Avoidable burden of illness: how much can prevention contribute to health?

The WHO campaign for health for all by the year 2000 brought health back into the centre of attention in health policy making. Different authors have analysed the determinants of health in different models. One of these is the well-known model of Lalonde, in which health is seen as the result of four determinants: human biology, life style, environment and health care. Dever, in the U.S., has tried to quantify this model in order to compare the percentages of mortality attributable to each of the four determinants with the percentage of resources from the health care budget, allocated to them. The authors have, individually, tried to replicate these estimates, through a survey of Dutch experts. The results of these surveys are presented and discussed. The authors conclude that, although a quantification of the relative importance of the determinants of health would be extremely useful in health policy making, the methodology proposed by Dever does not yield suitable results. An alternative approach suggested, would be to subdivide the broad determinants into known risk factors and to arrive at a quantification through the utilization of known epidemiologic relationships between risk factors and disease.