Population health

Last updated

Income inequality and mortality in 282 metropolitan areas of the United States. Mortality is correlated with both income and inequality. Inequality and mortality in metro US.jpg
Income inequality and mortality in 282 metropolitan areas of the United States. Mortality is correlated with both income and inequality.

Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". [1] It is an approach to health that aims to improve the health of an entire human population. It has been described as consisting of three components. These are "health outcomes, patterns of health determinants, and policies and interventions". [1]

Contents

A priority considered important in achieving the aim of population health is to reduce health inequities or disparities among different population groups due to, among other factors, the social determinants of health (SDOH). The SDOH include all the factors (social, environmental, cultural and physical) that the different populations are born into, grow up, and function with throughout their lifetimes which potentially have a measurable impact on the health of human populations. [2] The population health concept represents a change in the focus from the individual-level, characteristic of most mainstream medicine. It also seeks to complement the classic efforts of public health agencies by addressing a broader range of factors shown to impact the health of different populations. The World Health Organization's Commission on Social Determinants of Health reported in 2008 that the SDOH factors were responsible for the bulk of diseases and injuries, and that these were the major causes of health inequities in all countries. [3] In the US, SDOH were estimated to account for 70% of avoidable mortality. [4]

From a population health perspective, health has been defined not simply as a state free from disease but as "the capacity of people to adapt to, respond to, or control life's challenges and changes". [5] The World Health Organization (WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." [6] [7]

Healthy People 2020

Healthy People 2020 is a web site sponsored by the US Department of Health and Human Services, representing the cumulative effort of 34 years of interest by the Surgeon General's office and others. It identifies 42 topics considered social determinants of health and approximately 1200 specific goals considered to improve population health. It provides links to the current research available for selected topics and identifies and supports the need for community involvement considered essential to address these problems realistically. [8]

Economic inequality

Recently, there has been increasing interest from epidemiologists on the subject of economic inequality and its relation to the health of populations. There is a very robust correlation between socioeconomic status and health. This correlation suggests that it is not only the poor who tend to be sick when everyone else is healthy, given that conditions such as heart disease, ulcers, type 2 diabetes, rheumatoid arthritis, certain types of cancer, and premature aging are present in all socioeconomic levels. Despite the reality of the SES Gradient, there is debate as to its cause. A number of researchers (A. Leigh, C. Jencks, A. Clarkwest—see also Russell Sage working papers) see a definite link between economic status and mortality due to the greater economic resources of the better-off, but they find little correlation due to social status differences.

Other researchers such as Richard G. Wilkinson, J. Lynch, and G.A. Kaplan have found that socioeconomic status strongly affects health even when controlling for economic resources and access to health care. Most famous for linking social status with health are the Whitehall studies—a series of studies conducted on civil servants in London. The studies found that, despite the fact that all civil servants in England have the same access to health care, there was a strong correlation between social status and health. The studies found that this relationship stayed strong even when controlling for health-affecting habits such as exercise, smoking and drinking. Furthermore, it has been noted that no amount of medical attention will help decrease the likelihood of someone getting type 1 diabetes or rheumatoid arthritis—yet both are more common among populations with lower socioeconomic status. Lastly, it has been found that amongst the wealthiest quarter of countries on earth (a set stretching from Luxembourg to Slovakia) there is no relation between a country's wealth and general population health —suggesting that past a certain level, absolute levels of wealth have little impact on population health, but relative levels within a country do. The concept of psychosocial stress attempts to explain how psychosocial phenomena such as status and social stratification can lead to the many diseases associated with the SES gradient. Higher levels of economic inequality tend to intensify social hierarchies and generally degrades the quality of social relations—leading to greater levels of stress and stress related diseases. Richard Wilkinson found this to be true not only for the poorest members of society, but also for the wealthiest. Economic inequality is bad for everyone's health. Inequality does not only affect the health of human populations. David H. Abbott at the Wisconsin National Primate Research Center found that among many primate species, less egalitarian social structures correlated with higher levels of stress hormones among socially subordinate individuals. Research by Robert Sapolsky of Stanford University provides similar findings.

