A Framework for Assessing the Value of Investments in Nonclinical Prevention

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The figure shows the flow of the effects of an investment in primary prevention through the determinants of health to their ultimate impacts as viewed by different stakeholders. A box at the upper left of the figure represents a primary prevention intervention. Arrows pointing downward from the box indicate that the intervention can affect both upstream determinants of health (public policy, social norms, education, occupation, income, access to care, physical environment, social position, and social cohesion, listed from more upstream to less upstream) and direct determinants of health (genetics/epigenetics, health care, health behaviors, environmental exposures, stress, and positive emotions). Arrows connecting the upstream and direct determinants boxes point to the complex effects that the determinants have on each other. To the right of the primary prevention intervention and determinants of health boxes is a column of 4 boxes that represent the ultimate impacts of the intervention, connected by arrows from the intervention and determinants boxes that affect them: cost of the intervention (driven by the primary prevention intervention), health care costs (affected by all the determinants of health), health status and health disparities (affected by the direct determinants), and nonhealth impacts (affected by all the determinants). Arrows from each of these impact boxes indicate that they can be viewed from the perspectives of alternative stakeholders (eg, society, government, business).

Figure. High-level framework. A primary prevention intervention modifies health determinants to affect health, costs, and other factors. These effects are viewed differently from the perspectives of various stakeholder groups that can influence investment in the intervention.

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