Population health examines the health outcomes of groups and the disparities in health among subgroups. This issue of the NCMJ illustrates population health efforts in the areas of obesity prevention, tobacco cessation, and clean water. Articles in this issue also discuss community health needs assessments, integrated health improvement, social determinants of health, and the Healthy North Carolina 2020 program.
Raising Our Gaze to Improve Population Health
Public health often receives attention when there is alarm about a high-profile disease such as AIDS, SARS, H1N1 flu, or Ebola, but public health is concerned with much more than containment and control of infectious diseases. Indeed, public health aims to prevent disease whenever possible, rather than addressing it after the fact. Although public health efforts are often unseen and unappreciated, the impact of these efforts can be pervasive and long-lasting. This issue of the NCMJ challenges us to raise our gaze and see the bigger picture of population health.
Primary care clinicians use problem lists and apply best practices to guide individual patients to quality outcomes. Working on a larger scale, public health experts measure changes in health among groups of individuals and aim to improve the quality of life for all residents of an area. Public health also continues to push the envelope with progress in community health through tobacco control, air monitoring, and water quality.
Another lens through which we can view the health of large groups is population health, which uses community health needs assessments to address the problems identified by a population. Spurred in part by the Patient Protection and Affordable Care Act of 2010, these efforts have received renewed attention as nonprofit hospitals and local health departments have new impetus to collaborate on community health assessments. Recognizing that populations are not homogenous, population health also considers the troubling differences in health outcomes for subgroups, some of which have outcomes that are disproportionately worse than that of the population as a whole.
Our tools change as our line of sight rises. From the science of medicine—with its tools of history, examination, assessment, and treatment—we have progressed to the science of epidemiology and from there to the description and measurements of social impacts driven by changes in public policy. Population health joins all of these tools and interventions with additional sensitivity and direction from the community.
Primary care saves individual lives. Public health protects populations. Community health broadens the focus further and addresses problems as seen by the community. The progression is clear. We raise our gaze as we move our attention and interventions from individuals to groups—from primary care patients, to communities, to entire populations. Raising our line of sight to this level requires effort, but it is worth straining our sight to embrace a vision of improved population health.
Peter J. Morris, MD, MPH, MDiv
Editor in Chief