Geographic Inequality

There is well-documented variation in health outcomes by geographic variation in many countries around the globe. This includes the U.S., with the addition of health care utilization & costs geographic variation, down to the level of Hospital Referral Regions (defined as a regional health care market, which may cross state boundaries, of which there are 306 in the U.S.). [9] [10] However, data availability of health indicators for sub-national geographies is limited in both number, data source and geographic scale. Across the 38 OECD countries, region, or equivalent large subnational entities, is the predominant geographic level for both mortality and morbidity indicators. Health indicator availability at smaller geographies was sparse, and varied considerably by geographic definition, health indicator, age range of population and years available. In all cases, geographic boundaries used only administrative definitions. [11]

There is ongoing debate as to the relative contributions of race, gender, poverty, education level and place to these variations. The Office of Epidemiology of the Maternal and Child Health Bureau recommends using an analytic approach (Fixed Effects or hybrid Fixed Effects) to research on health disparities to reduce the confounding effects of neighborhood (geographic) variables on the outcomes.[ citation needed ]

Critiques

Population health has been subject to ongoing critiques and its assumptions. [12] [13]

Subfields

Family planning

Family planning programs (including contraceptives, sexuality education, and promotion of safe sex) play a major role in population health. Family planning is one of the most highly cost-effective interventions in medicine. [14] Family planning saves lives and money by reducing unintended pregnancy and the transmission of sexually transmitted infections. [14]

For example, the United States Agency for International Development lists as benefits of its international family planning program: [15]

Mental health

There are three main kinds of population-based approaches to mental health: health care system interventions; public health practice interventions; and social, economic, and environmental policy interventions. Health care system interventions are mediated by the health care system and hospital leaders. Examples of these interventions include enhancing the efficacy of clinical mental health services, providing consultations and training for community partners, and sharing aggregate health data to inform policy, practice, and planning for public mental health. Public health practice interventions are mediated by public health department officials. These interventions include advocating for policy changes, initiating public service announcements to reduce the stigma of mental illness, and conducting outreach to increase the accessibility of community mental health resources. Elected officials and administrative policy makers implement social, economic, and environmental policy interventions. These can include reducing financial and housing insecurity, changing the built environment to increase urban green space and decrease nighttime noise pollution, and reducing structural stigma directed at those with mental illness. [16]

Population health management (PHM)

One method to improve population health is through population health management (PHM), which has been defined as "the technical field of endeavor which utilizes a variety of individual, organizational and cultural interventions to help improve the morbidity patterns (i.e., the illness and injury burden) and the health care use behavior of defined populations". [17] PHM is distinguished from disease management by including more chronic conditions and diseases, by use of "a single point of contact and coordination", and by "predictive modeling across multiple clinical conditions". [18] PHM is considered broader than disease management in that it also includes "intensive care management for individuals at the highest level of risk" and "personal health management... for those at lower levels of predicted health risk". [19] Many PHM-related articles are published in Population Health Management , the official journal of DMAA: The Care Continuum Alliance. [20]

The following road map has been suggested for helping healthcare organizations navigate the path toward implementing effective population health management: [21]

Healthcare reform and population health

Healthcare reform is driving change to traditional hospital reimbursement models. Prior to the introduction of the Patient Protection and Affordable Care Act (PPACA), hospitals were reimbursed based on the volume of procedures through fee-for-service models. Under the PPACA, reimbursement models are shifting from volume to value. New reimbursement models are built around pay for performance, a value-based reimbursement approach, which places financial incentives around patient outcomes and has drastically changed the way US hospitals must conduct business to remain financially viable. [22] In addition to focusing on improving patient experience of care and reducing costs, hospitals must also focus on improving the health of populations (IHI Triple Aim [23] ).

