This paper is an attempt to explore the population health of the US, its importance, the techniques used in the US, and what factors are critical for population health, including the social factors with reference to medical model. The term population health is relatively new and is not well-defined yet, but its impact is well-known and vast. However, Kindig and Stoddart (2003) in American Journal of Public Health article defined population as, “… the health outcomes of a group of individuals, including the distribution of such outcomes within the group” (page#). Population health also includes the patterns of health determinants, policies and interventions that connect the two. It is not the same, however, as public health, health promotion, and social epidemiology (Kindig & Stoddart, 2003). The degree to which population health and public health are different is one that is often highly spirited (Kindig, 2007). Elements related to population include but are not limited to outcomes, disparities, determinants and risk factors (Kindig, 2007). This paper will also discuss the innovative synergism approaches that integrate the population health model and overall health policy, and its return on investment and how a local health care system, Wellspan, making a difference in this field.
Keywords: population health, public health
Building from the Kindig and Stoddart (2003) definition of population health as “health outcomes of a group of individuals, including the distribution of such outcomes within the group,” there several studies that examine the salient characteristics of the terminology (p. 380). Prior to examining the elements of population health and public health for similarities and differences, it is best to highlight what current literature states about the subject. Outcomes, disparities, determinants, and risk factors all work together in a systems capacity to highlight the elements related to population health. Population health is often framed within social inequality designations. In this capacity, Htzenbuehler, Phelan, and Link (2013) have characterized stigma as being the fundamental driver of population health inequalities. Stigma disrupts multiple life domains including resources, social relationships, and coping mechanisms, thereby impacting the health of certain populations in a sweeping manner (Htzenbuehler, Phelan & Link, 2013).
In a case study of Lithuania, some of the population health determinants established by Murauskiene et al. (2013) included cultural habits of the people, economic prosperity, and the compulsory health insurance required from the government. In this model, it was concluded that major progress could be achieved by reducing the burden of amenable and preventable mortality (Murauskiene, et al., 2013). This public health determinant works together in a systems capacity with progress plausibly being facilitated with better policy (ie. checkups and routine preventative care in health insurance program) and the influence of personal habits of the population. Additionally, economic policy can influence the amount of disposable income and facilitate better standards of living that could impact the population health. In rapidly-changing low-income and middle-income countries, the health, sustainability, and living standards can fluctuate radically (Giles-Corti, et al., 2016). For city planners, population health is a matter of immense concern because the way in which people are dispersed can reduce or promote the spread of diseases, road trauma, and other elements that can hurt population health (Giles-Corti, et al., 2016). A better mass transportation system can keep less cars off the road, thereby reducing accidents and emissions and encouraging people to be more mobile by walking to and from terminals for public transits (Giles-Corti, et al., 2016). Healthier cities are generally those that have elements that keep it more sustainable and make better environments for the people living within them (Giles-Corti, et al., 2016).
Overall, population health plays a key role in the focus of health care reform (Gourevitch, 2014). Academic medical centers have been deemed to be convergent with the discipline of population health (Gourevitch, 2014). The optimization of health of the population has never seen more attention and the convergence of academics and practice facilitate the advancement of the health of populations (Gourevitch, 2014). In the United States, specifically, Eggleston and Finkelstein (2014) contend that focusing on population health is a potential solution to the persistent problems facing the US health care system with a sustainable budget. The authors used examples of how proposals and the Affordable Health Care Act (ACA) could alter existing incentives and align health care, public health, and social services into a synergetic phenomenon (Eggleston & Finkelstein, 2014). Additional research, according to Eggleston and Finkelstein (2014) is necessary in order to designate the specific health care system-based activities that contribute most to population health improvements and overcoming the barriers necessary for them to be successful. In the present paradigm, there are stakeholder interests that are not necessarily aligned with the investments in actual population health.
