Population health
Encyclopedia
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 population. One major step in achieving this aim is to reduce health inequities among population groups. Population health seeks to step beyond the individual-level focus of mainstream medicine
and public health
by addressing a broad range of factors that impact health on a population-level, such as environment, social structure, resource distribution, etc. An important theme in population health is importance of social determinants of health
and the relatively minor impact that medicine and healthcare have on improving health overall.
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".
on the subject of economic inequality
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, but that there is a continual gradient, from the top to the bottom of the socioeconomic ladder, relating status to health. This phenomenon is often called the "SES gradient
". Lower socioeconomic status has been linked to chronic stress
, heart disease
, ulcers
, type 2 diabetes, rheumatoid arthritis
, certain types of cancer
, and premature aging.
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
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 in London
. 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, smoking
and drinking
. Furthermore, it has been noted that no amount of medical attention will help decrease the likelihood of someone getting type 1 diabetes or rheumatoid arthritis
- 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
to Slovakia
) 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 phenomenon such as status
and social stratification
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
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
provides similar findings.
programs (including contraceptives
) play a major role in population health. For example, the United States Agency for International Development
lists as benefits of its international family planning program:
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
.
Health
Health is the level of functional or metabolic efficiency of a living being. In humans, it is the general condition of a person's mind, body and spirit, usually meaning to be free from illness, injury or pain...
that aims to improve the health of an entire population. One major step in achieving this aim is to reduce health inequities among population groups. Population health seeks to step beyond the individual-level focus of mainstream medicine
Medicine
Medicine is the science and art of healing. It encompasses a variety of health care practices evolved to maintain and restore health by the prevention and treatment of illness....
and public health
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" . It is concerned with threats to health based on population health...
by addressing a broad range of factors that impact health on a population-level, such as environment, social structure, resource distribution, etc. An important theme in population health is importance of social determinants of health
Social determinants of health
Social determinants of health are the economic and social conditions under which people live which determine their health. They are "societal risk conditions", rather than individual risk factors that either increase or decrease the risk for a disease, for example for cardiovascular disease and...
and the relatively minor impact that medicine and healthcare have on improving health overall.
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 role of economic inequality
Recently, there has been increasing interest from epidemiologistsEpidemiology
Epidemiology is the study of health-event, health-characteristic, or health-determinant patterns in a population. It is the cornerstone method of public health research, and helps inform policy decisions and evidence-based medicine by identifying risk factors for disease and targets for preventive...
on the subject of economic inequality
Economic inequality
Economic inequality comprises all disparities in the distribution of economic assets and income. The term typically refers to inequality among individuals and groups within a society, but can also refer to inequality among countries. The issue of economic inequality is related to the ideas of...
and its relation to the health of populations. There is a very robust correlation between socioeconomic status
Social status
In sociology or anthropology, social status is the honor or prestige attached to one's position in society . It may also refer to a rank or position that one holds in a group, for example son or daughter, playmate, pupil, etc....
and health. This correlation suggests that it is not only the poor who tend to be sick when everyone else is healthy, but that there is a continual gradient, from the top to the bottom of the socioeconomic ladder, relating status to health. This phenomenon is often called the "SES gradient
Socioeconomic status
Socioeconomic status is an economic and sociological combined total measure of a person's work experience and of an individual's or family’s economic and social position in relation to others, based on income, education, and occupation...
". Lower socioeconomic status has been linked to chronic stress
Stress (medicine)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
, heart disease
Heart disease
Heart disease, cardiac disease or cardiopathy is an umbrella term for a variety of diseases affecting the heart. , it is the leading cause of death in the United States, England, Canada and Wales, accounting for 25.4% of the total deaths in the United States.-Types:-Coronary heart disease:Coronary...
, ulcers
Peptic ulcer
A peptic ulcer, also known as PUD or peptic ulcer disease, is the most common ulcer of an area of the gastrointestinal tract that is usually acidic and thus extremely painful. It is defined as mucosal erosions equal to or greater than 0.5 cm...
