The Population Health Picture


The current situation in the U.S. when it comes to discussions about health bring to mind the story of the Blind Men and the Elephant. You can learn more about this story at Wikipedia.

The gist of the story is that six blind men examine an elephant. Based on the part of the element examined, their conclusions of what an elephant is differ greatly. Click HERE to hear a reading of a poem based on this story.

In general, our health care system resembles this story. Each group or organization or specialty is only looking at a part of the elephant. And while each part is important and necessary, it does not represent the totality.

Wikipedia says, “It [this story] has been used to illustrate a range of truths and fallacies; broadly, the parable implies that one’s subjective experience can be true, but that such experience is inherently limited by its failure to account for other truths or a totality of truth. At various times the parable has provided insight into the relativism, opaqueness or inexpressible nature of truth, the behavior of experts in fields where there is a deficit or inaccessibility of information, the need for communication, and respect for different perspectives.”

Population Health is an attempt to look at the totality of truth. The Friedell Committee is working to collaborate with other organizations and individuals to ensure that there are Kentucky citizens actively working to ensure that the whole picture is being considered when it comes to the health of the population.


The Relationship Between Population Health and Individual Health


Population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. ( These groups are often geographic populations such as nations or communities, but can also be other groups such as employees, ethnic groups, disabled persons, prisoners, or any other defined group. The health outcomes of such groups are of relevance to policy makers in both the public and private sectors.
Note that population health is not just the overall health of a population but also includes the distribution of health. Overall health could be quite high if the majority of the population is relatively healthy—even though a minority of the population is much less healthy. Ideally such differences would be eliminated or at least substantially reduced.

Article/blog link:



Healthy People 2020 says, “Positive changes in individual behavior can reduce the rates of chronic disease in this country. (Source:
The Association of Faculties of Medicine of Canada (AFMC) says in their Primer on Population Health, A virtual textbook on Public Health concepts for clinicians (
Many of the underlying health determinants influence health via personal behaviours. For example, a lack of exercise, high-fat diet, and alcohol or tobacco consumption form personal risk factors for disease, whereas regular activity and a healthy diet confer health benefits.
Clinicians generally find that altering patients’ health behaviour (helping them to stop smoking, take up exercise, etc.) is slow and difficult. Psychology offers several theoretical models that identify the personal and situational factors likely to influence health behaviour; these help explain why behaviour is often so hard to change.


Population health and individual health are intertwined. The same external factors (see the infographic above) affect both. To effectively improve the health in a community, both aspects need to be considered.

Onyebuchi A. Arah says in an article (

The relationship between individual and population health is partially built on the broad dichotomization of medicine into clinical medicine and public health. Potential drawbacks of current views include seeing both individual and population health as absolute and independent concepts. I will argue that the relationship between individual and population health is largely relative and dynamic. Their interrelated dynamism derives from a causally defined life course perspective on health determination starting from an individual’s conception through growth, development and participation in the collective till death, all seen within the context of an adaptive society. Indeed, it will become clear that neither individual nor population health is identifiable or even definable without informative contextualization within the other. For instance, a person’s health cannot be seen in isolation but must be placed in the rich contextual web such as the socioeconomic circumstances and other health determinants of where they were conceived, born, bred, and how they shaped and were shaped by their environment and communities, especially given the prevailing population health exposures over their lifetime. We cannot discuss the “what” and “how much” of individual and population health until we know the cumulative trajectories of both, using appropriate causal language.


Components of health (continued)


As we talked about in our last post:  The health of individual people and their communities are affected by a wide range of contributory factors. People’s good or bad health is determined by their environment and situations …


  1. Where we live: this can affect health by determining access to affordable, effective health care and by defining the cultural norms for what is considered healthy.  For instance, if your community feels that “having a touch of sugar” is the norm, then diabetes is likely to be prevalent.
  2. Environment: this can refer to the natural environment (climate, geography, etc.) and to the built environment (urban, rural, etc.). Both natural and built environments can make it easier or more difficult to be healthy.  For instance, access to the natural environment can be made easier by things such as biking or hiking paths.  Environment may also refer to actions taken by humans to improve or destroy the natural environment.  For instance, allowing toxic chemicals to enter the water system can result in health issues.
  3. Genetics – our genetic make-up will affect our predisposition for certain diseases. It is not the final say, however.
  4. Income – research shows that our socio-economic level is one factor in health. See page 40 of this publication by Health and Human Services for one example of this: [Figure 35]
  5. Education – research shows that the higher our education level, the healthier we tend to be. See page 37 of this publication by Health and Human Services for one example of this: [Figure 22]
  6. Relationships – research shows that having a strong support system improves our ability to fight disease. See this article for information on positive and negative impacts of social relationships:


Think about the 6 components defined above. Select one component that you feel needs major improvement in your community.  Identify ways that you might be able to help improve it, such as attending a government meeting where the component will be a topic or writing a letter to a member of your community with ideas on how to improve the component that will have a positive effect on community health.





GetWellKy – an initiative of The Friedell Committee

The Friedell Committee for Health was formed out of concerns by individuals about the health of Kentucky citizens. It was believed that ideal “health systems” would affect population health in a positive way. It is important to be clear that current thinking is that a “health system” is not just healthcare. It is generally recognized that every aspect of the community (natural environment, built environment, laws, health care, jobs, education, etc.) has an impact on health of the population, thus is part of the “health system”. These are known as the social determinants of health (here is a good link for an overview: One major issue is that the impact on health, either in a positive or negative direction, is not being considered in every decision within a community.



For our purposes, we are going to go with the 1948 World Health Organization (WHO) definition of health. “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” This definition was later changed, as in 1986, the WHO said that health is: “a resource for everyday life, not the objective of living. Health is a positive concept emphasizing social and personal resources, as well as physical capacities.”

Now what are the components of the system that has arisen around health?

There are several aspects to the “system” [NOTE: this list is not exhaustive]:

  • social determinants
  • affordability and accessibility of health
  • cultural issues
  • individual behavior

If you are not familiar with the term “social determinants”, this article ( says this:

The health of individual people and their communities are affected by a wide range of contributory factors. People’s good or bad health is determined by their environment and situations – what is happening and what has happened to them, says WHO. WHO says that the following factors probably have a bigger impact on our health than access and use of health care services:

  • Where we live
  • The state of our environment
  • Genetics
  • Our income
  • Our education level
  • Our relationship with friends and family.



In order for Kentucky to become “Healthier, Wealthier & Wiser” we will have to work on improvement in the five areas that society can affect (all except genetics). These five areas are all interconnected and it is through focus on the interconnection that we will have the greatest success. The Robert Wood Johnson Foundation calls this a Culture of Health (



The Friedell Committee has committed to take action to promote health and wellness in Kentucky. Our approach will be to support local organizations that have taken ownership of the health of a community and are seeking to take action. We will be sharing more information on the components of health identified above (where we live; environment, genetics, income, education, relationships). Are there organizations in your community that address these issues? What opportunities are there for you to participate? What role does your local health department play? What role can you or your family play? What specific actions can be taken in your community take make a difference?