Population heatlh

Preliminary definitions

"Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity" [1].

"Public health is what we, as a society, do collectively to assure the conditions in which people can be healthy" [2].

Public health leadership is "the practice of mobilizing people, organizations, and communities to effectively tackle tough public health challenges" [3].

Defining population health

Definition 1: "Population health is a systems framework for studying and improving the health of populations through collective action and learning" [4].

Definition 2: Population health is "the health outcomes of a group of individuals, including the distribution of such outcomes within the group" [5].

I strongly prefer definition 1: it is socioecologically holistic and action-oriented towards continuous transformation and improvement of complex systems. However, definition 2 has been broadly adopted by official bodies (see for example https://www.practicalplaybook.org/). To appreciate the different arguments I highly recommend reading Dr. Stoto's article [6]. Also read Dr. Kindig's blog post [7]. 

For me, population health is a call to action for transforming socioecological systems to protect and promote health and equity.

Systems framework

By systems we mean socioecological, lifecourse systems. We live, learn, work, and play in complex social environments. We face seemingly intractable social problems that impact health (poverty, racism, homelessness, ideological conflict, and war). Sometimes simple solutions works, but often they do not. Unfortunately, we must make strategic, operational, and tactical decisions in complex environments in the setting of ambiguity, uncertainty, and urgent time constraints.

What are complex adaptive systems? A complex adaptive system consists of
  1. diverse entities that are
  2. connected,
  3. interdependent, and exhibit learning and
  4. adaptation.
Social systems are complex adaptive systems (teams, organizations, communities, etc.). This poses special challenges for us because complex adaptive systems can ambiguous and unpredictable. For us this requires relentless humility, curiosity, probing, and sensemaking.

One useful conceptual model for dealing with complexity is the Stacey Complexity Matrix (Figure 1):

Figure 1: Stacey Complexity Matrix


  1. Simple - 
  2. Complicated, technically - 
  3. Complicated, socially - 
  4. Complexity
  5. Chaos - 
The key message is that population health requires systems thinking and being open to exploration and discovery of emergent solutions. This requires diverse, transdisciplinary teams that includes community stakeholders.

Studying and improving

By studying we mean knowledge discovery (research) and community needs assessments, and by improving we mean knowledge deployment and continuous improvement.

Health of populations

By the health of populations we mean the multi-dimensional determinants and outcomes of health and well-being, including the social, economical, cultural, and environmental.  

Collective action

By collective action we mean the cross-sector, trans-disciplinary collaborative partnerships to achieve common goals, which in population health should include the following:
  • Protecting and promoting health and equity
  • Transforming people and place
  • Ensuring a healthy planet
  • Achieving health equity

Learning

By learning we mean the continuous improvement of
  • decision making and influencing
  • knowledge discovery and deployment
  • strategy development and deployment
  • collective action and impact

References

  1. 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. World Health Organization. 1948. url: http://www.who.int/about/definition/en/print.html.
  2. Institute of Medicine, Committee for the Study of the Future of Public Health. The Future of Public Health. National Academy Press, 1988. isbn: 0-309-58190-7. url: http://www.nap.edu/catalog/1091.html.
  3. James Begun and Jan Malcolm. Leading Public Health: A Competency Framework. 1st ed. Springer Publishing Company, June 4, 2014. isbn: 978-0826199065. url: http://amzn.com/0826199062.
  4. Tomás J. Aragón, Leading Population Health. PHDS 2016. Available from http://phds.io
  5. Kindig D, Stoddart G. What is population health? Am J Public Health. 2003 Mar;93(3):380-3. PubMed PMID: 12604476; PubMed Central PMCID: PMC1447747.
  6. Stoto MA. Population Health in the Affordable Care Act Era. Academy Health Report 2013. Available from: http://www.academyhealth.org/files/AH2013pophealth.pdf
  7. Kindig D. What Are We Talking About When We Talk About Population Health? Health Affairs Blog 2015. Available from: http://healthaffairs.org/blog/2015/04/06/what-are-we-talking-about-when-we-talk-about-population-health/



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