For the Public's Health The Role of Measurement in Action and Accountability (2011) / Chapter Skim
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1 Introduction
1 Introduction
Pages 13-34
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of GDP by 2019 (Truffer et al., 2010) and to 34 percent of GDP 1 "The comprehensive health care reform law was enacted in two parts: The Patient Protec tion and Affordable Care Act was signed into law in March 23, 2010[,]
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. The individual and population health return on those substantial clinical care expenditures is inadequate.
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The act also offers an opportunity to integrate parts of clinical care and public health efforts better to improve population health in 2 Woolf and colleagues (2007) conducted an analysis and examined the literature on the contribution of education to preventing death and found that improvements in educational status could have dramatic effects on health outcomes.
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Establishment of a National Prevention, Health Promotion and Pub lic Health Council to bring together many of the executive branch cabinet secretaries to strategize about the potential health impact of policies and programs in areas of government not explicitly con cerned with health or charged with assuring population health,a and development of a National Prevention and Health Promotion Strategy (National Prevention Health Promotion and Public Health Council, 2010)
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, the act calls for a key national indicator system that will include health and is to be constructed with guidance from the National Academies. CHARGE TO THE COMMITEEE Recognizing the potential of systems-oriented public health approaches to achieve greater improvement in population health outcomes than changes in clinical care alone, the Robert Wood Johnson Foundation asked the Institute of Medicine (IOM)
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First, the committee believes that health strategies, interventions, and policies applied at the population level can advance current approaches to our nation's most pressing health concerns (such as obesity, infant mortality, injuries, cardiovascular disease, and health inequities) more efficiently and effectively than can isolated, intensive individual-level actions within the clinical care sector (see, for example, Woolf et al., 2007, estimating the effect on mortality of changes in one of the determinants of health, education)
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Because a public health agency is only one actor among many, there is increasing emphasis on engaging the highest-level elected officials, whether mayors, governors, or the president, to promote Health-in-All Policies -- an approach that considers the implications on population health of policies in other sectors of government (e.g., transportation, land use, agriculture) and that uses such tools as health impact assessments, described elsewhere in this report (Kickbusch and Buckett, 2010; Stahl et al., 2006)
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are also key actors in the circle, and replacing health care with clinical care. The government public health agencies are in the center not because they are the most important in the population health system but because they are specifically tasked with ensuring the health of the public through their actions and by working with and through others.
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The two paradigms are complementary, and a balanced investment in both would create health policy that produces improved health. The World Health Organization has defined health as "a state of physical, mental and social well-being and not merely the absence of dis 4 See, for example, Social Science Research Council (2009)
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. The present report argues that data can help communities to assess their status in those respects and to take steps to improve conditions for health with the ultimate goal of improving population health outcomes.
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The dotted lines between FIGURE 1-2 A guide to thinking about the determinants of population health. levels of the model denote interaction effects between and among the various levels a Social conditions include economic inequality, urbanization, mobility, cultural of health determinants ( Worthman, 1999)
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Researchers have found that poverty, low levels of education, lower social status, and income inequality are linked with higher mortality and higher rates of poor health, with more or stronger evidence regarding some conditions (see, for example, Berkman and Kawachi, 2000; Carstairs and Morris, 1989; Daniels et al., 2000; Kaplan, 1996; Kennedy et al., 1998; Kogevinas et al., 1991; Marmot and Wilkinson, 1999)
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Unlike clinical interventions that focus on downstream factors (for example, individual-level factors) , such as using prescription medication to lower blood sugar concentrations or blood pressure, population health interventions by public health agencies and their partners can address a broader spectrum of causation ranging from proximal conditions that lead to unhealthy behaviors and exposures in communities to sick people's need for services in the medical care delivery system.
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. As one moves further upstream, to the outermost ring of the illustration in Figure 1-2, although strong evidence links health outcomes to various dimensions of the socioeconomic environment (such as education, income, housing and neighborhood quality, social cohesion, and social capital)
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. MEETING THE CHARGE To meet its charge, the committee reflected on the implications of the Affordable Care Act and the case for moving toward a population health approach as seen through the lens of measurement of health outcomes and system performance.
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In the present report, on measurement and health, the committee uses the scope of measurement as a tool to improve population health. This report focuses on measurement and on the US population health statistics and information system (which collects, analyzes, and reports population health data, clinical care data, and health-relevant information from other sectors)
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Madison: University of Wisconsin Population Health Institute. Brownson, R
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Findings from the Commonwealth Fund Biennial Health Insurance Survey (2005)
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2003. What is population health?
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2010. Socioeconomic indicators that matter for population health.
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American Journal of Preventive Medicine 20(2S)
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