Population Health: If It’s Everything, Is It Nothing?

Originally posted 8/9/2010

As you know, I am new to blogging, and still getting used to it from a career of more academic writing. Several of you, as well as our MATCH staff, have observed that the topics seem to be a bit random and “out of the blue” from week to week. In addition, a respected colleague emailed a response to the post on advance directives that “it could imply that everything about population health (which, as you and I agree, I hope) doesn’t do much to advance the cause of purchasing population health.

Hmmm…if it’s everything, is it nothing? A look at the population health model underpinning this blog and all I work on in population health, suggests that indeed it is perhaps everything: a broad set of outcomes produced by a comprehensive set of determinants which are influenced or activated by programs and policies in the public and private sectors.

You will not, however, find me blogging on each and every micro-determinant or program/policy that theoretically and actually has some detectable impact on population health outcomes. What is then the decision rule that makes a topic of program or policy of importance not only for this blog but for public and private policy makers?

In this resource-limited world, I believe the criterion should be largely based on economics, and in particular, the relative effectiveness and cost-effectiveness of the determinant or the program and policy on health outcomes. I have previously noted that we do not yet have adequate evidence to make this an easy exercise. Research is needed to explore the effectiveness and cost effectiveness of broad policies and programs designed to effect health improvement at the population level. Some investments have an evidence base, like smoking cessation and immunization and early childhood programs. Other investments, such as removing the LAST microgram of a toxic substance in a Superfund site, would probably have some marginal effectiveness but extremely low cost-effectiveness.

Of course, determining what action to take toward health improvement is hardly straightforward. Decision makers must weigh not only on available evidence on effectiveness and cost-effectiveness but must also take into account many other factors, especially resource (financial and nonfinancial) and political supports and constraints.

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