Chapter 1: The Population Health Approach

Introduction

• What do we mean by Public Health?

• How has the Approach to Public Health Changed over Time?

• What is Meant by Population Health?

• What are the Implications of Each of the Four Components of Population Health?

Introduction

• Should we focus on Everyone or on Vulnerable Groups?

• What are the Approaches to Protect and Promote Health?

• What Factors Determine the Occurrence of Disease Disability and Death?

Eras ofPublichealth

Focus ofattention/Paradigm

Action framework Notable eventsand movements in public health and

epidemiology

Healthprotection(Antiquity

-1830s)

Authoritybased control ofindividual andCommunitybehaviors

Religious and culturalpractices and prohibited

behaviors

Quarantine for epidemics;sexual prohibitions to

reduce diseasetransmission;

dietary restrictions toreduce food-borne disease

Eras of Public Health

Awofeso N. What’s new about the “New Public Health” American Journal of Public Health. 2004;94(5):705–709


Eras ofPublichealth


Action framework Notable events andmovements in public

health andepidemiology

Hygienemovement(18401870s)

Sanitaryconditions asbasis forImprovedhealth

Environmental action ona community-wide basisdistinct from healthcare

Snow on Cholera;Semmelweis and puerperalfever; collection of vitalstatistics as empiricalfoundation for public healthand epidemiology



Eras of public health




Contagioncontrol(1880–1940s)

Germ theory:Demonstrationof infectiousorigins ofdisease

Communicable diseasecontrol throughenvironmental control,vaccination,sanatoriums, andoutbreak investigation

ingeneral population

Linkage of epidemiology,bacteriology, andimmunology to form TBsanatoriums;outbreak investigation, e.g.,Goldberger and pellagra


Eras of Public HealthEras ofPublichealth




Filling holesin theMedicalcare system(1950s-mid-1980s)

Integration ofcontrol ofCommunicablediseases;modification ofrisk factors; andcare of high-risk populationas part ofmedical care

Public system for careof and control ofspecific infectiousdiseases and vulnerablepopulations distinctfrom general health caresystem; Integratedhealth maintenanceorganizations withintegration of preventiveservices into generalhealth care system

Antibiotics; randomizedclinical trials; concept ofrisk factors; SurgeonGeneral reports on cigarettesmoking; Framingham study on cardiovascularrisks; health maintenanceorganizations andcommunity health centerswith integration ofpreventive services intogeneral healthcare system



Eras ofPublichealth




HealthPromotionDiseaseprevention(Mid-1980-2000)

Focus onIndividualbehavior andDiseasedetection invulnerable andGeneralpopulations

Clinical and populationoriented prevention withfocus on individualcontrol of decisionmaking and multipleinterventions

AIDS epidemic and needfor multiple interventions toreduce risk; reductions incoronary heart diseasethrough multipleinterventions



Eras ofPublichealth




Populationhealth(21st

century)

Coordination ofpublic healthand health caredelivery basedupon sharedevidence-basedSystemsthinking

Evidence-basedrecommendations andInformationmanagement; focus onharms and costs as wellas benefits ofinterventions;globalization

Evidence-based medicineand public health;information technology;medical errors; antibioticresistance; globalcollaboration, e.g., SARS,tobacco control, climatechange


Components of Population Health

Health Population Examples ofsociety-wide

concerns

Examples of

Vulnerablegroups

Historical Physical Geographically limited

Communicable disease

High riskmaternal andchild, high riskoccupations



concerns

ExamplesOf

Vulnerablegroups

Current Physicaland mental

Local, state,national, global,Governmentally-defined

Toxicsubstances,product andTransportationsafety,Communicablediseases, costsof health care

Disabled, frailelderly,uninsured



concerns

Examplesof

Vulnerablegroups

Emerging Cosmetic,genetic,Socialfunctioning

Defined by local,

national, andGlobalcommunications

Disasters,climate change,Technologyhazards,EmergingInfectiousdiseases

Immune-suppressed,Geneticvulnerability

Approaches to Population Health

Characteristics Examples

Health care Systems for deliveringone-on-one individualhealth servicesincluding those aimedat prevention, cure,palliation, andrehabilitation

Clinical preventiveservices including:vaccinations,behavioral counseling,screening for disease,and preventivemedications



Traditionalpublic health

Group- andcommunity-basedinterventions directedat health promotion anddisease prevention

Communicable diseasecontrol, control ofenvironmental hazards,food and drug safety,reduction in riskfactors for disease



Social Interventions withanother non-healthrelated purpose, whichhave secondary impactson health

Interventions thatimprove the builtenvironment, increaseeducation, alternutrition, or addressSocioeconomicdisparities throughchanges in tax laws;globalization andmobility of goods andpopulations

Population Health

Health Care Systems

Traditional Public Health Social Policy

Improving the Average

Risk Factor

Chapter 1: The Population Health Approach

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