By Nahede Khosrovi
Almost a decade ago, the Institute for Healthcare Improvement (IHI) proposed a framework for optimizing health system performance. Owing to good timing and a ripe environment, this three-pronged strategy, the Triple Aim, became part of the US national strategy for healthcare reform. Nestled within the IHI framework, between improved patient experiences and lower per capita costs of care, was the improved health of populations. ‘Population Health,’ a term then in scant use, thus gained currency as signifying the “health outcomes of a group of individuals, including the distribution of such outcomes within the group.”
Some years earlier, a book by Marmor and Barer, Why Are Some People Healthy and Others Not? The Determinants of Health of Populations, had turned a lens on factors – many of them non-medical and outside the traditional scope of public health authority and responsibility – that help shape health outcomes. In this work, the term ‘population health’ was intended to marshal investigations of health disparities into such arenas as income, education, employment, social support, and culture, as well as to propel policy changes to address these influences more effectively. In the absence of precise definition, however, ‘population health’ has come to mean different things in different contexts.
To a newcomer, an online search of ‘population health’ provides little clarity. Still, any surprise at noting that ‘population’ now increasingly replaces ‘public ’ in matters of health is likely to be sensibly followed by the assumption that this new term delineates a significant departure from older approaches. One logical follow-up question thus might be, “Which population do you mean?” with each interlocutor pointing toward a different target group in response. Indeed, the array of groups and initiatives now linked to ‘population health’ suggests that seemingly any target might count, so long as it somehow may help someone in some populace. Insurance companies reference ‘population health’ in initiatives to improve member health and increase membership; care providers cite it in discussions on improving outcomes among their patients; IT companies use it for healthcare data analytics; and other vendors contribute their own solutions.
Without a doubt it is excellent that so many parties are interested in improving the health of the groups whom they see, treat, and service. Moreover, the tools, thought, and workforce at the disposal of many such systems are immense, and their every effort to use these resources toward making a healthy life better, cheaper, and easier to reach is commendable.
However, among all the initiatives proposed and discharged under the caption ‘population health,’ only a small percentage target the people whom no one sees, who live outside the purview of ready services. These people, the ones who don’t carry a health membership card in their wallet or walk into a clinic with understanding and ease, are usually the least healthy – and they remain the most likely to fall outside the radar of most of the commonly circulating population health interventions.
Originally, ‘population health’ was conceived with those who are left aside at key social intersections strongly in mind. A healthcare movement incorporating social and policy changes into the scope of healthcare reform initiatives was deemed critical to driving improved health outcomes among populations disproportionately experiencing chronically poor health. But indisputably, each initiative able to transform and drive the health system toward improved outcomes and lower costs for any target group is valuable and should be lauded and supported. Nevertheless, if ‘population health’ is to retain a connection to its original purpose and avoid dilution beyond meaningful usage, it should not be severed from its early imperative to support policies that provide some demonstrable impact on vexing social and environmental needs disproportionately affecting specific groups. Creative collaborations, external investments, and other coordinated initiatives can help further existing reforms and develop new ones able to contribute to eradicating health disparities and to developing and sustaining health.
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