April 4, 2022
National Center for Complementary and Integrative Health (NCCIH)
Purpose: The purpose of this Request for Information (RFI) is to solicit public comment on defining a set of key determinants of health that addresses all the elements of the whole person health model, i.e., factors that can influence health either positively or negatively, and that encompass the full continuum of biological, behavioral, social, and environmental domains.
Background: Most well-established frameworks for social determinants of health include factors within the social, environmental, and economic domains that can influence health. These factors generally include education, employment, housing, social connectedness, food access, and natural environment. Other frameworks also include behavioral determinants of health, such as diet, physical activity, and smoking. However, to our knowledge, no existing frameworks fully integrate the social, environmental, and behavioral factors together with biological determinants (e.g., fat/muscle mass, blood pressure, metabolic indices).
Moreover, existing frameworks are often biased toward risk factors for disease and do not encompass the bidirectional aspect of health/disease. For example, frameworks that list behavioral determinants of health rarely include stress management practices. Indeed, health and disease are not separate disconnected states, but rather a bidirectional continuum. We know that on the path between health and disease, biological, behavioral, social, and environmental determinants of health can lead to chronic diseases of multiple organ systems, such as diabetes, cardiovascular disease, degenerative joint disease, and depression. We also know that addressing these determinants collectively, with an emphasis on factors that promote health, can not only prevent multiple diseases but also restore health and stop progression to disease across the lifespan.
Having a framework that bridges the aforementioned domains and incorporates the bidirectional nature of the health/disease continuum is important to arrive at a truly integrative set of determinants of whole person health that can be used in both research and patient care. As outlined in the National Center for Complementary and Integrative Health (NCCIH) strategic plan, research on whole person health involves deepening our scientific understanding of the connections that exist across physiological systems and domains of human health, such that we can better understand how conditions interrelate, define single or multicomponent interventions that address these problems, and expand how we support patients through the full continuum of their health experience, including the return to health. An important step in implementing such a research strategy will be to define a set of determinants of whole person health that can be used consistently across studies and facilitate data harmonization.
NCCIH is currently seeking to compile a list of major determinants of health that encompass the full continuum of biological, behavioral, social, and environmental domains. This list could ultimately be used to identify a set of common data elements (CDEs) to be used in either research or patient care. We are limiting this request to no more than 20 determinants to ensure a list sufficiently comprehensive to capture the key elements of whole person health, yet succinct enough to be manageable in terms of any eventual development/deployment of a CDE-based measurement tool.
Some potential examples could include age, genetic predisposition, sleep, social connectedness, and environmental exposures, to name a few. Where possible, the proposed determinants should be listed as Medical Subject Heading (MeSH) terms to ensure consistency and interoperability. Note that a single determinant may span multiple domains (i.e., biological, behavioral, social, and environmental) and may interact with other determinants in causal and/or consequential roles. For example, psychological stress may be a consequence of socioeconomic factors, social support networks, environmental exposures, and genetic predisposition while simultaneously playing a causal role in unhealthy sleep habits and further exacerbating negative outcomes in socioeconomic factors and social support networks. As such, our goal is to identify a concise list of major determinants that best define the health/disease continuum from the whole person perspective, regardless of any potential interrelationships with other determinants.
How to Submit a Response: Response to this RFI is voluntary and may be submitted anonymously. To respond to this RFI, please enter your responses in this webform. To ensure consideration, responses must be submitted by June 17th, 2022.
This RFI is for planning purposes only and should not be construed as a solicitation or an obligation on the part of the Federal Government, the National Institutes of Health (NIH), or individual NIH Institutes or Centers. NIH does not intend to make any type of award based on responses to this RFI or to pay for either the preparation of information submitted or the Government’s use of such information.
NCCIH will use the information submitted in response to this RFI at its discretion and will not provide comments to any responder’s submission. However, responses to the RFI may be reflected in future funding opportunity announcements. The information provided will be analyzed and may be shared publicly or appear in reports. Respondents are advised that the Government is under no obligation to acknowledge receipt of the information received or provide feedback to respondents with respect to any information submitted. No proprietary, classified, confidential, or sensitive information should be included in your response. The Government reserves the right to use any nonproprietary technical information in any resultant solicitation(s).
Name: Mark Pitcher
IC Name: National Center for Complementary and Integrative Health (NCCIH)