As participation in value-based reimbursement models such as accountable care organizations (ACOs) increases, these initiatives will help drive population health. [24] Within the ACO model, hospitals have to meet specific quality benchmarks, focus on prevention, and carefully manage patients with chronic diseases. [25] Providers get paid more for keeping their patients healthy and out of the hospital. [25] Studies have shown that inpatient admission rates have dropped over the past ten years in communities that were early adopters of the ACO model and implemented population health measures to treat "less sick" patients in the outpatient setting. [26] A study conducted in the Chicago area showed a decline in inpatient utilization rates across all age groups, which was an average of a 5% overall drop in inpatient admissions. [27]

Hospitals are finding it financially advantageous to focus on population health management and keeping people in the community well. [28] The goal of population health management is to improve patient outcomes and increase health capital. Other goals include preventing disease, closing care gaps, and cost savings for providers. [29] In the last few years, more effort has been directed towards developing telehealth services, community-based clinics in areas with high proportion of residents using the emergency department as primary care, and patient care coordinator roles to coordinate healthcare services across the care continuum. [28]

Health can be considered a capital good; health capital is part of human capital as defined by the Grossman model. [30] Health can be considered both an investment good and consumption good. [31] Factors such as obesity and smoking have negative effects on health capital, while education, wage rate, and age may also impact health capital. [31] When people are healthier through preventative care, they have the potential to live a longer and healthier life, work more and participate in the economy, and produce more based on the work done. These factors all have the potential to increase earnings. Some states, like New York, have implemented statewide initiatives to address population health. In New York state there are 11 such programs. [32] These programs work to address the needs of the people in their region, as well as assist their local community based organizations and social services to gather data, address health disparities, and explore evidence-based interventions that will ultimately lead to better health for everyone.

See also

Related Research Articles

A health system, health care system or healthcare system is an organization of people, institutions, and resources that delivers health care services to meet the health needs of target populations.

Health has a variety of definitions, which have been used for different purposes over time. Health can be promoted by encouraging healthful activities, such as regular physical exercise and adequate sleep, and by reducing or avoiding unhealthful activities or situations, such as smoking or excessive stress. Some factors affecting health are due to individual choices, such as whether to engage in a high-risk behavior, while others are due to structural causes, such as whether the society is arranged in a way that makes it easier or harder for people to get necessary healthcare services. Still, other factors are beyond both individual and group choices, such as genetic disorders.

<span class="mw-page-title-main">Health care</span> Prevention of disease and promotion of well-being

Health care, or healthcare, is the improvement of health via the prevention, diagnosis, treatment, amelioration or cure of disease, illness, injury, and other physical and mental impairments in people. Health care is delivered by health professionals and allied health fields. Medicine, dentistry, pharmacy, midwifery, nursing, optometry, audiology, psychology, occupational therapy, physical therapy, athletic training, and other health professions all constitute health care. The term includes work done in providing primary care, secondary care, tertiary care, and public health.

<span class="mw-page-title-main">Mental health</span> Level of human psychological well-being

Mental health encompasses emotional, psychological, and social well-being, influencing cognition, perception, and behavior. According to World Health Organization (WHO), it is a "state of well-being in which the individual realizes his or her abilities, can cope with the normal stresses of life, can work productively and fruitfully, and can contribute to his or her community". It likewise determines how an individual handles stress, interpersonal relationships, and decision-making. Mental health includes subjective well-being, perceived self-efficacy, autonomy, competence, intergenerational dependence, and self-actualization of one's intellectual and emotional potential, among others. From the perspectives of positive psychology or holism, mental health may include an individual's ability to enjoy life and to create a balance between life activities and efforts to achieve psychological resilience. Cultural differences, personal philosophy, subjective assessments, and competing professional theories all affect how one defines "mental health". Some early signs related to mental health difficulties are sleep irritation, lack of energy, lack of appetite, thinking of harming oneself or others, self-isolating, and frequently zoning out.

Community health refers to non-treatment based health services that are delivered outside hospitals and clinics. Community health is a subset of public health that is taught to and practiced by clinicians as part of their normal duties. Community health volunteers and community health workers work with primary care providers to facilitate entry into, exit from and utilization of the formal health system by community members as well as providing supplementary services such as support groups or wellness events that are not offered by medical institutions.

