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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 Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
that aims to improve the
health Health, according to the World Health Organization, is "a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity".World Health Organization. (2006)''Constitution of the World Health Organ ...
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". 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 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 (such as the d ...
(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. The population health concept represents a change in the focus from the individual-level, characteristic of most mainstream
medicine Medicine is the science and practice of caring for a patient, managing the diagnosis, prognosis, prevention, treatment, palliation of their injury or disease, and promoting their health. Medicine encompasses a variety of health care pr ...
. It also seeks to complement the classic efforts of
public health Public health is "the science and art of preventing disease, prolonging life and promoting health through the organized efforts and informed choices of society, organizations, public and private, communities and individuals". Analyzing the det ...
agencies by addressing a broader range of factors shown to impact the health of different populations. The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
's Commission on Social Determinants of Health, reported in 2008, that the SDOH factors were responsible for the bulk of diseases and injuries and these were the major causes of health inequities in all countries. In the US, SDOH were estimated to account for 70% of avoidable mortality. 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". The
World Health Organization The World Health Organization (WHO) is a specialized agency of the United Nations responsible for international public health. The WHO Constitution states its main objective as "the attainment by all peoples of the highest possible level o ...
(WHO) defined health in its broader sense in 1946 as "a state of complete physical, mental, and social
well-being Well-being, or wellbeing, also known as wellness, prudential value or quality of life, refers to what is intrinsically valuable relative ''to'' someone. So the well-being of a person is what is ultimately good ''for'' this person, what is in th ...
and not merely the absence of disease or infirmity."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
World Health Organization. 2006
''Constitution of the World Health Organization''
– ''Basic Documents'', Forty-fifth edition, Supplement, October 2006.


Healthy People 2020

Healthy People 2020 is a web site sponsored by the
US Department of Health and Human Services The United States Department of Health and Human Services (HHS) is a cabinet-level executive branch department of the U.S. federal government created to protect the health of all Americans and providing essential human services. Its motto is ...
, 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 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 (such as the d ...
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.


Economic inequality

Recently, there has been increasing interest from
epidemiologists Epidemiology is the study and analysis of the distribution (who, when, and where), patterns and determinants of health and disease conditions in a defined population. It is a cornerstone of public health, and shapes policy decisions and evidenc ...
on the subject of
economic inequality There are wide varieties of economic inequality, most notably income inequality measured using the distribution of income (the amount of money people are paid) and wealth inequality measured using the distribution of wealth (the amount of ...
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 Cardiovascular disease (CVD) is a class of diseases that involve the heart or blood vessels. CVD includes coronary artery diseases (CAD) such as angina and myocardial infarction (commonly known as a heart attack). Other CVDs include stroke, h ...
, ulcers,
type 2 diabetes Type 2 diabetes, formerly known as adult-onset diabetes, is a form of diabetes mellitus that is characterized by high blood sugar, insulin resistance, and relative lack of insulin. Common symptoms include increased thirst, frequent urinatio ...
,
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are inv ...
, certain types of
cancer Cancer is a group of diseases involving abnormal cell growth with the potential to invade or spread to other parts of the body. These contrast with benign tumors, which do not spread. Possible signs and symptoms include a lump, abnormal b ...
, 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 Social status is the level of social value a person is considered to possess. More specifically, it refers to the relative level of respect, honour, assumed competence, and deference accorded to people, groups, and organizations in a society. St ...
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 The civil service is a collective term for a sector of government composed mainly of career civil servants hired on professional merit rather than appointed or elected, whose institutional tenure typically survives transitions of political leaders ...
in
London London is the capital and List of urban areas in the United Kingdom, largest city of England and the United Kingdom, with a population of just under 9 million. It stands on the River Thames in south-east England at the head of a estuary dow ...
. 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 Exercise is a body activity that enhances or maintains physical fitness and overall health and wellness. It is performed for various reasons, to aid growth and improve strength, develop muscles and the cardiovascular system, hone athletic ...
,
smoking Smoking is a practice in which a substance is burned and the resulting smoke is typically breathed in to be tasted and absorbed into the bloodstream. Most commonly, the substance used is the dried leaves of the tobacco plant, which have b ...
and drinking. Furthermore, it has been noted that no amount of medical attention will help decrease the likelihood of someone getting
type 1 diabetes Type 1 diabetes (T1D), formerly known as juvenile diabetes, is an autoimmune disease that originates when cells that make insulin (beta cells) are destroyed by the immune system. Insulin is a hormone required for the cells to use blood sugar f ...
or
rheumatoid arthritis Rheumatoid arthritis (RA) is a long-term autoimmune disorder that primarily affects joints. It typically results in warm, swollen, and painful joints. Pain and stiffness often worsen following rest. Most commonly, the wrist and hands are inv ...
—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 Luxembourg ( ; lb, Lëtzebuerg ; french: link=no, Luxembourg; german: link=no, Luxemburg), officially the Grand Duchy of Luxembourg, ; french: link=no, Grand-Duché de Luxembourg ; german: link=no, Großherzogtum Luxemburg is a small lan ...
to
Slovakia Slovakia (; sk, Slovensko ), officially the Slovak Republic ( sk, Slovenská republika, links=no ), is a landlocked country in Central Europe. It is bordered by Poland to the north, Ukraine to the east, Hungary to the south, Austria to the ...
) 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 Social stratification refers to a society's categorization of its people into groups based on socioeconomic factors like wealth, income, race, education, ethnicity, gender, occupation, social status, or derived power (social and politi ...
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 Stress may refer to: Science and medicine * Stress (biology), an organism's response to a stressor such as an environmental condition * Stress (linguistics), relative emphasis or prominence given to a syllable in a word, or to a word in a phrase ...
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 Stanford University, officially Leland Stanford Junior University, is a private research university in Stanford, California. The campus occupies , among the largest in the United States, and enrolls over 17,000 students. Stanford is conside ...
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.). 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. 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 The Maternal and Child Health Bureau (MCHB), is one of six Bureaus within the Health Resources and Services Administration, an agency of the U.S. Department of Health and Human Services located in Rockville, Maryland. MCHB administers the Title ...
recommends using an analytic approach (Fixed Effects or hybrid Fixed Effects) to research on
health disparities 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 inequiti ...
to reduce the confounding effects of neighborhood (geographic) variables on the outcomes.


