« Unpacking the Triple Aim Model | Main | Did You Find Population Health in the State of the Union? »



Feed You can follow this conversation by subscribing to the comment feed for this post.

Great post and I'm looking forward to the dialogue around your ongoing series. I'm curious to know how we might think about, measure, and prioritize the determinants, health outcomes and clinical utilization (where the costs currently reside). As we move our resources toward investing more in the determinants, we need to start with those things that will have the most immediate impact on reducing health care costs... thus releasing more resources to invest in the determinants...moving further and further upstream over time.

"In general, we think of outcomes as a reflection of our current health and determinants as a predictor of our future health."

While it's clear this is a simplified way to think about outcomes vs. determinants for the purposes of your piece, I think it is perhaps a dangerous simplification. Determinants are very much the causes of our current health problems. Without acknowledging this, I think we run the risk of losing sight of historical political decisions that have shaped the distribution of determinants over time.

Courtney, thanks for the thoughtful comment. Of course you are right. While we say the current determinant level is a predictor of future health, past determinants indeed produced over time current health outcomes. We need to understand much better these historical patterns of determinant investment in different places to give us better guidance about what will work for future outcome improvement.

Your comment also lets me call attention to the small left to right arrow on the model between outcomes and determinants. While we think that the causal path way is primarily from determinants to outcomes, there are some outcomes that influence determinants...this is called reverse causality. I discuss this in an Understanding Population Health Terminology paper (ref below) which you may find helpful....."There exist some causal relationships in which what we have previously called an outcome (e.g., morbidity) can produce a change in a determinant or risk factor, such as a childhood illness being responsible for lower educational attainment. In this case, the definitions are reversed, depending on the direction of the proposed causal relationship. Here, morbidity would be the determinant, and educational attainment, the outcome. Separating the different directions of causality is an important and difficult research challenge."

Understanding Population Health Terminology:

The comments to this entry are closed.

Recent Posts