More Perspectives on “Population Medicine”

Originally posted 7/18/2012

My previous post on population medicine prompted a number of thoughtful responses which I’d like to share. This is not simply a terminology discussion. The breadth of the population health view we espouse here can be undermined if it is confused with chronic disease management of enrolled patients.

Emma Eggleston, MD, MPH Instructor, Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA

Population medicine…takes a population perspective from a healthcare system base. It encompasses the intersection between the health care system and other determinants of (and partners in) populationhealth e.g. public health, communities, the built and social environments,etc.  In other words, it is the sum of 1) the population- specific activities of the health care system itself and 2) the intersection ofthe health care system with other determinants of population health. While the population-specific activities of the health care system are important and arguably easier to delineate and act upon, the exciting potential for long-term innovation and impact is in the intersection.

Marc Gourevitch, MD, MPH Chair, Department of Population Health, New York University Medical Center, New York, NY

Defining these terms helps by providing guideposts to the broad spectrum of approaches currently in play that focus on aggregate outcomes, ranging from the most narrowly-construed version of ‘panel management’ within a specific delivery system, on the one hand, to a broadly framed health-in-all-policies approach adopted by a large city or state, on the other.  Yet for many academic medical centers, incentive or reimbursement structures to support efforts to engage more broadly in non-clinical determinants of health lags behind understanding of the value of doing so. For this reason, while many engage in a limited fashion with the other determinants, others are more robustly addressing other determinants unrelated to their systems of care. The value of these definitional frameworks is anchoring the various interventions and approaches that are evolving in parallel across the country.

George Isham, MD, MSSenior Advisor, Health Partners, St. Paul, MN

I think of these concepts as overlapping. Beyond individual care, broader activity that improves preventive services and acute or chronic care for populations of individuals could be thought of as “population medicine” and could also contribute to the overall health of the population. This is a particularly useful concept now because many care systems are now figuring out how to provide better preventive care, acute and chronic care to defined populations using activities such as Medical Homes, outreach, case management and other techniques. It’s important to have health care organizations think about their relationship to the other determinants of health beyond health care because of the bigger potential impact of those other factors and the need to reallocate resources from health care to those other determinants. As significant community citizens, health care has the obligation, in my view, to positively impact the behavioral, socio-economic and environmental determinants of health.

Geoffrey Swain, MD, MPHChief Medical Officer and Medical Director, City of Milwaukee Health Department, Milwaukee, WI

Words and definitions do matter a lot. But I admit to remaining a bit confused. If a) Population Health is ‘the health outcomes of a group of individuals, including the distribution of such outcomes within the group’, and b) Population Medicine is ‘…the specific activities of the medical care system that, by themselves or in collaboration with partners, promote population health beyond the goals of care of the individuals treated’, then c) what do we call ‘the specific activities’ of anyone else (other than the medical care system) ‘that, by themselves or in collaboration with partners, promote population health’? In other words, why are activities that address socioeconomic or physical environmental drivers of health called ‘population medicine’ when the health care sector does them, but not when others do them? Or, more bluntly, why should only the medical care sector get a special name for its activities in these areas?”

Many thanks to Emma, Marc, George, and Geof for joining the conversation. Geof raises a great question, to which I would only note that the health care system is so strong and powerful that some special attention to the activities moving outside of the clinical arena is useful. This is not to diminish the health promoting activities of other sectors like public health and business and social service agencies. For these the term “population health” or even “total population health” seems appropriate. I agree with Marc that a bit of definitional conversation is useful to keep our eye on how all of us can contribute to the overall population health goal. It helps keep us on track, and prevents the fundamental aspects of the population health model from getting lost in translation.

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