Critiques

Population health has been subject to ongoing critiques and its assumptions


Subfields


Family planning

Family planning Family planning is the consideration of the number of children a person wishes to have, including the choice to have no children, and the age at which they wish to have them. Things that may play a role on family planning decisions include marita ...
programs (including
contraceptives Birth control, also known as contraception, anticonception, and fertility control, is the use of methods or devices to prevent unwanted pregnancy. Birth control has been used since ancient times, but effective and safe methods of birth cont ...
,
sexuality education Sex education, also known as sexual education, sexuality education or sex ed, is the instruction of issues relating to human sexuality, including emotional relations and responsibilities, human sexual anatomy, sexual activity, sexual reprod ...
, and promotion of
safe sex Safe sex is sexual activity using methods or contraceptive devices (such as condoms) to reduce the risk of transmitting or acquiring sexually transmitted infections (STIs), especially HIV. "Safe sex" is also sometimes referred to as safer ...
) play a major role in population health. Family planning is one of the most highly cost-effective interventions in medicine. Family planning saves lives and money by reducing unintended pregnancy and the transmission of
sexually transmitted infection Sexually transmitted infections (STIs), also referred to as sexually transmitted diseases (STDs) and the older term venereal diseases, are infections that are spread by sexual activity, especially vaginal intercourse, anal sex, and ora ...
s. For example, the
United States Agency for International Development The United States Agency for International Development (USAID) is an independent agency of the U.S. federal government that is primarily responsible for administering civilian foreign aid and development assistance. With a budget of over $27 b ...
lists as benefits of its international family planning program: * "Protecting the health of women by reducing high-risk pregnancies" * "Protecting the health of children by allowing sufficient time between pregnancies" * "Fighting HIV/
AIDS Human immunodeficiency virus infection and acquired immunodeficiency syndrome (HIV/AIDS) is a spectrum of conditions caused by infection with the human immunodeficiency virus (HIV), a retrovirus. Following initial infection an individual ma ...
through providing information, counseling, and access to
male Male (symbol: ♂) is the sex of an organism that produces the gamete (sex cell) known as sperm, which fuses with the larger female gamete, or ovum, in the process of fertilization. A male organism cannot reproduce sexually without access to ...
and
female condom An internal condom (also known as a femidom or female condom) is a barrier device that is used during sexual intercourse as a barrier contraceptive to reduce the probability of pregnancy or a sexually transmitted infection (STI). Meant as an al ...
s" * "Reducing
abortions Abortion is the termination of a pregnancy by removal or expulsion of an embryo or fetus. An abortion that occurs without intervention is known as a miscarriage or "spontaneous abortion"; these occur in approximately 30% to 40% of preg ...
" * "Supporting women's rights and opportunities for education, employment, and full participation in society" * "Protecting the environment by stabilizing population growth"


