Implementing the Population Health Approach
Implementing the Population Health Approach
Putting population health theory and policy into practice means acting on health issues in a way that is consistent with the key elements of a population health approach.
A population health approach plans and executes programs, policies, and interventions along the entire spectrum of health action, including:
- health promotion
- disease (and injury) prevention
- risk management
- policy coordination
- medical treatment
- palliative care
The population health approach is a unifying force for the entire spectrum of health system interventions - from prevention and promotion to health protection, diagnosis, treatment and care - which integrates and balances action between them.
Health promotion is one of the ways to take action on population health. It has long been recognized as a way of taking action on the social, physical, economic and political factors that affect health. It also emphasizes the need to work with other sectors to ensure that the collective policy environment becomes one that supports health. Health promotion is a concept that has been endorsed within Health Canada's Health Promotion and Programs Branch (now the Population and Public Health Branch) to assist in the development of programs and policies that support healthy living.
An upcoming Health Canada guidance document, Integrating Population Health and Risk Management Decision-Making, describes the general concepts of population health and risk management, explains the linkage between the two, and provides an example illustrating how a population health approach may be integrated into the risk management decision-making process.
Prevention of health problems (e.g., disease, injury) occurs at three levels:
- Primary prevention involves activities aimed at reducing factors leading to health problems.
- Secondary prevention activities involve early detection of and intervention in the potential development or occurrence of a health problem.
- Tertiary prevention is focused on treatment of a health problem to lessen its effects and to prevent further deterioration and recurrence.
Politicians, public servants and organizations at all levels are increasingly called upon to be transparent, open to comment and scrutiny, and accountable for the short- and long-term impact of their decisions. The desired outcome of our work depends on the role that we are fulfilling, how we are working, with whom we are working and what we are working on. If we are the intermediary or the facilitator and catalyst, then our desired outcomes are different than if we are the program deliverer.
The population health approach calls for an increased focus on health outcomes (as opposed to inputs, processes and products) and on determining the degree of change that can actually be attributed to our work. This emphasis will have an impact on planning and goal-setting processes as well as on the choice of interventions or strategies employed. In making decisions on the best investment of resources, strategies that have the potential to produce the greatest health gains will be given priority.
Outcome evaluation is essential in a population health approach. It examines long-term changes in both health and the determinants of health. These include changes in knowledge, awareness and behavior, shifts in social, economic and environmental conditions, as well as changes to public policy and health infrastructure. Outcome evaluation also seeks to measure reduction in health status inequities between population sub-groups. Longer-term outcome evaluation is essential to a comprehensive evaluation program, which also includes process evaluation (to determine whether a policy or program is meeting its goal and reaching its target population) and impact evaluation (to measure immediate results of a program or policy). The importance of both process evaluation and outcome evaluation can be seen in Health Canada's Community Action Program for Children.
Accountability is the obligation to answer for responsibilities conferred. It involves providing detailed information about how responsibilities have been carried out and what outcomes have or have not been achieved. A key element of accountability is transparency, which results from conducting one's activities in a manner that can be easily observed and understood by the public. This includes responding appropriately to requests for information and reporting to the public. For example, Toward a Healthy Future: Second Report on the Health of Canadians by the Federal, Provincial and Territorial Advisory Committee on Population Health (ACPH) reports and comments on the state of the nation's health. It alerts policy makers, practitioners and the public to current and future challenges in health.
Accountability at Health Canada
Increasingly, the federal government is emphasizing and taking measures to inform Canadians about the achievements and results of public spending. To provide Canadians with relevant information and report on program investments and results, the federal government is developing and implementing practices for accountability. These practices require that all policy documents to Cabinet and submissions to Treasury Board Ministers feature, first of all, a performance measurement and reporting strategy and, secondly, a performance and accountability framework.
Health Impact Assessment
Assessing the health and social impact of programs and policies is an important aspect of population health. Health impact assessment can be defined as any combination of procedures or methods by which a proposed policy or program may be judged as to the effect(s) it may have on the health of a population. Policies or programs of any nature may directly affect the health of a population, or may indirectly affect their health by altering, influencing, or affecting the determinants of health.
Health goals provide a framework to better understand the relationship between the health outcomes we want and our efforts to achieve them. When health goals are expressed in measurable objectives and quantified targets, they provide the yardstick to measure population health improvements (or lack thereof). Without specific targets to guide health actions, expectations for health gains remain vague. Targets specify the amount and timing of desired change expected on a health status indicator and set forth the parameters of success in a population health approach.
Policy development in population health has built on the shoulders of a series of prior policy initiatives with a similar purpose, namely to maintain and improve the health of Canadians. While various characterizations of the population health policy can be made, it is most fruitful to see population health as a framework for thinking about the social and economic forces that shape the health of citizens. As such, it builds on a long tradition of public health and health promotion, and goes beyond the more traditional focus on the individual as the medical, biological or lifestyle problem.
The Canadian Institute for Advanced Research has played a leadership role in building this framework, starting with a series of seminars led by Fraser Mustard at McMaster University in 1983.
The population health framework is a work in progress. While many elements are clear, others are yet to be fully developed. It is not yet a fully detailed model that identifies the specific causes of good health, nor does it enable us yet to predict the effects on health of specific social and economic conditions.
Nevertheless the population health policy provides, at the most general level, an approach which can increasingly set out the elements that are key to maintaining and improving the health of Canadians.
Health Canada supports initiatives that incorporate a population health approach in many areas, such as activities in the Population Health Regional Mobilization Strategy and the Population Health Fund. However, it will take time before these efforts yield meaningful results. As outcomes of current population health activities are compiled, Health Canada will develop case studies to fully examine and document applications of a population health approach to policy, research and practice.
Meanwhile, the Department is aware that there are projects not just in health but in other sectors, which (deliberately or otherwise) are using at least some elements of a population health approach. We are gathering information on these initiatives, which we believe will provide useful interim success stories and examples of population health in action. These examples will help stimulate discussion and increase knowledge of critical concepts in the population health approach. Keep in mind that examples of initiatives to date do not illustrate or even contain every element of a population health approach.
The Dufferin Mall Story is recognized internationally as a successful experiment in community development achieved by a unique partnership between business and government.
The Population Health Template Working Tool organizes and consolidates current understandings of population health. Health Canada has identified population health as a key concept and approach for program and policy development aimed at improving the health of Canadians. The working tool outlines the procedures and processes required to implement a population health approach and provides guideposts that help to assess preparedness and capacity to implement population health initiatives. The tool draws on the detailed and comprehensive discussion paper, The Population HealthTemplate: Key Elements and Actions that Define a Population Health Approach.
The linked table highlights the elements and issues that need to be considered in a population health approach.
Entry Points to Health
Health can be approached from many different perspectives and health concerns can manifest themselves in a wide variety of ways. None of these
Entry points include:
- demographic groups (e.g., children, women, Aboriginal peoples, persons with low income);
- diseases or causes of death (e.g., AIDS, cancer, influenza, heart disease, diabetes);
- hazards to health (e.g., radiation, contaminated water, unsafe products, environmental tobacco smoke, violence);
- settings (e.g., homes, schools, workplaces, municipalities, recreational facilities);
- behaviours/lifestyle (e.g., tobacco use, alcohol or drug abuse, nutrition, exercise);
- and determinants of health (e.g., income and social status, education, employment and working conditions, social support).
Checkpoints for Applying the Population Health Approach
As part of a 1998 pilot session to involve Health Canada staff in developing a population health approach, the BC Regional Office of the Health Promotion and Programs Branch produced a tool entitled Checkpoints for Applying the Population Health Approach.
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