Population health policies and interventions

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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". [1] 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". [2] Interventions encourage healthy behaviors for individuals or populations through "program elements or strategies designed to produce behavior changes or improve health status". [3]

Contents

Policies and interventions are needed due to the inequalities amongst populations and the inconsistent way care is administered. Policies can include "necessary community and personal social and health services" [2] as well as taxes on alcohol and soft drinks and implement smoking cessation policies. Interventions can include therapeutic or preventative health care and may also include actions taken by the individual or by someone on behalf of the individual. The application of population health is determined by the policies and interventions which can be implemented within an organization, city, state or country.

Common methodology

Countries, states, provinces and providers across the globe are shifting towards better systems to respond to inconsistent health outcomes, mitigate decreasing margins and replace outdated methods such as fee-for-service health delivery. Payment model reforms, including the Accountable Care Organization (ACO), provide roadmaps for healthcare reform and drive many of its constituents towards more effective and innovative means for improving health outcomes. Population health management is a common approach for resolving these challenges but it involves new methods, tools, systems and implementations to correct inefficiencies and improve health outcomes.

Population health tools and computer systems include data exchange, large datasets, and advanced software which are used to supply data scientists and research teams with appropriate information which can then be used by policy makers and change agents. This method helps to set policies around population health as well as intervention strategies which are then used to respond to the needs of a population.

Policies and policymakers

Policy for population health "sets priorities" [2] and are a "guide to action to change what would otherwise occur". [2] Policies are based on "social sciences of sociology, economics, demography, public health, anthropology, and epidemiology" [4] and determine how outcomes can be accomplished are implemented at various levels. Such guides determine laws, policies, and ordinances and are defined by policymakers. Examples of policies include "smoking bans, excise taxes on cigarettes and alcohol, seat belt laws, water fluoridation, and restaurant menu labeling". [5] They may be applied to a commercial establishment such as a restaurant, business workplace or within a city or state level. Policies should be evidence based and require academic studies or research to support the approach. This will assure that the appropriate measures needed for each demographic are promoted to encourage the necessary intervention practices which can be applied to each population or to the nation as a whole.

Policymakers can be classified as both private and public and are defined as someone who is in a position of authority to implement health policies. A public policy maker could be a government official and a private policymaker could be a business owner or administrator. Policymakers are influenced by, and can also be, change agents. Change agents include "legislators in Washington, an attorney general, regulators at the FDA, an advocacy group or other organizations that clearly have influence". [6]

Political strategy

The goal for any political strategies surrounding population health is to "improve chances of success for policy adoption and implementation". [2] Such strategies include the creation of funds to support initiatives and the construction of strategies which limit conflicts of interest in the implementation of public policy.

Tobacco control

A political strategy implemented to limit the sale and exposure to tobacco products and restrict the tobacco company's ability to benefit politically from charitable donations is the creation of the World Health Framework Convention on Tobacco Control (FCTC) treaty. The legally binding document is supported by numerous countries, government/nongovernment agencies and provides the necessary power to prevent negative influences on population health policies.

Interventions

Interventions in population health "shift the distribution of health risk by addressing the underlying social, economic and environmental conditions" [7] and are implemented through "programs or policies designed and developed in the health sector, but they are more likely to be in sectors elsewhere, such as education, housing or employment". [7] They are aimed at reducing such things as childhood obesity, cardiovascular disease, smoking and mental health issues throughout society. The means in which interventions are devised is through extensive research and contributions from medical scientists, researchers, and medical professionals. They are implemented by but are not limited to educators, practicing physicians, business administrators and mental health professionals.

Approaches and implementations

A typical approach includes assessing the conditions and possible improvements which can be made within the social determinants that have been identified. Each approach is handled at a state or health plan level.

