Population Health

Although maintaining good health is still culturally framed as an individual effort, research tends to show that a community-based approach can have a positive effect on the health of its members. By addressing the most common diseases that affect a particular group of people, medical professionals, human services professionals, and policymakers can adapt their practice to improve people’s overall health outcomes. 

What Is Population Health?

According to the CDC, the population health definition is that of an “interdisciplinary, customizable approach that allows health departments to connect practice to policy for change to happen locally.” This essentially means that it’s an umbrella term describing a common effort by multiple entities — such as public health professionals, medical professionals, representatives of industry and academia, and local government representatives — to improve the overall health of a specific group of people. The ultimate goal of population health policies is to improve the overall health of humankind.

The groups of people that population health management practices aim to help are determined by various factors like geographical location, ethnicity, disability status, or profession. Other cohorts may be formed based on specific characteristics, such as people who are currently incarcerated. Grouping people based on these kinds of factors makes it more feasible for local authorities to collaborate with other regional stakeholders to develop a unified approach to improving a community’s overall health outcomes. 

Besides improving the overall health of all these different people, population health actions and policies also aim to go deeper and identify subgroups that may require special attention. This means that, even if most people in a certain group enjoy relatively good health, a specific minority may suffer from unique factors disrupting their health. It’s important to go beyond broad statistics and make sure no one is left behind when it comes to improving population health.

How Does Population Health Work?

A broad description of how population health functions to help a specific community is that it promotes various policies and programs that determine an improvement in factors that influence overall health, which leads to better health outcomes. 

These are the three main components of this approach:

Health-Oriented Policies and Programs

Influencing the overall health of a large community often involves adapting local policies and government programs to promote effective health practices. Their exact nature is based on the target group’s specific characteristics, and local policymakers have to analyze local data to determine the most effective ways to utilize any available resources. This can be deeply challenging, as the factors that affect population health can be subjective and ever-changing, but the results are often worthwhile. 

The policies that may help improve the overall health of a community vary in scope, from the health policies of a specific institution all the way up to national health policies. Their exact nature typically depends on the most common health issues that the local population is facing. For instance, if a specific community struggles with health issues caused by tobacco and alcohol use, some appropriate policies would include smoking and drinking bans in public places and higher taxes on alcohol and tobacco products. Other common health-related policies range in scope from substance abuse regulations to anti-discrimination policies.

The programs put in place to improve population health also vary, with their nature being influenced by a multitude of factors. Their main goal is usually to find ways to improve the population’s access to health care and other types of support. This is likely to lead to disease prevention and reduction in factors that affect well-being — like mental health issues or homelessness. Other common programs aim to educate a community regarding effective health practices and to improve the environments where people live and work.

Social Determinants That Influence Overall Health

The environment where we live, work, learn, and play has a meaningful impact on our overall health. Working together to improve the social factors that impact our health not only leads to healthier communities but also significantly improves people’s overall quality of life. When your social surroundings enable you to thrive and develop as an individual, it can have a positive impact on those around you and your ability to inspire future generations. Some important social factors of population health are:

• Economic stability: Enjoying economic stability generally refers to having a roof over your head and not worrying about things like where your next meal will come from or how you’d be able to pay hospital bills should something bad happen to you or a member of your family. Being economically stable can have a major impact on your physical and mental health.
• Access to quality education: Getting a good education can impact a child’s future in multiple ways. One of them is the increased likelihood that a well-educated child will live a long and healthy life. Children from low-income families are usually more likely to suffer from a lack of educational opportunities, so finding ways to help them do well in school can enable them to have longer and more prosperous lives.
• Access to quality health care: We’re all likely to require some form of health care service at one point in our lives. Not being to afford it or not having access to it can severely impact overall health, so making sure everyone has a primary health care provider and can afford their treatments and medications can have a positive impact on local communities and on the population as a whole. 
• Living in safe environments: Another significant way to influence overall health outcomes is to eliminate factors like violence and pollution from our neighborhoods, especially those in areas where racial or ethnic minorities and low-income individuals may live. Providing a safe environment is key to achieving the social stability you need to stay healthy and improve your life.
• Getting social support from those around us: Although modern technology makes communication over long distances easier and cheaper, there’s no substitute for healthy social interactions. Getting support from your friends, family, and other members of your local community can improve your confidence and make it more likely that you’ll have a healthy and successful life.