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 The term built environment refers to human-made conditions and is often used in architecture, landscape architecture, urban planning, public health, sociology, and anthropology, among others. These curated spaces provide the setting for human ...
to increase
urban green space In land-use planning, urban green space is open-space areas reserved for parks and other "green spaces", including plant life, water features -also referred to as blue spaces- and other kinds of natural environment. Most urban open spaces ar ...
and decrease nighttime
noise pollution Noise pollution, also known as environmental noise or sound pollution, is the propagation of noise with ranging impacts on the activity of human or animal life, most of them are harmful to a degree. The source of outdoor noise worldwide is mai ...
, and reducing structural stigma directed at those with mental illness.


Population health management (PHM)

One method to improve population health is 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 A disease is a particular abnormal condition that negatively affects the structure or function of all or part of an organism, and that is not immediately due to any external injury. Diseases are often known to be medical conditions that a ...
patterns (i.e., the illness and injury burden) and the health care use behavior of defined populations". 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". 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". Many PHM-related articles are published in ''Population Health Management'', the official journal of DMAA: The Care Continuum Alliance. The following road map has been suggested for helping healthcare organizations navigate the path toward implementing effective population health management: *Establish precise
patient registries Disease or patient registries are collections of secondary data related to patients with a specific diagnosis, condition, or procedure, and they play an important role in post marketing surveillance of pharmaceuticals. Registries are different from ...
*Determine patient-provider attribution *Define precise numerators in the patient registries *Monitor and measure clinical and cost metrics *Adhere to basic clinical practice guidelines *Engage in risk-management outreach *Acquire external data *Communicate with patients * Educate patients and engage with them *Establish and adhere to complex clinical practice guidelines *Coordinate effectively between care team and patient *Track specific outcomes


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 Fee-for-service (FFS) is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality ...
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. 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). As participation in value-based reimbursement models such as
accountable care organization An accountable care organization (ACO) is a healthcare organization that ties provider reimbursements to quality metrics and reductions in the cost of care. ACOs in the United States are formed from a group of coordinated health-care practitione ...
s (ACOs) increases, these initiatives will help drive population health. Within the ACO model, hospitals have to meet specific quality benchmarks, focus on prevention, and carefully manage patients with chronic diseases. Providers get paid more for keeping their patients healthy and out of the hospital. 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. 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. Hospitals are finding it financially advantageous to focus on population health management and keeping people in the community well. 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. 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. Health can be considered a capital good; health capital is part of human capital as defined by the Grossman model. Health can be considered both an investment good and consumption good.Folland S, Goodman A, Stano M. The economics of health and health care (Vol. 6): Upper Saddle River: Pearson Education; 2007. Factors such as obesity and smoking have negative effects on health capital, while education, wage rate, and age may also impact health capital. 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. 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

* Auxology *
Community health Community health refers to simple health services that are delivered by laymen outside hospitals and clinics. Community health is also the subset of public health that is taught to and practiced by clinicians. Community health volunteers and commu ...
*
Economic inequality There are wide varieties of economic inequality, most notably income inequality measured using the distribution of income (the amount of money people are paid) and wealth inequality measured using the distribution of wealth (the amount of ...
*
Health disparities 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 inequiti ...
* Health impact assessment *
Inequality in disease Social epidemiology focuses on the patterns in morbidity and mortality rates that emerge as a result of social characteristics. While an individual's lifestyle choices or family history may place him or her at an increased risk for developing cert ...
* List of countries by income equality * Population Health Forum *
Social determinants of health 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 (such as the d ...
* popHealth


References


Further reading

*


External links

* * *
Canadian Policy Research Secretariate report on population health
* * Population Health Forumbr>website
{{Public health Demography Global health Health economics Social classes