One example was a workplace in China which implemented policies and interventions for their staff to fight depression. By recognizing the importance of mental health, they were able to reduce depression and improve job satisfaction across the company. The company published its research and findings to promote "enterprises taking more responsibility for the provision of mental health services to their employees". [8]

Another example was the implementation of a smoking cessation program to the province of Ontario. Studies were performed on weekly visit rates to psychiatric emergency departments before and after the implementation. The result was a "15.5% reduction in patient visits for patients with a primary diagnosis of psychotic disorder". [9]

Inequalities and variance of implementation

As is the common understanding of population health, health inequalities, defined as a "generic term used to designate differences, variations, and disparities in the health achievements of individuals and groups", [10] must be considered to correctly implement the most effective policies and interventions. Based on a population and its socioeconomic, geographic, ethnicity and other factors, policies and interventions may vary. Policies implemented for one population may be less effective and more costly than it would be for another similar population. For example, US policies tend to be more costly than European and have less impact. Research has shown that in some instances, "Americans had worse outcomes than their international peers" [11] and also had "the lowest life expectancy at birth of the countries studied". [11]

See also

Related Research Articles

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<span class="mw-page-title-main">Smoking cessation</span> Process of discontinuing tobacco smoking

Smoking cessation, usually called quitting smoking or stopping smoking, is the process of discontinuing tobacco smoking. Tobacco smoke contains nicotine, which is addictive and can cause dependence. As a result, nicotine withdrawal often makes the process of quitting difficult.

<span class="mw-page-title-main">WHO Framework Convention on Tobacco Control</span>

The World Health Organization Framework Convention on Tobacco Control is a treaty adopted by the 56th World Health Assembly held in Geneva, Switzerland on 21 May 2003. It became the first World Health Organization treaty adopted under article 19 of the WHO constitution. The treaty came into force on 27 February 2005. It had been signed by 168 countries and is legally binding in 182 ratifying countries. There are currently 14 United Nations member states that are non-parties to the treaty.

In epidemiology, a risk factor or determinant is a variable associated with an increased risk of disease or infection.

<span class="mw-page-title-main">Preventive healthcare</span> Prevent and minimize the occurrence of diseases

Preventive healthcare, or prophylaxis, is the application of healthcare measures to prevent diseases. Disease and disability are affected by environmental factors, genetic predisposition, disease agents, and lifestyle choices, and are dynamic processes that begin before individuals realize they are affected. Disease prevention relies on anticipatory actions that can be categorized as primal, primary, secondary, and tertiary prevention.

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eHealth describes healthcare services which are supported by digital processes, communication or technology such as electronic prescribing, Telehealth, or Electronic Health Records (EHRs). The use of electronic processes in healthcare dated back to at least the 1990s. Usage of the term varies as it covers not just "Internet medicine" as it was conceived during that time, but also "virtually everything related to computers and medicine". A study in 2005 found 51 unique definitions. Some argue that it is interchangeable with health informatics with a broad definition covering electronic/digital processes in health while others use it in the narrower sense of healthcare practice using the Internet. It can also include health applications and links on mobile phones, referred to as mHealth or m-Health. Key components of eHealth include electronic health records (EHRs), telemedicine, health information exchange, mobile health applications, wearable devices, and online health information. These technologies enable healthcare providers, patients, and other stakeholders to access, manage, and exchange health information more effectively, leading to improved communication, decision-making, and overall healthcare outcomes.

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.

<span class="mw-page-title-main">Population health</span> Health outcomes of a group of individuals

Population health has been defined as "the health outcomes of a group of individuals, including the distribution of such outcomes within the group". 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".

The social determinants of health 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 for a disease, or vulnerability to disease or injury. The distribution of social determinants is often shaped by public policies that reflect prevailing political ideologies of the area.

The Lalonde Report is a 1974 report produced in Canada formally titled A new perspective on the health of Canadians. It proposed the concept of the "health field", identifying two main health-related objectives: the health care system; and prevention of health problems and promotion of good health. The report is considered the "first modern government document in the Western world to acknowledge that our emphasis upon a biomedical health care system is wrong, and that we need to look beyond the traditional health care system if we wish to improve the health of the public.". The Report also recognizes that use of the local Health System shapes how people define their health-related need, options for care and definition of health.

