The Wheel of Causation

According to Stanhope and Lancaster (2010) the web of causation “…recognizes the complex interrelationships of many factors interacting, sometimes in subtle ways, to increase (or decrease) the risk of disease” (p. 163). All things that can affect risk of disease are divided into one of three categories, agents, host, or environment. Examples of agents include infectious agents such as bacteria and viruses, chemical agents such as heavy metals and pesticides, or physical agents such as heat, cold, or radiation. Host factors include genetic susceptibility, physical characteristics such as age, sex, or immunization status and lifestyle habits such as being a smoker, or being inactive versus active.

Finally environment includes climate, human population distribution, socioeconomic factors, and working conditions. The wheel of causation, an alternative model, according to Harkness and DeMarco (2012), “…de-emphasizes the agent as the sole cause of disease, whereas it emphasizes the interplay of physical, biological, and social environments” (p.94).

In relation to the priority diagnosis of deficient community health related to obesity, drug, and alcohol use, the wheel of causation would focus on how the physical, biological, and social environments affect Anoka County’s residents.

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Because poverty is on the rise in Anoka County, this could create stress and family conflict which could potentially set the stage for alcohol or drug abuse. Additionally, a study from the World Health Organization indicated that “lower educational levels in both sexes were associated with higher obesity. Moreover, the negative association between educational attainment and obesity increased over the 10-year study period, indicating that the obesity gap between well-educated and poorly educated individuals was increasing” (2007).

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Additionally, because of lower educational levels, families may have decreased knowledge about nutrition therefore decreasing their ability to prepare health foods and increasing the likelihood of consumption of foods such as fast-food, takeout, or prepackaged/convenience foods.


Harkness, G. & DeMarco, R. (2012). Community and public health nursing: Evidence for practice. (p. 94). Philadelphia, PA: Wolters Kluwer Health/ Lippincott Williams & Wilkins
Stanhope, M. & Lancaster, J. (2010). Foundations of nursing in the
community: Community-
oriented practice. (3rd ed.), (p. 163). St. Louis, MO: Mosby/Elsevier World Health Organization (2007). Stress and obesity: Partners in disease. Retrieved from:

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The Wheel of Causation. (2016, Apr 24). Retrieved from

The Wheel of Causation

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