While still a relatively new area of medical study, population health has gained increasing prominence around the world as more research has uncovered underlying social and cultural issues that affect the health of large populations. But what exactly is population health?
According to the National Institute of Health, population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.”
The study of population health, as a discipline, includes not only understanding the health outcomes and the pattern of health determinants, but also the policies and interventions that link those two issues. In time, researchers hope to provide policy makers and citizens with the tools they need to adapt and respond to the factors that adversely affect health outcomes.
Emergence of Population Health Research in Canada
Writing on population health for the NIH National Library of Medicine, Dr. David Kindig and Dr. Greg Stoddart explain the term was first widely used in Canada before coming to the United States. According to their research, the idea of population health as a field of study emerged from a book edited by colleagues at the Canadian Institute for Advanced Research entitled, “Why Are Some People Healthy and Others Not? The Determinants of Health of Populations. ”
Much of the focus of the work in Canada has been on the nonmedical determinants that affect the health of large population groups. Such determinants include socio-economic and environmental factors like race, gender, financial means and geographic access to medical care.
These factors, referred to generally as the Social Determinants of Health (SDOH), are not typically associated with the quality of medical care delivery per se (e.g. doctor training, hospital outcomes, etc.), but they are recognized as factors contributing to health status of individuals. It is difficult to argue against the premise that a person is more likely to be in poor health or remain in disease state if he or she is unable to travel to, pay for or otherwise access medical care – especially if the persons around him or her who might help or be encouraging are similarly disadvantaged.
A Shift from Traditional Medical Care
John Frank, director of the Canadian Institute of Population and Public Health, has called population health “a newer research strategy for understanding the health of populations.” As a field of medical study, population health management moves the emphasis from the traditional one-on-one health services typically provided to patients and looks to find patterns within certain populations – many of them nonmedical – that affect health outcomes.
The Commission on the Social Determinants of Health at the World Health Organization reports that these factors are responsible for most diseases and injuries and also lead to wide inequities between countries in terms of health outcomes. However, SDOH can also affect the health of poorer residents in even the most advanced countries. In fact, studies have found a direct and strong relationship between health and socioeconomic status.
Examples of Population Health Issues
In the United States, the Department of Health and Human Services has set up a website that gives examples of areas that studies in population health have shown affect health outcomes.
The website, called Healthy People 2020, lists many factors that affect public health. They include areas one might expect such as access to medical facilities, utilizing preventive care, tobacco use, environmental quality, mental health services and maternal and child health.
However, they also study issues such as areas where more injuries lead to death (nationwide the number is 57.1 injury-related deaths for every 100,000 people) to the homicide rate (nationally, about 5.3 people per 100,000).
They also consider social determinants such as high school graduation rates, because level of education can be a key indicator on health issues. While nationwide the rate is 78.2% (in 2010), the rates vary widely by race. About 93% of Asian students graduate high school. The numbers for other races include white students (82.9%), Hispanic students (71.4%) and black students (66.1%).
There are five main areas that Health People 2020 has focused on to improve social determinants of health. They are:
- Economic Stability
- Social and Community Context
- Health and Health Care
- Neighborhood and Built Environment
As more healthcare professionals move into research on the determinants of health, population health management is expected to become a bigger field of study. The hope is that data-driven findings will help change how governments and the healthcare industry respond to health care needs worldwide.