Originally posted 5/18/2010
Many health improvement models have identified two broad outcome goals:
increasing overall or mean population health and eliminating disparities within the population. The outcomes component of our population health model is shown in the left hand side of the figure above.
For overall or mean population health, two components are displayed: mortality (length of life), and health-related quality of life, or morbidity. Healthy People 2010 defined health-related quality of life as “a personal sense of physical and mental health and the ability to react to factors in the physical and social environments.” Simply put, one goal of population health improvement is to increase years of life and the quality of those life years.
Another goal is to reduce the differences or disparities in these health outcomes among different subgroups in the population. The figure indicates a number of subgroups that are associated with significant differences or disparities in both mortality and health-related quality of life. Those featured here are race/ethnicity, socioeconomic status (SES), gender, and geography. Many other subgroups besides these are associated with population health disparities. All differences are not necessarily of policy interest or are equally important in all situations.
It is important to note that in this figure each quadrant is arbitrarily sized equally, as are the components within disparities (i.e., race/ethnicity, SES, geography, and gender). The relative importance of each cell is not a research question but a value choice for different nations, states, or other population groups to make. Some may focus more on years of life and others more on the quality of those years. Some may think that socioeconomic disparities are the most important while others could prioritize disparities of gender or geography. In the Health of Wisconsin Report Card, an overall grade for health disparity was given based on a multidomain index across four disparity domains. Yukiko Asada has done pioneering work on how to develop such a multidomain disparity measure more fully.
(1) Kindig DA. (2007) Understanding Population Health Terminology. Milkbank Quarterly, 85(1), 139-161.
(2) Kindig DA, Ssada, Y, Booskie B. (2008). A Population Health Framework for Setting National and State Health Goals. JAMA, 299(17), 2081-2083
(3) Health People 2010. Office and Disease Prevention and Health Promotion. US Dept. of Health and Human Services. http://www.healthypeople.gov. Accessced April 19, 2010.
(4) Kawachi I, Subramanian SV, Almeida-Fiho N. (2002) A Glossary for Health Inequalities. Journal of Epidemiology and Community Health, 56:647-52
(5) Graham H. (2004) Social Determinans and their Unequal Distribution: Clarifying Policy Understandings. Milkbank Quarterly, 82(1): 101-24
(6) Booskie BC, Rohan AM, Kindig DA, Remington PL (2010). Grading an reporting health and health disparities. Preventing Chronic Disease. 7(1).
(7) Asada Y. A Summary measure of health inequalities for a pay-for-play population health performance system. Prev Chronic Dis 2010; 7(4). http://www/.cdc.gov/pcd/issues/2010/jul/09_0250.htm.