What is population health, and why does it matter? And how do various factors in our society and the world around us negatively affect multiple communities, and what can we do about it?
What is Population Health?
While the literature shows that there are a wide variety of proposed definitions of the term population health, it is generally agreed that population health refers to determinants of health that impact groups of people rather than single individuals.
In the delivery of healthcare, medical providers tend to focus on patients’ health on a one-to-one basis by managing chronic and acute medical conditions.
However, in the world of public health, the focus is on issues and conditions that significantly influence the collective, whether that be a particular subset of people (e.g., transgender individuals, women, elderly men, urban children of color), entire communities, towns, cities, or states, or even the country as a whole.
Considering this, what conditions lead to poor health, and why does investing in public health across multiple sectors matter?
Exploring Social Determinants of Health
The Centers for Disease Control and Prevention (CDC) defines social determinants of health in this way:
“Social determinants of health (SDOH) are the nonmedical factors that influence health outcomes. They are the conditions in which people are born, grow, work, live, and age. These forces and systems include a wide set of forces and systems that shape daily life such as economic policies and systems, development agendas, social norms, social policies, and political systems.”
The five areas of SDOH identified by the CDC include:
- Education access and quality
- Health care and quality
- Neighborhood and built environment
- Social and community context
- Economic stability
Considering this list, many argue that climate change is a frequently overlooked SDOH that is already having a profound impact on public health, including the most vulnerable among us.
An article titled “Climate Change as a Social Determinant of Health,” published in Pediatrics in May of 2020 and referenced on the website of the National Institutes of Health (NIH) ,offers a more expansive view of SDOHs:
“Social determinants of health (SDOHs), defined as the social circumstances in which people are born, grow, live, work, and play, profoundly affect children’s health and drive health disparities. SDOHs are shaped by the distribution of money, power, and resources at global, national, and local levels. The list of potential SDOHs is expansive and includes food insecurity, housing instability, violence exposure, structural racism, poverty, and immigration-related stressors.”
Population Health and the Big Picture
When considering population health, we must consider the big picture. As noted above, a narrow view of social determinants of health can stunt our appreciation of what factors most profoundly affect individuals and groups within our society.
If we consider poverty, we can appreciate that lack of financial resources can hold individuals and families back from achieving their educational goals, owning a home, having reliable transportation, and accessing healthy food.
Food insecurity and hunger are obviously tied to overall well-being on multiple levels, and substandard housing leads to exposure to poor sanitation, unhealthy water, and a host of other issues stemming from the places where we live.
In the face of climate change, the article above outlines its impact:
“Similar to other SDOHs, climate change worsens health, increases health care costs, disproportionately impacts vulnerable communities, and exacerbates the effects of other SDOHs.
“Research has revealed that the changing climate, including longer and hotter summers, more frequent and intense storms, sea-level rise, more severe droughts, and poorer air quality, are inextricably linked to poorer health.
“The child health impacts are numerous and include worsening asthma and allergies; physical trauma from disasters; mental health symptoms, including post-traumatic stress disorder after disasters and anxiety about the future; increased exposure to infectious diseases; and lack of access to adequate food and clean water.”
Changing for the Better
Climate change, food insecurity, access to education, housing, the built environment, and other SDOHs can seem like overwhelming issues that are just too hard to tackle. However, public health departments, non-profit foundations, and others are dedicated to addressing these serious challenges.
Pathways to Population Health Equity (P2PHE) “offers a framework, roadmaps, compass, and associated tools for public health practitioners to build a more prepared, resilient, and proactive public health system at every level.”
The National Association of City and County Health Officials (NACCHO) brings together public health professionals from around the country for education, advocacy, and a representation of local voices within the public health infrastructure.
The Public Health Accreditation Board’s (PHAB) Center for Innovation provides tools and resources for public health professionals and other concerned parties.
The Alliance of Nurses for Health Environments is a nurse-based advocacy group dedicated to addressing the role of climate and environmental factors on health.
And non-profit organizations like the Robert Wood Johnson Foundation (RWJF) work tirelessly to eradicate health inequities in every conceivable form.
No matter how we examine population health, the intersectionality of these issues calls for action and radical change. .
When citizens go hungry, lack safe and secure housing, suffer from the ravages of climate change, are unable to find well-paying jobs, and cannot find high-quality educational opportunities for their children, everyone suffers in the end.
If maternal or infant mortality rates increase, gender-based violence remains pervasive, or alcoholism and addiction hold entire groups of people hostage in damaged and unproductive lives, there is much work to do.
Although healthcare professionals may more often than not address the health needs of individual patients and their families, we must also look beyond that paradigm to the larger forces and structures at play in our society.
Population health and the social determinants of health are powerful lenses through which to examine the state of our society. Equally powerful tools and resources are available to those of us willing and able to engage in the fight to end disparities and deliver health equity for all.
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