Population Health: Determinants

What is a “population”?

• Whole number of people or inhabitants in a country or region

• Total of individuals occupying an area or making up a whole

• Group of people or animals of a particular kind that live in a place

Population Health v.s. Public Health

• Pop Health

  • Focuses on outcomes

  • Measures health of groups

    • E.X: Diabetes rates in Texas

• Public Health

  • Focuses on systems

  • protects communities

  • Implements programs and policies

    • E.X: Vaccinations campaign

Medicine and Health Care

“Medical thinking has been largely concerned with the needs of sick individuals”

• FOCUS: Treat disease after it occurs

Determinants of Health

• Policymaking

• Biology and genetic factors

• Individual behavior

• Social factors

• Environmental factors

Healthy People 2030: 5 Domains of Social Determinants of Health

• Economic stability

  • Employment

  • Income

• Education access and quality

  • Early childhood education

  • Literacy

• Health Care Access and quality

  • Insurance coverage

  • Primary care

• Neighborhood and Built Environment

  • Safe housing

  • Transportation

• Social and Community Context

  • Social support

  • Community engagement

Individual lifestyle factors

Exercise, sexual activity, and diet and constitutional factors within a person are direct determinants of a person’s health

Social and community networks

Within the immediate environment of an individual

DOH

Other general macro-environmental conditions of socioeconomic, cultural, and environmental conditions that impact health

• Education

• Work environment

• Food production

• Housing

• Water and sanitation

Physical environment

Public health interventions like clean water, sanitation, and food safety have prevented millions of illnesses before people ever needed medical treatment

• Clean air and safe drinking water

• Safe housing and neighborhoods

• Food safety and sanitation

Healthy environments reduce disease risk and improve quality of life

Environmental Health Challenges

Environmental conditions can influence the health of entire populations

• Climate change

  • More heat waves, floods

  • Loss of green spaces

  • Reduced opportunities for physical activity

• Air Pollution

  • Increased asthma, heart disease, premature death

  • Urban development

  • Housing quality, transportation

Environmental Health Problems

E.X of Environmental Exposures

• Air pollution and secondhand tobacco smoke

• Pesticides and other chemical exposures

• Poor housing quality (lead, paint, mold, asbestos)

One disaster, many health impacts

Socioeconomic States (SES): A powerful predictor of health

SES influences nearly every determinant of health

• Better housing

  • Safer neighborhoods and quality homes

• Better nutrition

  • More access to healthy, affordable foods

• Better education

  • More opportunities and higher educational attainment

• Better access to health care

  • Insurance, preventative care and quality providers

• Longer life expectancy

  • Better overall health, and longer, healthier lives

Why SES matters?

Resources create opportunities for better heatlh

Socioeconomic status v.s. Health

Research consistently shows that higher SES is associated with:

• Lower mortality

• Lower chronic disease

• Greater use of preventative care

• Better access to specialists and advanced treatments

• Better overall quality of life

Health Disparities in the United States

DIFFERENCES IN HEALTH OUTCOMES ACROSS POPULATIONS

• Disparities can occur across:

  • Race and ethnicity

  • Socioeconomic status

  • Geographic location

• Reflect unequal access to opportunities and resources, not simply individual choices

• Reducing health disparities is a major goal of population health and public heatlh

Social connectedness

• Complex relationships between individuals and among groups

• Strong social ties can have a direct and positive impact on health

• Strong social connectedness is associated with:

  • Lower risk of depression and anxiety

  • Better cardiovascular health

  • Stronger immune function

  • Lower risk of premature mortality

The importance of Place

• Housing quality— Safe and affordable housing

• Neighborhood environment— Parks, walkability and community safety

• Access to services— Health care, grocery stores, pharmacies, and public transportation

• Environmental conditions— Air quality, water quality, and environmental hazards

Population-Level Prevention

• Upstream interventions

  • Improve housing

  • Improve transportation

  • Reduce environmental hazards

  • Increase access to healthy foods

  • Improve education

• Downstream interventions

  • Health screenings

  • Vaccinations

  • Disease treatment

  • Rehabilitation

Universal preventive measure

Recommended for everyone in an eligible population

Selective preventive measure

Recommended only when an individual is a member of a subgroup of the population whose risk of becoming ill is above average

Indicated preventive measure

Applicable to a person who, on examination, manifests a risk factor, condition, or abnormality that identifies them individually as being at nigh risk for the future development of a disease

Effectiveness of Preventive Measures

• In some cases, universal measure may be more optimal and cost-effective than interventions targeted further downstream

  • Tobacco use prevention

  • Automobile-related injury prevention population-based strategies

• Upstream policy interventions may refer to modifying the broader, social determinants of health

Public Health: Not a One Agency Job!

• Partnership with all entities in public health system

• Make program and policy decisions based on the evidence

• Communicate effectively

• Accountability

Who is responsible for improving health?

• Individual

• Society

• Government

Prevention, collaboration, addressing social determinants

Health care is viewed as an economic good

Core beliefs:

• Individual responsibility

• Competition improves efficiency

• Ability to pay influences access

• Limited government involvement

• Private sector provides most services

Social justics

Health care is viewed as a social good

• Shared responsibility

• Government helps ensure access

• Ability to pay should not determine basic care

• population health benefits everyone

Market Justice

Individual responsibility and private markets

Social justice

Shared responsibility and equitable access