Nursing Care and Population Health
Whats is Population Health,Model of Implementation of Population Health,Elements of Population Health,Management Activities,Model of Population Health,Main Focus of Population Health
Whats is Population Health
The term population health is fairly new. Current emphasis on
improving health outcomes, eliminating health disparities, and reducing health
care costs amplify its importance, but a single accepted definition of
population health has yet to emerge.
Szreter (2003) traces the origin of the
concept of population health back to an historic 18th century debate over the
relationship between economic growth and human health.
In an article titled
Producing Health, Consuming Health Care, RG Evans and Stoddart (1990) merged
concepts and principles from economics and epidemiology to support the idea
that health is determined by multiple factors. In 1997 in a book titled
Purchasing
Population Health
Paying for Results, Kindig defined population
health as “the aggregate health outcome of health adjusted life expectancy
(quantity and quality) of a group of individuals, in an economic framework that
balances the relative marginal returns . from multiple determinants of health”
(p. 47).
Kindi’s definition proposed a unit of measure for population health
and underscored a relationship between economics and health.
Model of Implementation of Population Health
In 2001, two models for implementing population health were
published, one in Canada and the other in the United States. In July 2001,
Health Canada published a draft document titled The Population Health Template:
Key Elements and Actions That Define a Population Health Approach.
The
publication consolidated current understandings of population health and
outlined procedures and processes for implementing a population health
approach.
The health Canada template defined population health as “the health
of a population as measured by health status indicators and as influenced by
social, economic, and physical environments, personal health practices,
individual capacity and coping skills, human biology, early childhood
development , and health services” (Health Canada, p. 2).
Elements of Population Health
The population health
template also identified eight key elements of a population health approach:
(1) focusing on the health of populations
(2) addressing the determinants of
health and their interactions
(3) basing decisions on evidence
(4) increasing
upstream investments
(5) applying multiple strategies
(6) collaborating
across sectors and levels
(7) employing mechanisms for public involvement
(8) demonstrating accountability for health outcomes (Health Canada).
Management Activities
The Department of Defense Tricare Management Activity (DoDTMA)
published a Population Health Improvement Plan and Guide in December 2001.
The
guide adopted Kindig’s definition of population health and outlined an approach
to population health improvement focused on balancing awareness, education,
prevention, and intervention activities to improve the health of a specified
population (DoDTMA, 2001).
Much like the Health Canada template, the DoDTMA
guide identified several process steps for population health improvement:
(a)
identifying the population
(b) forecasting demand
(c) managing demand
(d)
managing capacity
(e) implementing evidence based primary, secondary, and
tertiary prevention
(f) community outreach
(g) analyzing performance and
health status.
Model of Population Health
In 2003, McAlearney published a model for population health in a
book titled Population Health Management: Strategies to Improve Outcomes. The
author used the term “population health management to describe a variety of
approaches developed to foster health and quality-of-care improvements while
managing costs.
McAlhaney outlined several major steps for implementing
population health management programs: targeting the program, selecting the
strategies, implementing and managing the program, and integrating critical
factors.
In March of 2003, in an article titled What is Population Health?
Kindig and Stoddart attempted to distinguish population health from public
health, health promotion, and social epidemiology. The authors also set out to
determine if population health was a field of study of health determinants or a
concept of health.
Following a critique of existing definitions and
understandings of population health dating back to the early 1990s, the authors
concluded that population health is concerned with both the definition and
measurement of health outcomes and the roles of determinants.
Kindig and
Stoddart defined population health as the health outcomes of a group, including
the distribution of the outcomes within the group, and argued that the field of
population health included health outcomes, patterns of determinants of health,
and interventions and policies that link outcomes with determinants.
Main Focus of Population Health
Current understandings and definitions of population health
emphasize the link between multiple determinants of health and health outcomes.
Population health is focused on improving the health status of populations,
enhancing health care quality and access, and decreasing costs.
A population
health approach targets entire populations; intervenes with families,
communities, systems, and individuals; recognizes and emphasizes multiple
determinants of health; incorporates primary, secondary, and tertiary
prevention ; and includes ongoing assessment, monitoring, and improvement.