Muir Gray: Population health—what’s in a name

muir_graySuddenly the word population is everywhere. The Oxford University Department of Public Health is now the Department of Population Health Sciences, the Institute for Healthcare Improvement has added population health to form its triple aim, the American Hospital Association talks about a second wave of hospitals with population health as their theme. Furthermore, Public Health England has launched Population Healthcare, which is defined below:

“The aim of population healthcare is to maximise value and equity by focusing not on institutions, specialties, or technologies, but on populations defined by a common symptom, condition, or characteristic, such as breathlessness, arthritis, or multiple morbidity.”

Population health is a broader concept than population healthcare. It is the health status of a population and is determined by many factors other than the healthcare that is focused on populations. Nevertheless, population healthcare offers us the opportunity to increase the value of available resources in a way that will not be possible through a more intense focus on the bureaucracies that have served us well, but which are insufficient to meet the challenges of the 21st century. There are three types of bureaucracies:

  • there are payers, usually politically determined;
  • there are institutions like hospitals and primary care teams; and
  • there are professions, bureaucracies just like the other two.

However these are all linear organisations and we are dealing with complexity—a non linear challenge. The population healthcare approach allows us to develop what are called complex adaptive systems. The brain, the city we live in, and the ant colony are all examples of complex adaptive systems; they are self organising and developmental.

The term population has also been applied to an approach to clinical practice called population medicine. Although this is probably the first published reference, it is fascinating to know that the Faculty of Community Medicine, which was founded in 1974 and later became the Faculty of Public Health, was very nearly called The Faculty of Population Medicine at its inception.

In all this emphasis on populations it is essential to remember that, as well as population value, we need to think of personal value, and as Jeremy Bentham emphasised in 1789:“It is in vain to talk of the interest of the community without understanding what is the interest of the individual.”

Muir Gray is the director of Better Value Healthcare (bvhc) and a partner in the Oxford Academic Health Science Network.