, type 2 diabetes, rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
, certain types of cancer
Cancer
Cancer , known medically as a malignant neoplasm, is a large group of different diseases, all involving unregulated cell growth. In cancer, cells divide and grow uncontrollably, forming malignant tumors, and invade nearby parts of the body. The cancer may also spread to more distant parts of the...
, and premature aging.
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
In sociology or anthropology, social status is the honor or prestige attached to one's position in society . It may also refer to a rank or position that one holds in a group, for example son or daughter, playmate, pupil, etc....
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
Whitehall Study
The original Whitehall Study investigated social determinants of health, specifically the cardiorespiratory disease prevalence and mortality rates among British male civil servants between the ages of 20 and 64. The initial prospective cohort study, the Whitehall I Study, examined over 18,000...
- a series of studies conducted on civil servants in London
London
London is the capital city of :England and the :United Kingdom, the largest metropolitan area in the United Kingdom, and the largest urban zone in the European Union by most measures. Located on the River Thames, London has been a major settlement for two millennia, its history going back to its...
. 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, smoking
Tobacco smoking
Tobacco smoking is the practice where tobacco is burned and the resulting smoke is inhaled. The practice may have begun as early as 5000–3000 BCE. Tobacco was introduced to Eurasia in the late 16th century where it followed common trade routes...
and drinking
Alcoholic beverage
An alcoholic beverage is a drink containing ethanol, commonly known as alcohol. Alcoholic beverages are divided into three general classes: beers, wines, and spirits. They are legally consumed in most countries, and over 100 countries have laws regulating their production, sale, and consumption...
. Furthermore, it has been noted that no amount of medical attention will help decrease the likelihood of someone getting type 1 diabetes or rheumatoid arthritis
Rheumatoid arthritis
Rheumatoid arthritis is a chronic, systemic inflammatory disorder that may affect many tissues and organs, but principally attacks synovial joints. The process produces an inflammatory response of the synovium secondary to hyperplasia of synovial cells, excess synovial fluid, and the development...
- 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
Luxembourg , officially the Grand Duchy of Luxembourg , is a landlocked country in western Europe, bordered by Belgium, France, and Germany. It has two principal regions: the Oesling in the North as part of the Ardennes massif, and the Gutland in the south...
to Slovakia
Slovakia
The Slovak Republic is a landlocked state in Central Europe. It has a population of over five million and an area of about . Slovakia is bordered by the Czech Republic and Austria to the west, Poland to the north, Ukraine to the east and Hungary to the south...
) 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 phenomenon such as status
Social status
In sociology or anthropology, social status is the honor or prestige attached to one's position in society . It may also refer to a rank or position that one holds in a group, for example son or daughter, playmate, pupil, etc....
and social stratification
Social stratification
In sociology the social stratification is a concept of class, involving the "classification of persons into groups based on shared socio-economic conditions ... a relational set of inequalities with economic, social, political and ideological dimensions."...
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 (medicine)
Stress is a term in psychology and biology, borrowed from physics and engineering and first used in the biological context in the 1930s, which has in more recent decades become commonly used in popular parlance...
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
Robert Sapolsky
Robert Maurice Sapolsky is an American scientist and author. He is currently Professor of Biological Sciences, and Professor of Neurology and Neurological Sciences and, by courtesy, Neurosurgery, at Stanford University. In addition, he is a Research Associate at the National Museums of...
of Stanford University
Stanford University
The Leland Stanford Junior University, commonly referred to as Stanford University or Stanford, is a private research university on an campus located near Palo Alto, California. It is situated in the northwestern Santa Clara Valley on the San Francisco Peninsula, approximately northwest of San...
provides similar findings.
The importance of family planning programs
Family planningFamily planning
Family planning is the planning of when to have children, and the use of birth control and other techniques to implement such plans. Other techniques commonly used include sexuality education, prevention and management of sexually transmitted infections, pre-conception counseling and...
programs (including contraceptives
Birth control
Birth control is an umbrella term for several techniques and methods used to prevent fertilization or to interrupt pregnancy at various stages. Birth control techniques and methods include contraception , contragestion and abortion...
