Root causes and organic budgeting: funding health from conception to the grave

Place: ‘Developed’ country. Time: Present day. Event: A sperm penetrates an egg. Months later, a child born at term, without identifiable genetic defects, normal birth weight, APGAR 10, and all organ systems exquisitely formed. Fantastic! Supposition 1: For a child like this, social determinants of health [101] are the major forces that affect your public-health goal of ‘wellness in every stage of life’ [102]. Supposition 2: You have sole power over the economic resources of your nation. Challenge: As holder of this economic power, your challenge is to choose the major predictor of this newborn child’s future social and cognitive development, health and wellbeing, adolescent and adult behavior, physical and mental health, adult functioning, risk for a variety of diseases, and cause of death. To determine where to place the money that will shape public-health policy and services that meets all of these needs, you must place a bet on the ‘root’ origins of health and wellbeing for children. Your choices: We live in a world of categorical thinking and categorical funding, so you only get one choice for your bet. Would you choose access to healthcare [1]? School achievement [103]? Racial disparities in health [2]? Socioeconomic status [3]? Poverty [104]? Now, consider the life stages in reverse order, since a ranking of health expenditures – from highest to lowest – would be ranked similarly. Start with the last stage of life: dying. In 1993, McGinnis and Foege quantified the contribution of adverse health behaviors (e.g., smoking, alcohol use and physical inactivity) to the leading causes of death, which they termed the ‘actual’ causes of death, in the