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.
Population health is defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group”. (http://ajph.aphapublications.org/doi/abs/10.2105/AJPH.93.3.380) 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.
Healthy People 2020 says, “Positive changes in individual behavior can reduce the rates of chronic disease in this country. (Source: http://www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health)
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 (http://phprimer.afmc.ca/Part1-TheoryThinkingAboutHealth/Chapter2DeterminantsOfHealthAndHealthInequities/HealthBehaviours):
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 vs. INDIVIDUAL HEALTH
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 (http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2698967/):
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.
CONTINUING THE DISCUSSION OF COMPONENTS OF HEALTH
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 …
HOW DO THESE COMPONENTS AFFECT HEALTH?
- 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.
- 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.
- Genetics – our genetic make-up will affect our predisposition for certain diseases. It is not the final say, however.
- 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: http://www.cdc.gov/nchs/data/hus/hus11.pdf. [Figure 35]
- 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: http://www.cdc.gov/nchs/data/hus/hus11.pdf. [Figure 22]
- 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: http://www.psy.cmu.edu/~scohen/AmerPsycholpaper.pdf
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.