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<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.

A public health intervention is any effort or policy that attempts to improve mental and physical health on a population level. Public health interventions may be run by a variety of organizations, including governmental health departments and non-governmental organizations (NGOs). Common types of interventions include screening programs, vaccination, food and water supplementation, and health promotion. Common issues that are the subject of public health interventions include obesity, drug, tobacco, and alcohol use, and the spread of infectious disease, e.g. HIV.

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<span class="mw-page-title-main">Tobacco control</span> Field of health science

Tobacco control is a field of international public health science, policy and practice dedicated to addressing tobacco use and thereby reducing the morbidity and mortality it causes. Since most cigarettes and cigars and hookahs contain/use tobacco, tobacco control also concerns these. E-cigarettes do not contain tobacco itself, but (often) do contain nicotine. Tobacco control is a priority area for the World Health Organization (WHO), through the Framework Convention on Tobacco Control. References to a tobacco control movement may have either positive or negative connotations, depending upon the commentator.

Schizophrenia and tobacco smoking have been historically associated. Smoking is known to harm the health of people with schizophrenia, and to negatively affect their cognition.

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.

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.

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.

References

  1. ↑ Kindig, David; Stoddart, Greg (2016-10-15). "What Is Population Health?". American Journal of Public Health. 93 (3): 380–383. doi:10.2105/ajph.93.3.380. ISSN   0090-0036. PMC   1447747 . PMID   12604476.
  2. 1 2 3 4 5 Milio, N (2016-10-10). "Glossary: healthy public policy*". Journal of Epidemiology and Community Health. 55 (9): 622–623. doi:10.1136/jech.55.9.622. ISSN   0143-005X. PMC   1731988 . PMID   11511639.
  3. ↑ "What is an intervention?". health.mo.gov. Retrieved 2016-10-15.
  4. ↑ Kindig, David A (2016-10-13). "Understanding Population Health Terminology". The Milbank Quarterly. 85 (1): 139–161. doi:10.1111/j.1468-0009.2007.00479.x. ISSN   0887-378X. PMC   2690307 . PMID   17319809.
  5. ↑ "Policies and Programs".
  6. ↑ Interdisciplinary Association for Population Health Science (IAPHS), Christina Roberto, Ph.D. (Nov 18, 2015). "Building Bridges to Improve Population Health" (2015) – Public Policy Presentation #2 (YouTube). Event occurs at 2:33. Retrieved Oct 9, 2016.
  7. 1 2 Hawe, Penelope; Potvin, Louise (2017-02-01). "What is population health intervention research?". Canadian Journal of Public Health. 100 (1): Suppl I8–14. doi:10.1007/BF03405503. ISSN   0008-4263. PMC   6973897 . PMID   19263977.
  8. ↑ Sun, Jing; Buys, Nicholas; Wang, Xinchao (2013-05-14). "Effectiveness of a Workplace-Based Intervention Program to Promote Mental Health among Employees in Privately Owned Enterprises in China". Population Health Management. 16 (6): 406–414. doi:10.1089/pop.2012.0113. ISSN   1942-7891. PMID   23672231.
  9. ↑ Kurdyak, Paul; Cairney, John; Sarnocinska-Hart, Anna; Callahan, Russell C.; Strike, Carol (2008-11-01). "The impact of a smoking cessation policy on visits to a psychiatric emergency department". Canadian Journal of Psychiatry. 53 (11): 779–782. doi: 10.1177/070674370805301110 . ISSN   0706-7437. PMID   19087472.
  10. ↑ Kawachi, I; S Subramanian; N Almeida-Filho (2002), "A Glossary for Health Inequalities", Journal of Epidemiology and Community Health, 56 (9): 647–652, doi:10.1136/jech.56.9.647, PMC   1732240 , PMID   12177079
  11. 1 2 Squires, David; Anderson, Chloe (2015). "U.S. Health Care from a Global Perspective". Commonwealth Fund. doi:10.26099/77tf-5060.{{cite journal}}: Cite journal requires |journal= (help)

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