Health Outcomes 

Health outcomes are the differences in population health that result from the programs and policies that trigger changes in the various factors that influence overall health. Besides helping policymakers assess the effectiveness of their programs and policies, analyzing health outcomes can also improve the way people are treated and reduce overall health care costs. Some common elements used to measure health outcomes are:

• Readmission rates: Another common metric for measuring health outcomes is the rate of readmission after prior hospitalization. Besides improving population health, reducing readmission rates also saves resources.
• Individual experience: This refers to the ways people perceive their experience with the health care facility they interact with. Measuring satisfaction and analyzing the specific reasons why some found their experience dissatisfactory can lead to significant improvement in health care systems and procedures.
• Care effectiveness: This measures the concrete results of health care procedures. The two main factors analyzed are the ways medical professionals comply with optimal practice care guidelines and the outcomes of treatments and procedures. 
• Care timeliness: Besides studying the effectiveness of care, measuring health outcomes also involves analyzing a population’s access to health care facilities. This may lead to the discovery that people in a certain area lack access to specific kinds of health care facilities that would otherwise greatly improve their overall health.
• Access to mental health care: This is a measure of how people who are at risk of developing mental health care issues can get quick and effective access to care services. It can be particularly helpful for those who are most at risk of developing mental health issues, like people living in low-income and rural areas.
• Mortality: This is the main measure that shows the effectiveness of health-related programs and policies. Depending on each specific situation, programs and policies can be seen as successful if they reduce overall mortality or mortality caused by one or multiple specific issues.
• Safety of care: This refers to the possibility of individuals being affected by medical errors. The two elements commonly used to measure it are skin breakdown, which refers to skin injuries resulting from prolonged pressure, and hospital-acquired infections caused by various factors, such as viral, fungal, and bacterial pathogens.

Why Is Population Health So Important?

Improving population health outcomes through population health management initiatives is crucial because it promotes collaboration between multiple types of specialists, such as medical professionals, human service professionals, and policymakers, with the goal of helping people live longer, more active, and more fulfilling lives. Some specific benefits of implementing population health initiatives are:

• People have access to superior health care. The most straightforward effect of successful population health approaches is the fact that the people within the targeted communities have access to superior health care services. This can have a positive effect on their everyday lives and on the greater economy at large.
• People are generally more satisfied with the health services they receive. Lack of access to effective health care can also lead to deeper stress and dissatisfaction, as people may find it challenging to enjoy their lives while worrying that a major health event may leave them in bad health or bankrupt them. Implementing population health programs can improve overall satisfaction with health care services, which creates a stronger and longer-lasting relationship between medical professionals and their communities.
• People are more likely to get early care for illnesses and diseases. Having more efficient and effective access to health care services can help people discover various diseases and illnesses in their early phases. This leads to far greater odds of overcoming their challenges and reduces the time and money that both individuals and medical services spend on wellness.
• People are more likely to better manage their health. Knowing that the health care system in their area is accessible and effective can lead to superior engagement. People are generally better informed regarding their health care options and can manage their own health, reducing instances of serious disease.
• People are less likely to let mental health issues affect their lives. Knowing that you have access to support if you’re dealing with psychological problems can have a major positive influence on your ability to get better. Effective community-led support groups and initiatives can help those in need and give them the strength and stability to overcome their challenges and live fulfilling lives.

Population Health vs. Public Health

The main difference between population health and public health is that the former refers to specific groups of people based on factors like location or a more specific sociological connection. In contrast, the latter refers to the health of an entire population of people. Analyzing the relationship between the two can lead to a better understanding of why population health is important. Some characteristics of public health include:

• It has a far wider scope of interest than population health, with experts in this field working to promote various health guidelines and practices across entire populations.
• It includes policies referring to educating the public on health care practices, setting health care policies, and finding ways to prevent the spreading of diseases.
• Its scope also covers issues like making the public aware of epidemics and pandemics, encouraging healthy practices and behaviors in everyday life, and preventing environmental hazards that may affect the health of the people in a region.
• It includes initiatives to promote everyday practices that are likely to improve a person’s health, such as regular exercise, a balanced diet, and appropriate personal hygiene.

Subfields of Population Health

Subfields of population health are specific areas of concern that specialized professionals can focus on to improve a community’s overall health. They either specialize in a specific health aspect, like mental or developmental health, or they try to improve external factors that could then eliminate common health concerns and improve population health as a whole.

There are multiple such subfields that deal with specific aspects of a population’s health. Some common ones are:

Mental Health

Mental health is a subfield of population health that addresses psychological, emotional, and social well-being. Being in good mental health helps people successfully overcome life’s daily challenges, find greater gains in both their personal and professional lives, and help contribute to the overall well-being of their own community. This generally involves overcoming or working with mental health concerns and finding effective ways to achieve meaning and happiness while managing their mental health.

Improving a population’s mental health often involves identifying and mitigating the risk factors that contribute to mental health challenges. These are some often-encountered ones, with people who struggle with mental health issues often being affected by more than one:

• Social and economic pressures: Socio-economic factors that may affect mental health are either modifiable or non-modifiable. The former refers to situations that people may be able to change — like their social status, occupation, education, and housing quality — while the latter refers to unchangeable characteristics such as ethnicity, age, and nationality.
• Biological factors: Mental health issues may also result from genetic predispositions. Although having specific genes and gene variants may increase the risk of developing mental health issues, people with no family history of mental illness may still struggle with these issues.
• Childhood adversities: Another major risk factor for mental health issues is having a difficult childhood. Situations like abuse, parental loss, and parental separation can have a significant impact on a child’s well-being, which may lead to post-traumatic stress disorder (PTSD) later in their lives.

