What is Population Health? Definitions from the Field
The New York Academy of Medicine (NYAM) conducted a survey of 17 thought leaders* across America's primary care and public health sectors on the definition of population health. In this post, Nicholas Stine, MD, and Dave Chokshi, MD, MSc, on behalf of the NYAM Primary Care and Population Health Working Group, share a synthesis of what those leaders had to say. All quotes are printed with permission. In a follow-up post on the NYAM website, the authors discuss challenges and opportunities in an urban context for achieving population health.
The New York Academy of Medicine was the National Program Office for the Robert Wood Johnson Foundation (RWJF) Health & Society Scholars program, a signature RWJF initiative which ended in 2017. In a corresponding video, the program interviewed additional leaders who discuss the role of public policy and cross-sector collaboration in achieving population health. Watch the video.
What is Population Health?
In a survey conducted by the New York Academy of Medicine on the definition of public health, many discussants cited the definition developed by David Kindig, MD, PhD, as a reference point: “health outcomes of a group of individuals, including the distribution of such outcomes within the group.” Regardless of specific vantage point, there was a generally shared sentiment that population health should be thought of broadly and in common terms by a range of clinical and non-clinical stakeholders.
More discussants described a baseline framework of a clinical delivery system oriented around patients in a practice, in contrast with a public health system oriented around geographic communities. A more clinical, or “population medicine,” perspective often centered around evidence-based interventions and disease management categories so as to triage and allocate health care resources in a cost-effective manner.
“There is an intentionality to what goes into managing patients,” said Henry Chung, “including stratification, determining out-of-office needs, and organizing into panels of patients that meet certain criteria... We're thinking about them in terms of clusters where we have strong evidence based guideline for managing these chronic illnesses.”
Those more engaged in public health were more likely to start with the geographic population and move inwards to interventions, focused on broad notions of determinants of health and incorporating interventions from clinical care to social services and environmental interventions.
Glen Mays, PhD, stressed the importance of thinking of population health “as more than just the aggregate of individual health status,” incorporating elements that relate to characteristics of the community itself, such as the healthiness of the food environment and the physical environment.
Karen DeSalvo, MD, pointed to the importance of measurement in fulfilling this aim. For example, one could ensure that participants in social programs like WIC (Special Supplemental Nutrition Program for Women, Infants, and Children) are integrated with more traditional health care programs—via health information exchange—thereby broadening the population of “ever-touched” patients.
Jim Hester, PhD, from his position at the Innovation Center, a part of the Centers for Medicare and Medicaid Services, sought to bridge the clinical and public health divide by describing the Health 1.0-2.0-3.0 framework, developed by Neal Halfon, MD, MPH, with 1.0 representing acute clinical care, 2.0 representing coordinated care for chronic illnesses, and 3.0 representing interventions addressing the root causes of disease.
*The 17 leaders interviewed for this survey were:
John Auerbach, Institute on Urban Health Research, Northeastern University
Tom Bodenheimer, Department of Family and Community Medicine, University of California-San Francisco Henry Chung, Montefiore Medical Center
Karen DeSalvo, Health Commissioner, City of New Orleans
Allen Dobson, Community Care of North Carolina
David Fleming, Director and Health Officer for Public Health, Seattle
Gary Gunderson, Methodist Healthcare (Memphis) and Congregational Health Network
Jim Hester, Innovation Center, Centers for Medicare and Medicaid Services
David Kindig, University of Wisconsin Department of Population Health
Bob Lawrence, Center for a Livable Future, Johns Hopkins University
John Lumpkin, Robert Wood Johnson Foundation
Glen Mays, University of Kentucky College of Public Health
Lloyd Michener, Duke University Medical Center
Arnold Milstein, Pacific Business Group on Health
Ram Raju, Cook County Health and Hospitals System
David Stevens, National Association of Community Health Centers
Steven Teutsch, Los Angeles County Department of Health