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".
The role of economic inequality
Recently, there has been increasing interest from
epidemiologists 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 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.
The importance of family planning programs
Family planning 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:
- "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"
- "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 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.
See also
