The new craze: Population health
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I can’t attend a virtual or physical face-to-face medical meeting today without a presentation, panel discussion or even a poster on population health.
Why did it take so long to recognize its importance? Maybe because there are so many definitions of it. In just 0.68 seconds, Google coughed up 203,000,000 results for a search of population health.
Defining population health
According to one definition from a New York State Health Summit, population health refers to “the health status and health outcomes within a group of people rather than concerning the health of one person at a time.”
“For public health practitioners,” the definition continues, “improving population health involves understanding and optimizing the health of a population broadly defined by geography. Health care providers, insurers and employers may consider population health to refer to their patient panel or insured members or employees. However, health reform encourages all sectors to think more broadly than the sum of the individuals under their charge. This is because to improve population health, it is necessary to influence the social determinants that affect health outcomes through population-wide policies and interventions that impact the determinants.”
I am originally from New York and that definition exceeds a New York minute — a phrase that refers to the hectic pace of New Yorkers and is believed to have been coined in Texas in the late 1960s. It means a New Yorker does in an instant what a Texan would do in a whole minute. Now, I don’t want my Texas colleagues to be offended and send me email. Back to population health.
With 203,000,000 descriptions of population health, I’ve concluded that the best definition is this “CliffNotes” version: “Getting sick people healthy, but also keeping healthy people well.”
In the United States, keeping healthy people well is a hard thing to do, as demonstrated by individuals who refuse to receive the COVID-19 vaccine.
It also can be difficult to distinguish population health from public health. My CliffNotes version could be augmented to include “focusing on the geographic nature of treating patients in groups rather than as individuals.”
In contrast, public health generally refers to the health circumstances of the public at large and is subject to government regulation to ensure that I and my medical colleagues do our jobs properly. My colleagues would probably agree with me that sometimes government regulation is overregulation.
Population health and public health are not mutually exclusive. Both are needed to keep people safe and healthy, and also to prevent disease.
As my colleagues know, prevention is critical in the cancer arena. This is especially true in the world of genetic counseling and gene testing, next-generation sequencing and even gene editing. The skyrocketing progress of CRISPR gene editing over the last several years demonstrates that with new technology comes better and more efficient procedures, as well as means of making existing methods even better.
Components of population health
The literature describes four main components of a strong population health initiative:
- emphasis on primary care;
- careful data-driven environment;
- physician leadership; and
- off-the-radar disease management.
The last point is vital. No one would disagree that a good health care experience for a patient comes at the time of the physician encounter. However, that encounter does not constitute complete health care. Rather, a complete health care experience involves the greater responsibility of caring for patients who are not seeing a health care provider at any given moment in time — that is, caring for patients who are off the radar screen. This is critical because patients’ activities outside any hospital system influence what happens in the hospital and may get them in the hospital in the first place.
Focusing on what is off the radar screen seems to be the essential component of population health. It concerns the challenge of how we take care of patients away from the medical environment, whether that medical environment is a walk-in clinic, physician’s office or hospital. I don’t have the answers to this challenge but, remember, there are 203,000,000 sources of information.
Let’s face it, despite all of the information on population health, none of us is going to fix health care in our lifetimes. The challenges are overwhelming — gun violence, unemployment, disparities in care, availability of mind-enhancing drugs, a McDonald’s or Burger King on every block. The list goes on.
However, we have to start somewhere so the next generation doesn’t have to start at square one. One thing is certain: experts in population health and public health must work together.
I’ll end with a quote from John Lennon: “Everything will be OK in the end. If it’s not OK, it’s not the end.”
Stay safe and encourage people to get vaccinated.
For more information:
Nicholas J. Petrelli, MD, FACS, can be reached at npetrelli@christianacare.org.
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New York State Department of Health. What is population health? Available at: www.health.ny.gov/events/population_health_summit/docs/what_is_population_health.pdf. Accessed May 10, 2021.
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