Health equity arises from access to the social determinants of health, specifically from wealth, power and prestige. Individuals who have consistently been deprived of these three determinants are significantly disadvantaged from health inequities, and face worse health outcomes than those who are able to access certain resources. It is not equity to simply provide every individual with the same resources; that would be equality. In order to achieve health equity, resources must be allocated based on an individual need-based principle.

Health promotion is, as stated in the 1986 World Health Organization (WHO) Ottawa Charter for Health Promotion, the "process of enabling people to increase control over, and to improve their health."

<span class="mw-page-title-main">Screening (medicine)</span> Brief medical evaluation to detect unnoticed health problems

Screening, in medicine, is a strategy used to look for as-yet-unrecognised conditions or risk markers. This testing can be applied to individuals or to a whole population without symptoms or signs of the disease being screened.

<span class="mw-page-title-main">Social determinants of health</span> Economic and social conditions that influence differences in health status

The social determinants of health (SDOH) are the economic and social conditions that influence individual and group differences in health status. They are the health promoting factors found in one's living and working conditions, rather than individual risk factors that influence the risk or vulnerability for a disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

Patient advocacy is a process in health care concerned with advocacy for patients, survivors, and caregivers. The patient advocate may be an individual or an organization, concerned with healthcare standards or with one specific group of disorders. The terms patient advocate and patient advocacy can refer both to individual advocates providing services that organizations also provide, and to organizations whose functions extend to individual patients. Some patient advocates are independent and some work for the organizations that are directly responsible for the patient's care.

<span class="mw-page-title-main">Social medicine</span> Understanding how culture and larger groups of people shape health procedures

Social medicine is an interdisciplinary field that focuses on the profound interplay between socio-economic factors and individual health outcomes. Rooted in the challenges of the Industrial Revolution, it seeks to:

  1. Understand how specific social, economic, and environmental conditions directly impact health, disease, and the delivery of medical care.
  2. Promote conditions and interventions that address these determinants, aiming for a healthier and more equitable society.
<span class="mw-page-title-main">Rural health</span> Interdisciplinary study of health and health care delivery in rural environments

In medicine, rural health or rural medicine is the interdisciplinary study of health and health care delivery in rural environments. The concept of rural health incorporates many fields, including wilderness medicine, geography, midwifery, nursing, sociology, economics, and telehealth or telemedicine.

While epidemiology is "the study of the distribution and determinants of states of health in populations", social epidemiology is "that branch of epidemiology concerned with the way that social structures, institutions, and relationships influence health." This research includes "both specific features of, and pathways by which, societal conditions affect health".

The social determinants of health in poverty describe the factors that affect impoverished populations' health and health inequality. Inequalities in health stem from the conditions of people's lives, including living conditions, work environment, age, and other social factors, and how these affect people's ability to respond to illness. These conditions are also shaped by political, social, and economic structures. The majority of people around the globe do not meet their potential best health because of a "toxic combination of bad policies, economics, and politics". Daily living conditions work together with these structural drivers to result in the social determinants of health.

The World Health Organization (WHO) has defined health as "a state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity." Identified by the 2012 World Development Report as one of two key human capital endowments, health can influence an individual's ability to reach his or her full potential in society. Yet while gender equality has made the most progress in areas such as education and labor force participation, health inequality between men and women continues to harm many societies to this day.

Health care quality is a level of value provided by any health care resource, as determined by some measurement. As with quality in other fields, it is an assessment of whether something is good enough and whether it is suitable for its purpose. The goal of health care is to provide medical resources of high quality to all who need them; that is, to ensure good quality of life, cure illnesses when possible, to extend life expectancy, and so on. Researchers use a variety of quality measures to attempt to determine health care quality, including counts of a therapy's reduction or lessening of diseases identified by medical diagnosis, a decrease in the number of risk factors which people have following preventive care, or a survey of health indicators in a population who are accessing certain kinds of care.

Health policy and management is the field relating to leadership, management, and administration of public health systems, health care systems, hospitals, and hospital networks. Health care administrators are considered health care professionals.