Population Versus Public Health
Population health has to do with the health of a specific group of individuals rather than collective society as a whole (Rosario, 2016). Populations can be identified by locations, racial demographics, or elements not associated with the macrosystem (Rosario, 2016). According to Gourevitch (2014):
“…population health is concerned with measuring and optimizing the health of groups, and in so doing embraces the full range of determinants of health, including health care delivery, whereas public health is concerned more generally with influences on health, and the levers to improve them, that exist largely outside of the personal health care system” (p. 544). Additionally, population health views medical outcomes of individuals as seen in a respective group (Rosario, 2016). Population health generally takes on the core elements of the what Gourveitch (2014) referred to as the triple aim paradigm. These three aims are linked goals for health care delivery that include: improving care for individuals, improving health of populations, and reducing per capita costs (Gourveitch, 2014).
Public health, in contrast, is a macro consideration and one of concern for everyone. There is larger group element in public health and less individualized considerations within a smaller subset group like population health. For example, Hartley (2004) illustrated population health differences between urban and rural culture. He found that rural culture and policy had different health determinants (example) than urban counterparts (Hartley, 2004). The differences can be further illustrated through a study conducted by Nemeth et al. (2012). This study found that males in the Ohio Valley Appalachian region use smokeless tobacco at a rate double the national average. On a public health level, smokeless tobacco use may not be as statistically significant of a problem as it is among this specific population group. Therefore, a large-scale level intervention may not focus on this issue because it is not perceived as a problem. Among this population, however, these individuals have more periodontal disease than the national average, and other negative health outcomes than may be attributed to this cultural activity that is characterized as a rite of masculine passage and reinforced through social norms (Nemeth, et al., 2012). Population health would be focused on interventions and treatment directly for this population group as individuals.
While there is clearly overlap between public and population health, these differences illustrate how the two are fundamentally different in regards to these specific elements. The public health sector, however, can help eradicate causes of disease and works in conjunction with the afore-established elements of public health (Gourveitch, 2014). Despite the identified differences, routine searches of data bases often use “population” and “public” health interchangeably.
Synergy and Collaboration
Understanding the systems process in which population health operates is central for efficacious interventions. For example, the traditional separation between public health care providers and public health officials is “impeding greater success in meeting their shared goal of ensuring the health of the populations” (Rosemary, 2014, p. 698). The solution, in contrast, is creative collaboration between health care and public health systems for improving population health (Rosemary, 2014). While theoretical literature has identified these barriers, without culture change and a development of skills not necessarily taught in conventional medical education, meaningful change will be illusive (Rosemary, 2014). For example, Rosemary (2014) expressed that education that shows medical professional community-based participation skills, as well as general collaboration with non-medical professionals is central. Increasing population or public health does not happen with just breakthroughs in medical knowledge, it requires attention to the social determinants of health disparities as well (Gollust, Lantz & Ubel, 2009).
Population and public health advocates have been focusing more on social factors of health, including but not limited to non-medical, social, economic, political, and environmental factors that influence the distribution of health and disease among the population (Gollust, Lantz & Ubel, 2009). Even the World Health Organization has recommended that governments incorporate social determinants into their political agendas with attention to raising public awareness of their impact on population health (Gollust, Lantz & Ubel, 2009). In the United States, presently, there is a vast political divide, and this impacts the way in which health policy is evolving. Gollust, Lantz & Ubel (2009) conducted an experiment with both Republicans and Democrats being exposed to the social determinant message rather than their own straight party dogma dialogue. While the message did facilitate calls to action and raise awareness, it did not uniformly increase public support for policy action (Gollust, Lantz & Ubel, 2009). Americans who hold values related to personal responsibility had the most conflict with a social determinant perspective that does not acknowledge an individual’s role, as many of them feel it removes personal responsibility (Gollust, Lantz ; Ubel, 2009). Political messages and efficacious policy development will have to pay attention to the present divide to ensure that subgroups find social determinant messages credible and not antagonistic of a worldview that values personal responsibility (Gollust, Lantz ; Ubel, 2009). Synergy and communication in the population health modality has been identified as being important, but the way in which the message is presented can be the difference between success or failure.