What is the Population Health Approach?

The population health approach is positioned in the Public Health Agency of Canada as a unifying force for the entire spectrum of health system interventions -- from prevention and promotion to health protection, diagnosis, treatment and care -- and integrates and balances action between them. The approach is integral to the Department's broader role of improving the health of Canadians.

In January 1997, the Federal, Provincial and Territorial Advisory Committee on Population Health (ACPH) defined population health as follows: Population health refers to the health of a population as measured by health status indicators and as influenced by social, economic and physical environments, personal health practices, individual capacity and coping skills, human biology, early childhood development, and health services. As an approach, population health focuses on the interrelated conditions and factors that influence the health of populations over the life course, identifies systematic variations in their patterns of occurrence, and applies the resulting knowledge to develop and implement policies and actions to improve the health and well-being of those populations.

-from Toward a Healthy Future, Second Report on the Health of Canadians,

Key Elements of a Population Health Approach

Address Determinants of Health Recognizing That They Are Complex and Interrelated

Our understanding of what makes and keeps people healthy continues to evolve and be further refined. A population health approach reflects the evidence that factors outside the health care system or sector significantly affect health.

It considers the entire range of individual and collective factors and conditions - and their interactions - that have been shown to be correlated with health status. Commonly referred to as the "determinants of health," these factors currently include:

1. Income and Social Status
2. Social Support Networks
3. Education
4. Employment/Working Conditions
5. Social Environments
6. Physical Environments
7. Personal Health Practices and Coping Skills
8. Healthy Child Development
9. Biology and Genetic Endowment
10. Health Services
11. Gender
12. Culture

This list may evolve as population health research progresses.

See also What makes people healthy? This question was prepared by the Canadian Council on Social Development.

Focus on the Health of Populations

A population health approach focuses on improving the health status of the population. Action is directed at the health of an entire population, or sub-population, rather than individuals. Focusing on the health of populations also necessitates the reduction in inequalities in health status between population groups. An underlying assumption of a population health approach is that reductions in health inequities require reductions in material and social inequities. The outcomes or benefits of a population health approach, therefore, extend beyond improved population health outcomes to include a sustainable and integrated health system, increased national growth and productivity, and strengthened social cohesion and citizen engagement.

Invest Upstream

Efforts and investments in a population health approach are directed at root causes to increase potential benefits for health outcomes.

The identification and definition of health issues and the investment decisions within a population health approach are guided by parameters based on evidence about what makes and keeps people healthy. A population health approach directs investments to those areas that have the greatest potential to influence population health status positively. A population health approach is grounded in the notion that the earlier in the causal stream action is taken, the greater the potential for population health gains.

Base Decisions on Evidence

A population health approach uses "evidence-based decision making." Quantitative and qualitative evidence on the determinants of health is used to identify priorities and strategies to improve health. An important part of the population health approach is the development of new sources of evidence on the determinants of health, their interrelationship, and the effectiveness of interventions to improve health and the factors known to influence it.

Apply Multiple Strategies to Act On the Determinants of Health

A population health approach takes action based on analyses and understandings of the entire range of the determinants of health. A population health approach recognizes the complex interplay between the determinants of health. It uses a variety of strategies and settings to act on the health determinants in partnership with sectors outside the traditional health system or sector.

Contemporary research has clearly demonstrated the relationship between population health status and the multiple determinants of health. Our current state of knowledge rests on the notion that the health of populations is correlated with factors that fall outside the health system or established health sector. This understanding has set the context for new approaches to health improvement that draw upon multiple strategies applied within multiple settings. It calls for innovative and interconnected strategies that give due consideration to the full spectrum of social, economic and environmental health determinants. Based on the analysis of evidence, strategies are developed that will have the greatest relative impact on population health risks and conditions. Strategy development includes the identification of (a) who will employ strategies, (b) to whom, (c) when, and (d) where, in order to ensure maximum contribution to desired health outcomes.

Collaborate Across Levels and Sectors

A population health approach recognizes that improving health is a shared responsibility. "Intersectoral collaboration" is the joint action among health and other groups to improve health outcomes. A population health approach calls for shared responsibility and accountability for health outcomes with groups not normally associated with health, but whose activities may have an impact on health or the factors known to influence it. Intersectoral collaboration in a population health approach includes the horizontal management of health issues. Horizontal management identifies common goals among sectoral partners. It then ensures coordinated planning, development and implementation of their related policies, programs and services.

Employ Mechanisms to Engage Citizens

A population health approach promotes the participation of all Canadians in developing strategies to improve health. The approach ensures appropriate opportunities for Canadians to have meaningful input into the development of health priorities, strategies and the review of outcomes. A benefit of public involvement is that public confidence in decision making and information sharing is increased, as those Canadians who are most affected by a health issues contribute to possible solutions early in the planning process.

Increase Accountability for Health Outcomes

A 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 an intervention. Changes are examined in health status, determinants of health and health status inequities between population sub-groups. Process, impact and outcome evaluation are used to assess these changes. Regular and timely reporting of results and sharing of information with partners and Canadians is an integral part of a population health approach.

History

Population health builds on a long tradition of public health and health promotion. In 1974, the federal government's White Paper, A New Perspective on the Health of Canadians (Lalonde Report), proposed that changes in lifestyles or social and physical environments would likely lead to more improvements in health than would be achieved by spending more money on existing health care delivery systems. The Lalonde Report gave rise to a number of highly successful, proactive health promotion programs which increased awareness of the health risks associated with certain personal behaviours and lifestyles (e.g., smoking, alcohol, nutrition, fitness).

In 1986, The Ottawa Charter for Health Promotion (World Health Organization, 1986) and Achieving Health for All: A Framework for Health Promotion (Jake Epp, 1986) expanded on the White Paper by focusing on the broader social, economic and environmental factors that affect health. These factors, or "determinants of health", include things like income level, education, and the physical environment where one lives and works as important influences on health.

In 1989, the Canadian Institute for Advanced Research (CIAR) introduced the population health concept, proposing that individual

determinants of health do not act in isolation. It is the complex interaction among determinants that can have a far more significant effect on health. For example, unemployment can lead to social isolation and poverty, which in turn influences one's psychological health and coping skills. Together, these factors can then lead to poor health. As we learn more about how these interactions affect health, we'll better understand why and how policies and different health approaches affect the health of a population. We'll also better understand why some groups within populations are healthier than others in spite of the fact that all Canadians have access to the health care system.

In 1994, the population health approach was officially endorsed by the federal, provincial and territorial Ministers of Health in a report entitled Strategies for Population Health: Investing in the Health of Canadians. The report, which summarizes what we know about the broad determinants of health, also lays out a framework to guide the development of policies and strategies to improve population health.

As part of a departmental restructuring and realigning of priorities, the Public Health Agency of Canada has now made promoting the population health approach one of its four business lines.

-from Towards A Common Understanding: Clarifying the Core Concepts of Population Health, A Public Health Agency of Canada Discussion Paper

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