What is Population Health?
The term “population health” has become quite the buzzword in Ontario and I’ve seen many definitions floating around – but it doesn’t need to be so complicated. Population health is just that: the health of the population.
At Health Commons, we pride ourselves on taking a population health view and digging into the nuances of this approach in our work. We hope this definition can help you and your leadership team take the same approach.
Population Health: The sum of the whole (population)
Population health is about thinking beyond an individual patient and looking at the whole community. It considers all the factors that influence and help you understand the overall health of a specific population. This means looking at the social determinants of health that influence our health and well-being like income, education, race and ethnicity, access to housing and early childhood development.
The Public Health Agency of Canada defines it as, "an approach to health that aims to improve the health of the entire population and to reduce health inequities among population groups." They also tie it to the definition of health itself: "A population health approach reflects a shift in our thinking about how health is defined. The notion of health as a positive concept, signifying more than the absence of disease, led initially to identifying it as a state of complete physical, mental, and social well-being."
For many, this ends up looking like numbers on disease prevalence and life expectancy but the version we’re interested in in health care right now is one that has a more practical application for how we plan our services, focus our efforts, and where we spend our next available dollar. It is taking the sum of all people in a population and looking at trends. This can mean monitoring outcomes over time or looking at the outlier groups to understand how they compare to the average.
For OHTs, a population health approach is about getting to know the people you serve and understanding the pockets of disparity and inequitable health outcomes. Learning about a complex population will extend benefits to everyone who uses the health care system, even in a more episodic way.
A more equitable future for Ontario health
In Ontario, health care is a 61-billion-dollar+ industry that is tasked with the huge responsibility of providing care to all 13 million Ontarians. We have a good understanding of the average health across these people – but many groups fall outside of this spectrum. This includes the ultra-healthy and the unwell. Population health allows us to address these deviations.
For many years, the health care sector has taken a one-size-fits-all approach, but the truth is that health and health outcomes are shaped by more than just the access and quality of health care services. Some people experience much worse health outcomes than others. We know this is largely because of the conditions they were born into, the structural and systemic barriers they are up against, and the access to resources in their communities.
A population health approach is important to address these inequities and huge disparity. Dr. Laura Rosella, Associate Professor of Epidemiology at the Dalla Lana School of Public Health, has published research in the Ontario Health Atlas that shows that across those 13 million people, there are huge discrepancies. Their study demonstrates that females in the former North East and North West LHINs experienced no improvement in premature mortality between 1992 and 2015. This was compared to 19% improvement for women in Ontario overall and 33% improvement in Toronto Central LHIN – a clear indication that the saying “location, location, location” applies beyond the real estate industry. Another recent study published in Canadian Journal of Public Health, "found that there were 124,000 avoidable deaths in the most materially deprived areas of Ontario versus 66,000 avoidable deaths in the most well-off areas between 1993 and 2014.”
This problem is not unique to Ontario - in London, England and cities across the United States, research has shown that there is a measurable, marked difference in life expectancy between people living at different subway stops. ’Lives on the Line' is a neat data visualization tool, created by Oliver O’Brien at University College London, that shows that residents near some London Tube stops live, on average, 20 years long than those who live near stations in more low-income areas. These glaring inequities have a lot to do with the factors of where people live but there are plenty of opportunities to intervene and, as a result, improve everyone’s health outcomes.
A rising tide lifts all boats
These solutions show up in complex spaces, leading to a deeper understanding of need, a new type of partnering, and a human-centred approach to planning, systems design, and care delivery.
Deep understanding: Population health is useful to deeply understand the whole health and what truly shapes the health of people. It can help identify the root causes of what makes us sick. For chronic diseases, the health care system is set up to focus on the medical side of the disease - the symptoms and biological markers (like elevated blood glucose levels or high blood pressure). But what if we pushed ourselves to always ground our understanding in the bigger picture of the patient, their experiences, and their community? Do they have access to nutritious, affordable food? Do they have access to financial stability that reduces stress? What could we uncover if we looked closer?
Learning from outside health care: It can be useful to look outside of the public sector when thinking about population health. Every successful private sector endeavour is rooted in a deep understanding of its market. Private companies segment people into groups that have common characteristics and do a great job of targeting their offer to each group. There’s an opportunity for health care to do the same.
Integrating the experience: Targeting specific populations improves the whole picture, ensuring there is a connected network of care that doesn’t leave gaps or redundancies. Focusing efforts on improving the health outcomes of smaller groups, specifically the 1% of people who are responsible for 35% of Ontario’s annual health spend, enhances the experience of the majority.
Population health can reduce the overall spend and raise the average outcomes. This understanding also equips the system with the skills it needs to learn and have a beneficial impact on all 13 million Ontarians. By deeply understanding the factors that shape those targeted groups and their health and partnering broadly to deliver an integrated offer of health and health care, every person in Ontario stands to benefit from a more deeply integrated, empathetic, and cost-effective health system.
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The views and material presented here are not endorsed by any funders or collaborators of Health Commons Solutions Lab. Our work does not reflect the views or the policy development of the Ontario Ministry of Health. The Health Commons Solutions Lab is funded in part by the Ontario Ministry of Health and based at Bridgepoint Health (part of Sinai Health), with collaborators across Ontario.
References
Population Health Approach: Organizing Framework Contrast. Image: Organizing Framework Contrast. Public Health Agency of Canada.
Ontario Health Atlas. Rosella, Laura. Dalla Lana School of Public Health.
Neighbourhood-level marginalization and avoidable mortality in Ontario, Canada: a population-based study. Canadian Journal of Public Health.
Tube Creature, Lives on the Line. O’brien, Oliver.
Mapping Life Expectancy. Virginia Commonwealth University, Center on Society and Health.