Population health, a field which focuses on the improvement of the health outcomes for a group of individuals, has been described as consisting of three components: "health outcomes, patterns of health determinants, and policies and interventions". Policies and Interventions define the methods in which health outcomes and patterns of health determinants are implemented. Policies which are helpful "improve the conditions under which people live". Interventions encourage healthy behaviors for individuals or populations through "program elements or strategies designed to produce behavior changes or improve health status".

There are various factors affecting the health of ethnic minorities in the UK due to health inequalities. The term "BAME" is often used however, the use of this term can be problematic for various reasons, such as an indicating power relations and also having a focus on skin colour. Therefore, this article will use the term ethnic minorities.

The social determinants of mental health (SDOMH) are societal problems that disrupt mental health, increase risk of mental illness among certain groups, and worsen outcomes for individuals with mental illnesses. Much like the social determinants of health (SDOH), SDOMH include the non-medical factors that play a role in the likelihood and severity of health outcomes, such as income levels, education attainment, access to housing, and social inclusion. Disparities in mental health outcomes are a result of a multitude of factors and social determinants, including fixed characteristics on an individual level – such as age, gender, race/ethnicity, and sexual orientation – and environmental factors that stem from social and economic inequalities – such as inadequate access to proper food, housing, and transportation, and exposure to pollution.

