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ARCHIVED - Implementing the Population Health Approach

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Health Impact Assessment

Assessing the health and social impact of programs and policies is an important aspect of population health. Health impact assessment can be defined as any combination of procedures or methods by which a proposed policy or program may be judged as to the effect(s) it may have on the health of a population. Policies or programs of any nature may directly affect the health of a population, or may indirectly affect their health by altering, influencing, or affecting the determinants of health.

The health impacts of policies or programs are only one of many consequent impacts which may include economic, social, or environmental impacts. In recognizing the complexity and potentially far-reaching effects of many policies and programs, however, it should be noted that where such activities may potentially have impacts beyond the health field (i.e. economic, social, and environmental fields), assessments should involve intersectoral cooperation and collaboration.

A population health approach reflects a shift in our thinking about how health is defined. It recognizes that health is a capacity or resource rather than a state - a definition which corresponds more to the notion of being able to pursue one's goals, to acquire skills and education, and to grow. This broader notion of health recognizes the range of social, economic and physical environmental factors that contribute to health. The number of potential populations is infinite, and the population health perspective, while seeking to predict adverse health outcomes among identified populations, also aims to control or influence these outcomes. Nevertheless, it is possible to isolate the various components of health so that an examination of health impact assessment is both possible and fruitful.

Health Goals

Health goals provide a framework to better understand the relationship between the health outcomes we want and our efforts to achieve them. When health goals are expressed in measurable objectives and quantified targets, they provide the yardstick to measure population health improvements (or lack thereof). Without specific targets to guide health actions, expectations for health gains remain vague. Targets specify the amount and timing of desired change expected on a health status indicator and set forth the parameters of success in a population health approach.

In a population health approach, the articulation of health goals and targets includes the clear delineation of strategies to be undertaken and parties responsible for achieving targets. Health goals relate to all factors that influence a person's health (referred to as determinants of health), including social, economic and environmental factors. Research demonstrates that while target setting in traditional areas such as morbidity, mortality, injury and disability is accomplished with relative ease; target setting relating to the health determinants is more difficult. Experience in several jurisdictions reveals, however, that efforts undertaken to overcome challenges associated with target setting are worth the potential benefits accrued. Under a population health approach, health goals are instrumental in advancing policy making, program planning and evaluation, resource reallocation, population based planning methodologies, and health status and health system monitoring.

Considering Issues in a Population Health Approach

Key Considerations in Managing Issues the "Population Health Way"

  Steps in Issues Management Population Health Considerations

1.

Identifying problems or opportunities -

"What might we need to move on or respond to"

  • Collect population health data
  • Analyze data considering wide range of risk factors and conditions, not just those that

2.

Defining the population health issues -

"What is the issue?"

  • Describe how the health issue is distributed in the population (time, place and person)
  • Identify:
    - determinants/causes of health issue
    - the risk factors/conditions for the population
    - how general health can be promoted
    - whether or not health problem can be prevented
    - needs of people/families with health problem
  • Assess capacity to change (within Health Canada, and with partners)
  • Identify need for taking action (and role of Health Canada and existing/potential partners)

3

Assessing significance -

"Is the issue significant enough to merit further work?

  • Work with and consult stakeholders - draw on their knowledge and expertise
  • Analyze population health data

4

Analyzing existing intervention strategies and identifying options for additional/new strategies -

"Is the issue being addressed sufficiently and appropriately by existing strategies?"

and

"What alternative or additional strategies would be appropriate?"

  • Work with and consult stakeholders - effective population health depends on including perspectives from many disciplines and fields
  • Gather and assess information on the community's situation and strengths (individual, family, local community, provincial, national)
  • Review evidence of "what works"
  • Identify possible strategies such as health promotion, health protection, health care, and those based in non-health sectors
  • Consider strategies directed at individuals/family/ community and systems/sectors/society
  • Select strategies based on best possible impact on health of the population
  • Develop an evaluation framework for selected strategies to ensure effective evaluation of strategies and to contribute to a broader knowledge base

5.

Implementing the interventions/strategies

"How should they be implemented?"

  • Work with and consult stakeholders, recruit new partners if needed
  • Assess and change resource allocation as needed
  • Maintain on-going communication with partners/ stakeholders
  • Carry out an evaluation of activities and adjustment of strategies as needed

6.

Monitoring and evaluating progress

"Is the intervention adequately addressing the issue?"

  • Work with and consult stakeholders
  • Assess progress toward outcome objectives
  • Disseminate findings to expand the evidence base
  • As required, modify goals, outcomes, and strategies and recruit new partners

Entry Points to for Applying the Population Health Approach

Health can be approached from many different perspectives and health concerns can manifest themselves in a wide variety of ways. None of these "entry points" is unique to the population health approach and all are valid places to begin in considering health and interventions to improve health. An essential feature of the population health approach is understanding health in terms of its broad determinants. Because determinants interact, pursuing a population health approach beginning with any given entry point will typically lead to consideration of an array of inter related perspectives and concerns, many of which could equally well have served as the entry point.

Entry points include:

  • demographic groups (e.g., children, women, Aboriginal peoples, persons with low income);

  • diseases or causes of death (e.g., AIDS, cancer, influenza, heart disease, diabetes);

  • hazards to health (e.g., radiation, contaminated water, unsafe products, environmental tobacco smoke, violence);

  • settings (e.g., homes, schools, workplaces, municipalities, recreational facilities);

  • behaviours/lifestyle (e.g., tobacco use, alcohol or drug abuse, nutrition, exercise);

  • and determinants of health (e.g., income and social status, education, employment and working conditions, social support).

The following table demonstrates that regardless of the entry point chosen, it is always possible to identify one or more population groups that are of particular concern. A population health approach goes beyond acknowledging that it is always possible to identify one or more population groups for a given entry point.

An understanding of the populations experiencing a particular health concern or problem is crucial to understanding that health problem, and, in turn, to assessing possible interventions. In other words, whatever the entry point, selecting the best mix of interventions (e.g., programs, policy, education, research) at the appropriate levels (e.g., individual, family, community, regional, national, international) requires a thorough understanding of the health concern and the populations that are affected.

Entry Points

Type of entry point Example of entry point Example of target population

Disease/cause of death

AIDS

IV Drug users, men who have sex with men

Hazards to health

Radon

Residents of bunglows built on uranium beds

Setting

Workplace

Employers/employees

Behaviour/lifestyle

Tobacco use

Young women/Aboriginal peoples

Determinants of health

Social support

Seniors living alone/street youth