Is Population Medicine Population Health?

By David A. Kindig, MD, PhD

Terminology can be tricky; a word or phrase can sometimes mean different things to different people. This is currently the case with both population medicine and population health.

On this blog we have been explicit in our definition of population health, from the 2003 article I wrote with Greg Stoddart: “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.“ Population health also encompasses the multiple determinants of health that produce these outcomes.

The term population medicine has recently come into use. I was privileged to spend a few days last month in the Harvard Pilgrim Department of Population Medicine where our agenda included discussion of these definitions. They have defined population medicine as  “…the specific activities of the medical care system that, by themselves or in collaboration with partners, promote population health beyond the goals of care of the individuals treated.” Much of the discussion centered on how a health care organization, whose day-today work is closely tied to clinical practice, can also take action on the broader determinants of health. I think their definition gets it right. Population medicine is primarily concerned with clinical or health care determinants of health, but acknowledges the vital role of multi-sector partnerships (such as with public health, education, business, and social services) to influence health more broadly.

A colleague in Minnesota has taken this idea a bit further. As a part of the 2014 strategic planning process at HealthPartners in Minneapolis/St.Paul, George Isham worked with staff and board members to  identify and commit to those traditional responsibilities over which the organization has influence or control (i.e., healthcare and health behavior). But they are also seeking other opportunities aligned with their mission for which they (as a health care organization) have limited opportunity for direct influence. They are therefore developing partnerships with others to expand the scope of their influence beyond clinical care and health behaviors to the socioeconomic factors and the physical environment. Specific three-year goals were set for these partnership activities in the same way as was done for the traditional health care cost and quality goals of the organization.

Occasionally I hear population health being used to describe the clinical, often chronic disease, outcomes of patients enrolled in a given health plan. Certainly an enrolled patient group can be thought of and managed as a population, but defining population health in terms of patient populations undermines our goal of emphasizing the critical role that non-clinical factors such as education and income play in producing health. Such a view is even more limiting than population medicine, and certainly is not appropriately termed population health from a modern policy framework.

In a recent and very thoughtful policy paper for the National Quality Forum Jacobson and Teutsch address these issues and recommend that "current use of the abbreviated phrase population health should be abandoned and replaced by the phrase total population health." They state that “this will avoid confusion as the clinical care system moves rather swiftly toward measuring the health of the subpopulations they serve. Geopolitical areas rather than simply geographic areas are recommended when measuring total population health since funding decisions and regulations are inherently political in nature.”

I think we should use the term population medicine to describe and promote efforts by leading clinical organizations to use their professional and financial base to actively participate and partner in improving total population health through a multi-sectoral approach to address broad health outcomes and disparity reductions.

David A. Kindig, MD, PhD is Emeritus Professor of Population Health Sciences and Emeritus Vice-Chancellor for Health Sciences at the University of Wisconsin School of Medicine and Public Health. Follow him on twitter: @DAKindig.

Comments

[Geof Swain]

Dave - I greatly appreciate your continued efforts at precision in wording here. Words and definitions do matter, they matter a lot, and I think it's important that we all have a common understanding of definitions - - and, in this case, the distinctions in meaning between "population medicine" and "population health."

But I admit to remaining a bit confused. If

a) Population Health is “the health outcomes of a group of individuals, including the distribution of such outcomes within the group“, and

b) Population Medicine is “…the specific activities of the medical care system that, by themselves or in collaboration with partners, promote population health beyond the goals of care of the individuals treated”,

then c) what do we call "the specific activities" of anyone else (other than the medical care system) "that, by themselves or in collaboration with partners, promote population health"?

In other words, why are activities that address socioeconomic or physical environmental drivers of health called "population medicine" when the health care sector does them, but not when others do them?

Or, more bluntly, why should only the medical care sector get a special name for its activities in these areas?

[Renie Schapiro]

Geof raises an interesting question. Another question I have is whether pop med's primary focus is applications in the one-on-one clinical setting rather than clinicians promoting health outside the clinic. The Harvard pop med determinants schematic shows clinical care at the center with social factors influencing it and their website guides address how to bring pop med principles (largely epi) into the clinic.

This ultimately speaks to what we are preparing MD students to do. Should competencies for MD students in pop med/pop health focus on both clinical applications and going beyond the clinic? One more than the other? What does the new MD look like?