References

  1. 1 2 Kindig D, Stoddart G (March 2003). "What is population health?". American Journal of Public Health. 93 (3): 380–3. doi:10.2105/ajph.93.3.380. PMC   1447747 . PMID   12604476.
  2. ↑ Social Determinants of Health overview tab.
  3. ↑ Meeting Report of World Conference of Social Determinants of Health held in Rio de Janeiro, Brazil, 2008.
  4. ↑ McGinnis JM, Williams-Russo P, Knickman JR (2002). "The case for more active policy attention to health promotion". Health Aff (Millwood). 21 (2): 78–93. doi:10.1377/hlthaff.21.2.78. PMID   11900188.{{cite journal}}: CS1 maint: multiple names: authors list (link). See also National Academies Press free publication: The Future of Public Health in the 21st Century.
  5. ↑ Frankish, CJ et al. "Health Impact Assessment as a Tool for Population Health Promotion and Public Policy" Archived 8 March 2010 at the Wayback Machine . Vancouver: Institute of Health Promotion Research, University of British Columbia, 1996. Retrieved 12 October 2008.
  6. ↑ World Health Organization. WHO definition of Health, Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19–22 June 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948. In Grad, Frank P. (2002). "The Preamble of the Constitution of the World Health Organization". Bulletin of the World Health Organization. 80 (12): 982. PMC   2567708 . PMID   12571728.
  7. ↑ World Health Organization. 2006. Constitution of the World Health Organization – Basic Documents, Forty-fifth edition, Supplement, October 2006.
  8. ↑ Health People 2020
  9. ↑ Chandra, A; Skinner, JS (2004). Geography and Racial Health Disparities, Chapter 16 of Critical Perspectives on Racial and Ethnic Differences in Health in Late Life (PDF). National Research Council.
  10. ↑ "Data by Region, the Dartmouth Atlas of Health Care" . Retrieved 16 November 2013.
  11. ↑ Murray, Emily T.; Shelton, Nicola; Norman, Paul; Head, Jenny (1 January 2022). "Measuring the health of people in places: A scoping review of OECD member countries". Health & Place. 73: 102731. doi: 10.1016/j.healthplace.2021.102731 . ISSN   1353-8292. PMID   34929525. S2CID   245322428.
  12. ↑ Coburn, David; Denny, Keith; Mykhalovskiy, Eric; McDonough, Peggy; Robertson, Ann; Love, Rhonda (2003). "Population Health in Canada: A Brief Critique". American Journal of Public Health. 93 (3): 392–396. doi:10.2105/AJPH.93.3.392. PMC   1447750 . PMID   12604479.
  13. ↑ Raphael, Dennis; Bryant, Toba (1 June 2002). "The limitations of population health as a model for a new public health". Health Promotion International. 17 (2): 189–199. doi: 10.1093/heapro/17.2.189 . PMID   11986300.
  14. 1 2 Tsui AO, McDonald-Mosley R, Burke AE (April 2010). "Family planning and the burden of unintended pregnancies". Epidemiol Rev. 32 (1): 152–74. doi:10.1093/epirev/mxq012. PMC   3115338 . PMID   20570955. International studies confirm that family planning is among the most cost-effective of all health interventions (80, 81). The cost savings stem from a reduction in unintended pregnancy, as well as a reduction in transmission of sexually transmitted infections, including HIV.
  15. ↑ USAID. Family planning Archived 15 October 2008 at the Wayback Machine . Retrieved 12 October 2008.
  16. ↑ Purtle, Jonathan; Nelson, Katherine L.; Counts, Nathaniel Z.; Yudell, Michael (2 April 2020). "Population-Based Approaches to Mental Health: History, Strategies, and Evidence". Annual Review of Public Health. 41 (1): 201–221. doi: 10.1146/annurev-publhealth-040119-094247 . ISSN   0163-7525. PMC   8896325 . PMID   31905323.
  17. ↑ Hillman, Michael. Testimony before the Subcommittee on Health of the House Committee on Ways and Means, hearing on promoting disease management in Medicare Archived 8 May 2017 at the Wayback Machine . 16 April 2002. Retrieved 12 October 2008.
  18. ↑ Howe, Rufus, and Christopher Spence. Population health management: Healthways' PopWorks Archived 17 December 2008 at the Wayback Machine . HCT Project 2004-07-17, volume 2, chapter 5, pages 291-297. Retrieved 12 October 2008.
  19. ↑ Coughlin JF, Pope J, Leedle BR (April 2006). "Old age, new technology, and future innovations in disease management and home health care" (PDF). Home Health Care Management & Practice. 18 (3): 196–207. doi:10.1177/1084822305281955. S2CID   26428539.
  20. ↑ DMAA: The Care Continuum Alliance. Publications. Population Health Management Archived 24 September 2008 at the Wayback Machine . Retrieved 12 October 2008.
  21. ↑ Sanders, Dale A Landmark, 12-Point Review of Population Health Management Companies. Retrieved 17 March 2014.
  22. ↑ "The Revised Medicare ACO Program: More Options ... And More Work Ahead". Health Affairs. 2015. doi:10.1377/forefront.20150616.048573 . Retrieved 21 November 2015.
  23. ↑ "The IHI Triple Aim". www.ihi.org. Retrieved 21 November 2015.
  24. ↑ DeVore S, Champion RW (2011). "Driving Population Health Through Accountable Care Organizations". Health Affairs. 30 (1): 41–50. doi:10.1377/hlthaff.2010.0935. PMID   21209436.
  25. 1 2 "Accountable Care Organizations, Explained". Kaiser Health News. 14 September 2015. Retrieved 21 November 2015.
  26. ↑ Kutscher B. Outpatient care takes the inside track. Modern Healthcare. 2012. Retrieved 31 October 2015.
  27. ↑ "Where Have All The Inpatients Gone? A Regional Study With National Implications". Health Affairs. 2014. doi:10.1377/forefront.20140106.035895.
  28. 1 2 "Population Health Management: Hospitals' Changing Employer Role". www.beckershospitalreview.com. 26 February 2014. Retrieved 21 November 2015.
  29. ↑ "What is Population Health Management?". Wellcentive. Retrieved 21 November 2015.
  30. ↑ Grossman M (1972). "On the Concept of Health Capital and the Demand for Health". Journal of Political Economy. 80 (2): 223–255. CiteSeerX   10.1.1.604.7202 . doi:10.1086/259880. S2CID   27026628.
  31. 1 2 Folland S, Goodman A, Stano M. The economics of health and health care (Vol. 6): Upper Saddle River: Pearson Education; 2007.
  32. ↑ "Population Health Improvement Program". www.health.ny.gov. Retrieved 10 March 2022.

Further reading

This page is based on this Wikipedia article
Text is available under the CC BY-SA 4.0 license; additional terms may apply.
Images, videos and audio are available under their respective licenses.