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Measuring Population Health, Maximising Population Health

Author:

Jason Yap

Saw Swee Hock School of Public Health, National University of Singapore, SG
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Abstract

Introduction & Context: Population Health is a term popularised by Kindig and Stoddart in their 2003 paper which defined it as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Its initial formulation focused on health statuses and was synonymous with the “health of the population”. The paper pointed out that many (commercial and socio-ecological) factors beyond the usual biomedical determinants influence health outcomes, and encouraged a greater focus ""on health outcomes (as opposed to inputs, processes, and products) and on determining the degree of change that can actually be attributed to our work.”

Over time, the semantic range of the term has expanded beyond the initial tension between “a field of study” and “a concept of health”, to include the actions undertaken by various agencies to improve the health status of the population (much like how the single phrase “Public Health” can connote (a) the interventions based on (b) a field of skills and knowledge for (c) desired outcomes).

It would seem logical (especially to the clinically-oriented professional seeking always to improve the health of an individual whatever their current situation as presented) that the ultimate health of the population is the sum of the health of its members, and each professional and provider will do their and its bits wherever they are.

In the context of unending needs and wants and limited resources however, it is not tenable to adopt the scattershot approach of multiple disparate efforts by all and sundry. The challenge is to focus not only on ""what moves the needle the most significantly” but also ""what moves the most significant needles”. Disease and death are inevitable, and measuring current outcomes as “population health” data can be insightful and suggest next actions for specific problem areas but does not help design the complex “portfolio” of different interventions for multiple problems across the whole population.

Method & Results: What is needed then is a way to (a) first summarise across the health of the population with clear, defined and agreed top-level objectives based on the relative disease burdens and community priorities, and then (b) systematically analyse each top level indicator for its key determinants and subdeterminants, to (c) identify and intervene intentionally on those elements that most contribute to the larger health of the population based on societal mores and national policies, and (d) monitor and evaluate progress and impact on the health and wellness of the population.

This presentation will first propose a high-level population health dashboard that summates the current health outcomes and healthcare delivery, based on the paradigm that the key to the best possible health of the population is in optimising (a) disease prevention, (b) early detection and (c) clinical management.

Similarly to how financial statements efficiently present a financial picture of a firm for more effective and informed decision making and enterprising planning systems enable efficient resource and process management, this dashboard will guide policy setting, portfolio design and programme implementation, and progress monitoring, to maximise the outcomes for the whole population based on intentional objectives. While illustrations will pertain to the local context, the general principles, like accounting standards, can be applied to a wide variety of constituencies and contexts.

Conclusion: Healthcare is complex and adaptive, and is not susceptible to “simplistic reductionist” silver bullets.  The concept of population health as defined by Kindig and Stoddart highlighted the need to move beyond the biomedical conceptualisation of health and healthcare. Implementing interventions and reforms across a fragmented or disjointed front will make some progress but will also create unintended side-effects amid potentially considerable wastage.

A dashboard, analogous to financial reporting and enterprise planning systems, that is able to present an integrated and coherent construct linking macro objectives and policies with ground programmes and resource utilisation will be very useful to a coherent intentional approach to maximising the health of the population through population health action.  

How to Cite: Yap J. Measuring Population Health, Maximising Population Health. International Journal of Integrated Care. 2022;22(S3):480. DOI: http://doi.org/10.5334/ijic.ICIC22252
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Published on 04 Nov 2022.

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