Behavioral Health

Behavioral health is a subfield of population health that studies emotions and behaviors from a scientific perspective. The purpose of behavioral health programs and policies is usually to study the biological responses to everyday occurrences that affect a person’s general well-being. As opposed to mental health, which solely focuses on the biological triggers of mental issues, behavioral health also studies external factors that can impact mental wellness, such as behavior patterns, potentially harmful habits, substance abuse, and others.

Since one encompasses the other, the negative effects that may result from behavioral health struggles are similar to mental health concerns. Some common ones are anxiety, depression, learning disabilities, chronic stress, difficulties in forming and maintaining relationships, addiction, and overwhelming grief. A population health-type approach to behavioral health involves various types of medical professionals, like psychologists, psychiatrists, counselors, therapists, and nurses, collaborating to develop advanced ways to address behavioral health concerns through therapy and medication. It also involves policymakers implementing programs and policies that help the population be able to improve their own behavioral health.

Developmental Disability Education and Assistance

Development disabilities originate due to impairment in a child’s behavior, learning, language, or physical arenas. The name derives from the fact that they begin during a child’s developmental period. They’re sometimes permanent and can affect the individual’s ability to lead a normal life. Discovering the early signs that may reveal a developmental disability is crucial for giving the child every chance at a positive life. This means that educating the public to recognize these early signs is a major focus for developmental disability programs. 

One of these programs is the CDC’s “Learn the Signs. Act Early.” initiative, which aims to educate parents, grandparents, early childhood educators, and other types of child caregivers on how to monitor a child’s development and determine if they are reaching the typical developmental milestones. This program also involves developing standard research-based screening questionnaires and checklists that can help medical professionals compare a child’s behavior and emotions, as well as their movement, language, and thinking skills, with that of other children their age.

Housing and Homelessness Programs

Having a safe and clean place to live is a key contributing factor to someone’s overall health. This makes the fight to combat homelessness a major part of any population health approach. Barriers to getting quality health care and proper recovery are compounded when someone is facing a housing crisis.

In addition to addressing the specific housing-related issues that each community is facing, policymakers can also mitigate the issue by creating housing programs for groups of people that may have difficulties finding a home on their own. A variety of federal, state, and local housing programs can help special groups of people, like those with disabilities, seniors, veterans, and minorities, gain access to housing resources and to other programs that may improve their livelihood. They may also get access to special loans to help buy, refinance, or repair a home to keep them housed.

Population Health Analytics and Its Importance 

Population health analytics are a crucial part of population health planning and management, as they reveal valuable insights regarding the areas that require the most resources. Data analytics professionals gather and analyze large quantities of data to identify populations in need of assistance, deliver it effectively, and measure its effects to determine how the assistance measures can be improved in the future. The gathered and analyzed data typically comes from health care providers and insurers. Health care professionals and policymakers can use the resulting insights to develop individualized population health management strategies that target specific groups and their particular needs.

Some specific insights that population health analytics can provide include:

• The distinct characteristics of high-risk individuals and groups.
• Areas of health care that require additional support and resources.
• Opportunities for reducing the cost of various health care procedures.
• Each individual health care provider’s performance, compared to national standards.

Potential Population Health Concerns

Although population health strategies usually have a net positive effect on the communities they target, there are multiple potential concerns that usually must be addressed when implementing them. Some major ones are:

• Deciding where to start: The wide range of potential issues and measures that may fall under the scope of a population health initiative can make it difficult to decide on a clear starting point. Since organizations generally have limited resources, it’s essential to find ways to use them as efficiently and effectively as possible.
• Prioritizing based on risk factors: Another major potential issue when implementing a population health strategy is deciding who should benefit from it. This usually requires a ranking-based approach that takes multiple factors into account to maximize the strategy’s true impact.
• Developing collaboration procedures and policies: Population health strategies typically require institutions from different fields, like medicine, government, and industry, to collaborate on behalf of the communities they serve. This involves implementing new workflow approaches that facilitate collaboration between different entities.
• Raising awareness: The success of a population health initiative usually depends on the number of people who are aware of it and willing to follow it. This often requires medical professionals to take the time and explain these initiatives to the people they target. 
• Assessing outcomes: Achieving continuous success when aiming to improve population health requires accurate and objective feedback regarding already-implemented measures. This allows those involved to discover ways to improve the effectiveness of population health measures.

A community-based approach to improve population health can be effective not only from a health care perspective but also for our society as a whole. Having a healthier population leads to better collaboration and a broader sense of community between people, which would benefit everyone’s well-being.