During this past month, I have prepared a series of three commentaries on wellbeing and health-related quality of life. The series describes personal health and wellbeing (http://www.behavioral.net/blogs/ron-manderscheid/personal-and-social-wellbeing-are-foundation-our-health-first-era), personal health literacy and health activation (http://www.behavioral.net/blogs/ron-manderscheid/learning-love-literacy-about-our-personal-health), and community health literacy and action (http://www.behavioral.net/blogs/ron-manderscheid/fostering-good-health-related-quality-life-through-community-health-literacy-). Here, I would like to take one step further and describe two radically different approaches to community action. They are commonly known as the public health approach and the population health approach.
The public health approach seeks to manage social and environmental factors that can promote or impede the health and disease of a population. In this framework, effort is devoted to modifying the negative and positive determinants of health. These include social determinants (e.g., poverty and social support) and physical determinants (e.g., poor air quality and urban green space). Changing these determinants can improve the life chances of population members and, subsequently, their health and wellbeing.
By contrast, the population health approach seeks to manage a population’s disease states through medical interventions. Here, the initial task is to classify the population into subgroups based upon disease status from well to catastrophically ill. This population assessment is necessary to configure a collaborative care network to manage the disease of each of these subgroups. With the recent advent of the Affordable Care Act, these management efforts are beginning to take the form of medical homes and health homes.
Just a few moments reflection will convince you that the public and population health approaches are complementary. What becomes immediately obvious is that the strengths of one are the weaknesses of the other, and vice versa. Hence, it is very important to ask how we can develop a bridge between the two approaches.
Adding Medical Interventions to the Public Health Approach. The public health approach seeks to eliminate or minimize negative determinants and introduce or enhance positive determinants through community action. Further, population-level disease prevention and health promotion interventions frequently are provided. Population subgroups exposed to negative determinants and those lacking positive determinants are at increased risk of poor health and disease onset. Hence, if medical interventions are added to this model, medical screening and intervention should first be made available to these high risk groups. A very interesting question arises regarding the effectiveness of such targeted early medical interventions in delaying or minimizing disease.