.