Home --> Health Equity Lens --> Data, Research and Evaluation --> Data to Identify and Understand Health Inequities --> Root Cause Mapping
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Root Cause Mapping |
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Many models analyze the underlying causes and factors of health outcomes. One model is the root cause mapping process described in the policy-oriented strategies for health equity. It is useful for identifying important indicators of community health and inequities such as per capita spending and racial segregation. The root cause diagram, reproduced in Figure 1, highlights how data collection efforts also need to shift upstream. However, it should be noted that more exhaustive models, such as causal diagrams (see Pearl, 2000), depict the relations between causes and indicators and more accurately represent how root causes interplay to influence health outcomes. In either case, looking at the upstream causes of health inequities allows stakeholders to focus on the most meaningful indicators and helps shift the focus from individual risk factors and behaviors to community health and the structures that underlie inequities.
In the context of this diagram, one can think of root causes as the focus of upstream interventions, and contributing factors as the focus of more downstream interventions. Although a policy that attempts to combat a contributing factor may positively influence a given health outcome, it is likely that this improvement will be short-lived or less influential than a policy that seeks to resolve a problem farther upstream. This is because contributing factors are not independent factors; they are consequences of larger, more salient social problems.
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Obesity is a useful example of a health outcome that can be discussed in the context of Figure 1. Two contributing factors to obesity are poor diet and lack of physical activity. However, poor diet and a lack of physical activity are not the root causes of obesity. In an urban setting, physical activity habits may be negatively influenced by an unsafe built environment characterized by broken sidewalks, busy multi-lane streets, a lack of bike lanes, and high rates of violence and crime. Transportation, housing, and economic policies (all upstream approaches to addressing a health problem) might improve the built environment, creating more opportunities for physical activity and indirectly reducing the rates of obesity.
Therefore, the two contributing factors to obesity are poor diet and lack of physical activity. However, they are not the root causes of obesity. Rather, elements or structures within the built environment underlie these individual risk factors. Using this diagram to identify root causes of obesity might lead stakeholders to collect and track data on convenience and fast food retail locations, and/or the availability and safety of parks and playgrounds