Population health has been defined in many ways, of which this opening gambit from Wikipedia is a good example, “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”.[1]
I think that’s a bit dry! I like to think of population health at the scale of a community; with a diverse interaction of people who support one and other to respond, adapt and flourish in the face of life’s challenges. For me, the impact is all about people living better and for longer, within their chosen community.
What’s more; population health is not simply about the absence of disease. Improving the health of a population is often considered in respect to reducing health inequities or disparities between different groups. This includes amongst other factors, the social determinants of health: the social, environmental, cultural and physical circumstances that the different groups are born into, grow up and function within, throughout their lifetimes. The World Health Organization’s Commission on Social Determinants of Health, reported in 2008, that these factors were responsible for the bulk of diseases and injuries and these were the major causes of health inequities in all countries.[2]
Since the 1960s there has been a drive within healthcare to implement evidence based practice, to standardise protocols and procedures and universally improve the average quality of care. This industrialisation of healthcare has certainly reaped significant rewards. A side effect however, has been to reduce recognition within the wider system, of the value of personalised care and the rights to individual choice or preference. More recently the pendulum began to swing in the opposite direction, with initiative after initiative reinforcing the needs of the individual over the dominant industrial structures and processes in place across our institutions. The inevitable tension between the two extremes of universal and individual has played out loudly and publically on several occasions over the past few years.
What if the real answer to better population health is neither universal nor individual, but a more nuanced understanding? What if sustainable improvement in the health of a population can be built on a strong common foundation and still respond to the natural diversity of its communities? I like to think of this central concept as ‘tailoring’, there is a standard pattern, but the work is all about making it fit properly.
The only way to understand theses communities is to get in and amongst them and hear the stories of their everyday lives. There will be a lot of commonality but a great deal of diversity, even in the few unique people and circumstances at the far end. Afterall, we’re all human and the only way to understand and improve that humanity, is hidden in and amongst our personal stories.
Perhaps even, the story is the measure, I’m attempting to illustrate?
[1] Kindig D, Stoddart G. What is population health? American Journal of Public Health 2003 Mar93(3):380–3. Retrieved 2008-10-12 Courtesy of
[2] World Conference of Social Determinants of Health, Brazil, 2008: http://www.who.int/sdhconference/resources/Conference_Report.pdf
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