Tuesday, January 03, 2006
Science of Population Health
The discussion of how to approach a science of population health seems to be not unlike the science of making a stew or a casserole. Each of the ingredients are of their own particular nature and “flavour”, yet when they are added together, spiced, and simmered, the result is something quite different from what one started with. Preference for one method or another appears to be one of taste. I could not distinguish a clear method to determine how to best judge what is most effective approach, yet I could see value in most views presented in the readings.
This also brings to mind the difference between complicated and complex. It appears impossible to pull apart the interconnected elements of population health without destroying the powerful framework in which to study the health of populations. Not that population health is the “Holy Grail” of a unified theory. It seems to approach however, the necessary level of completeness to arrive at a more effective; perhaps more efficient, understanding of how to reduce harm to individuals within populations as well as improving the macroscopic conditions which “manufactures” health.
The pulling apart of Evans & Stoddart and to a lesser extent Frank & Mustard by Labonte, Robertson, Poland and colleagues is “normal” behavior found in most fields of research. The setting of boundaries and the dismantling of other frameworks are regular exercises of influence and power. With tongue in cheek, whenever I read any article, I am looking for actionable alternatives that are applicable, feasible, sustainable, and transferable to other contexts. Most of the critiques did not provide this and thus I find them in some respects, to be of limited utility.
Each of the articles however, provided interesting points to consider, the following being what I consider highlights:
Friedman:
A good introduction to models of population health “…it is important to acknowledge that no single widely accepted definition of population health exists.”
Evans & Stoddart:
“There are always unmet needs.”
“…most of the public and political debate over health policy continues to be carried on in the rhetoric of “unmet needs” for health care.”
“Once we recognize the importance and potential controllability of factors other than health care in both the limitation of disease and the promotion of health, we simultaneously open for explicit consideration the possibility that the direct positive effects of health care on health resources may be outweighed by its negative effects through competition for resources with other health-enhancing activities.”
(This is of particular interest to my thinking on examining the models of mental health service delivery and looking for alternatives outside the current framework which has been subject to gross under-funding for decades.)
Frank & Mustard:
“It is not lack of access to health care that is setting this gradient but the underlying social economic factors (unemployment, income, and education) as in Marmot’s study…”
Dunn and colleagues:
“A population health framework situates the importance of social relations centre-stage…Many dimensions of social relations are simultaneously involve in shaping our health experience – global capitalism, gender, ethnicity, religion, identity, power, housing, telecommunications, etc.”
Frank:
“The major determinants of human health status…are not medical care inputs and utilization, but cultural, social and economic factors – at both the population and individual level.”
Labonte:
“Population health arguments are largely silent on ecological issues.”
Poland and colleagues:
“the rhetoric of community-based care…the burden of health care is not being removed from society, but simply shifted from the public domain to the private (domestic) sphere.”
Robertson:
“…what counts as data depends on what we judge to be important to notice in the first place, and them to measure.”
Mechanic:
“If the field of population health is to have sustained policy influence, it requires a persistent constituency, a strong organizational base both within and outside of government, and academic respectability.”
“Population health is most basically about aggregates and not about individuals.”
“Population health policy is different from medical care policy…”
Wilkinson and Marmot:
“…the common causes of ill health that affects populations are environmental: they come and go far more quickly than the slow pace of genetic change because they reflect the changes in the way we live.”
“People further down the social ladder usually run at least twice the risk of serious illness and premature death as those near the top.”
“People who have more control over their work have better health.”
As I move towards an idea for a paper, what is emerging is an examination of child and youth mental health service delivery in Ontario rated against a population health perspective rather than a health care perspective.
Most of these readings address mental and psychological issues but almost exclusively from an adult perspective. I would appreciate suggestions for readings that may show population health from a child and youth perspective – beyond what I can infer from what I have currently read. ¶ 10:05 p.m.
This also brings to mind the difference between complicated and complex. It appears impossible to pull apart the interconnected elements of population health without destroying the powerful framework in which to study the health of populations. Not that population health is the “Holy Grail” of a unified theory. It seems to approach however, the necessary level of completeness to arrive at a more effective; perhaps more efficient, understanding of how to reduce harm to individuals within populations as well as improving the macroscopic conditions which “manufactures” health.
The pulling apart of Evans & Stoddart and to a lesser extent Frank & Mustard by Labonte, Robertson, Poland and colleagues is “normal” behavior found in most fields of research. The setting of boundaries and the dismantling of other frameworks are regular exercises of influence and power. With tongue in cheek, whenever I read any article, I am looking for actionable alternatives that are applicable, feasible, sustainable, and transferable to other contexts. Most of the critiques did not provide this and thus I find them in some respects, to be of limited utility.
Each of the articles however, provided interesting points to consider, the following being what I consider highlights:
Friedman:
A good introduction to models of population health “…it is important to acknowledge that no single widely accepted definition of population health exists.”
Evans & Stoddart:
“There are always unmet needs.”
“…most of the public and political debate over health policy continues to be carried on in the rhetoric of “unmet needs” for health care.”
“Once we recognize the importance and potential controllability of factors other than health care in both the limitation of disease and the promotion of health, we simultaneously open for explicit consideration the possibility that the direct positive effects of health care on health resources may be outweighed by its negative effects through competition for resources with other health-enhancing activities.”
(This is of particular interest to my thinking on examining the models of mental health service delivery and looking for alternatives outside the current framework which has been subject to gross under-funding for decades.)
Frank & Mustard:
“It is not lack of access to health care that is setting this gradient but the underlying social economic factors (unemployment, income, and education) as in Marmot’s study…”
Dunn and colleagues:
“A population health framework situates the importance of social relations centre-stage…Many dimensions of social relations are simultaneously involve in shaping our health experience – global capitalism, gender, ethnicity, religion, identity, power, housing, telecommunications, etc.”
Frank:
“The major determinants of human health status…are not medical care inputs and utilization, but cultural, social and economic factors – at both the population and individual level.”
Labonte:
“Population health arguments are largely silent on ecological issues.”
Poland and colleagues:
“the rhetoric of community-based care…the burden of health care is not being removed from society, but simply shifted from the public domain to the private (domestic) sphere.”
Robertson:
“…what counts as data depends on what we judge to be important to notice in the first place, and them to measure.”
Mechanic:
“If the field of population health is to have sustained policy influence, it requires a persistent constituency, a strong organizational base both within and outside of government, and academic respectability.”
“Population health is most basically about aggregates and not about individuals.”
“Population health policy is different from medical care policy…”
Wilkinson and Marmot:
“…the common causes of ill health that affects populations are environmental: they come and go far more quickly than the slow pace of genetic change because they reflect the changes in the way we live.”
“People further down the social ladder usually run at least twice the risk of serious illness and premature death as those near the top.”
“People who have more control over their work have better health.”
As I move towards an idea for a paper, what is emerging is an examination of child and youth mental health service delivery in Ontario rated against a population health perspective rather than a health care perspective.
Most of these readings address mental and psychological issues but almost exclusively from an adult perspective. I would appreciate suggestions for readings that may show population health from a child and youth perspective – beyond what I can infer from what I have currently read. ¶ 10:05 p.m.