) play a major role in population health. For example, the United States Agency for International Development
United States Agency for International Development
The United States Agency for International Development is the United States federal government agency primarily responsible for administering civilian foreign aid. President John F. Kennedy created USAID in 1961 by executive order to implement development assistance programs in the areas...
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 through providing information, counseling, and access to male and female condoms"
- "Reducing abortions"
- "Supporting women's rights and opportunities for education, employment, and full participation in society"
- "Protecting the environment by stabilizing population growth"
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 patterns (i.e., the illness and injury burden) and the health care use behavior of defined populations”. PHM is distinguished from disease managementDisease management (health)
Disease management is defined as "a system of coordinated health care interventions and communications for populations with conditions in which patient self-care efforts are significant." For people who can access health care practitioners or peer support it is the process whereby persons with...
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
DMAA: The Care Continuum Alliance
The Care Continuum Alliance is an industry trade group of corporations and individuals that "promotes the role of population health improvement in raising the quality of care, improving health outcomes and reducing preventable health care costs for individuals with chronic conditions and those at...
.
See also
- AuxologyAuxologyAuxology, sometimes called Auxanology , is a meta-term covering the study of all aspects of human physical growth...
- Community healthCommunity healthCommunity health, a field of public health, is a discipline that concerns itself with the study and betterment of the health characteristics of biological communities. While the term community can be broadly defined, community health tends to focus on geographic areas rather than people with shared...
- Economic inequalityEconomic inequalityEconomic inequality comprises all disparities in the distribution of economic assets and income. The term typically refers to inequality among individuals and groups within a society, but can also refer to inequality among countries. The issue of economic inequality is related to the ideas of...
- Egalitarian mortality
- Health disparitiesHealth disparitiesHealth equity refers to the study of differences in the quality of health and health care across different populations....
- Health Impact AssessmentHealth Impact AssessmentHealth Impact Assessment is defined as "a combination of procedures, methods and tools bywhich a policy, program or project may be judged as to its potential effects on the...
- Inequality in diseaseInequality in diseaseThis article discusses social inequality in the United States and its effects on individual health, and more specifically likelihood of developing diseases....
- List of countries by income equality
- Population Health ForumPopulation Health ForumThe Population Health Forum is a group based at University of Washington in Seattle, Washington, and composed of academics, citizens, students, and activists from around North America.- Purpose and activities :...
- Social determinants of healthSocial determinants of healthSocial determinants of health are the economic and social conditions under which people live which determine their health. They are "societal risk conditions", rather than individual risk factors that either increase or decrease the risk for a disease, for example for cardiovascular disease and...
- popHealthPopHealthis an open source reference implementation software tool that automates population health reporting. popHealth integrates with a healthcare provider's electronic health record system to produce summary quality measures on the provider's patient population.- Overview :popHealth is a open source...
External links
- Population Health MS and PhD Graduate Programs MS and PhD Graduate Programs in Population Health at the University of Wisconsin–Madison
- Population Health Institute Population Health Institute at the University of Wisconsin–Madison
- Canadian Institute for Health Information
- Institute of Population Health Institute of Population Health at the University of Ottawa, Canada
- Examples of population based health management metrics Population Based Health intervention analysis, business case evaluations, epidemiology
- Population and Health Graduate Program Population and Health Graduate Program in the Dept of Population and Family Health Sciences at the Johns Hopkins Bloomberg School of Public Health
- Population Health ForumPopulation Health ForumThe Population Health Forum is a group based at University of Washington in Seattle, Washington, and composed of academics, citizens, students, and activists from around North America.- Purpose and activities :...
website - A Population-Based Risk Management Framework for Cancer Control
- Public Health Agency of Canada's take on population health
- Canadian Policy Research Secretariate report on population health
- Private Sector Partnerships for Better Health
- Ph.D. in Population Health Program Ph.D. in Population Health Program at the University of Ottawa, Canada
- MS Programs & PhD in Population Health Sciences At Thomas Jefferson University School of Population Health, Philadelphia, PA