Perceptions of Nursing and Midwifery

The rise of population health

I often get asked the question, “Why is the current focus on population health?” 

People often mean different things when we talk about population health. Put simply, population health means the health outcomes of a defined group of people, as well as the distribution of health outcomes within the group. This means that health equity – the avoidable differences in health between different parts of the population – is a core part of understanding population health.

The health of a population is influenced by a wide range of factors and the interactions between them. They include the local environment – such as the conditions in which people live and work; social and economic factors – like education, income and employment; lifestyles – including what people eat and drink, whether they smoke, and how much physical activity they do; and access to health care and other public and private services. Age, sex and genes make a difference to health too, as well as social networks and the wider society in which people live (see Figure below)

Figure 1: What are the influences on population health?

                       

While health care services play an important role in keeping people healthy – particularly when they become ill – estimates suggest that wider social, economic and environmental factors play a greater role. Failure to address these non-medical factors can increase use of health services. On the flipside, investment in services to address the wider influences on health can, in some cases, reduce the burden on the NHS and provide returns on investment to society.

It is important to note, however, that investing in preventing ill-health is fundamentally about improving people’s lives rather than producing financial savings or reducing health care demand. In fact, successful prevention that means people live longer can lead to greater care needs in the long term.

Other terms, like population health management or population health care, are sometimes used interchangeably with population health. While the meanings of these terms aren’t fixed, they are typically used to refer to a narrower definition of population health than the one we have described above – focusing more heavily on medical services and particular groups of patients. Another closely related term is public health, which refers to the organised efforts of society to promote and protect people’s health and wellbeing, and to prevent ill-health - for example NHS England commission routine immunisations, national childhood & adult screening programmes and child health informatics services. 

Improving population health

Improving population health is not a simple task. The complex range of influences on health means that many different interventions and approaches are needed. This ranges from decisions about taxation, public spending and legislation at a national level, all the way down to the actions of individuals and the support they give to each other in their communities.

For the NHS, this means that improving population health depends on collective action with different services, sectors, and community groups – including the ‘assets’ found in local communities (like people’s time and skills, social networks and physical spaces like schools). Homerton University Hospital, for example, works with Positively UK, a charity, to provide one-to-one support, group sessions and workshops with other people living with HIV in clinics across London. This has been associated with improvements in people’s mental health and emotional wellbeing, and reductions in social isolation.

Collaboration with local government is particularly important, given local government’s responsibility for public health spending and a wider range of services that influence people’s health. Priority areas for public health spending include giving every child the best start in life, helping people find good jobs and stay in work, and ensuring that people live in warm and safe homes.

The NHS also has a direct role in identifying people’s health needs and intervening early to address them. Data about people’s health can be used to identify groups of the population that would benefit from different types of support (an approach sometimes called population segmentation) - this is why we need to integrate safeguarding data into other NHS datasets. Some population groups, such as people with long-term conditions, like heart disease or diabetes, require more intensive support than others to stay healthy and maintain independence. Also through integrated data we have established that men with Black African or Caribbean decent die 11 years earlier on average than their Caucasian neighbours. 

As well as providing relevant medical care, the NHS should also connect people with non-medical services – such as housing or employment advice – to address their social needs. GPs in Derbyshire, for example, work with the Citizens Advice Bureau to offer advice on benefits, employment, immigration and many other issues in primary care. This is sometimes called social prescribing.

Improving population health also means developing targeted approaches to improving health equity. Within the NHS, this includes action to reduce inequalities in access, quality and outcomes of care (and monitoring the results). Interventions by the NHS to encourage healthy behaviours must also take into account the role of social context in shaping people’s behaviour. People from more deprived backgrounds, for example, are more likely to engage in unhealthy behaviours, and as we know vulnerable citizens are more likely to be impacted by safeguarding issues. 

Where next?

The NHS has an huge and important role to play in improving population health. But the complex range of influences on our health means that efforts to improve it face the ‘problem of many hands’, where no single organisation can be held responsible for the overall health of the population.

The NHS must therefore work with local government and other partners to develop more co-ordinated approaches to improving population health. At a local level, this should involve developing common aims for improving health, defining how these goals will be measured, and sharing resources to achieve them. It may also involve developing more systematic ways for NHS staff to identify people’s non-medical needs and work with others in the community to address them. STPs and Integrated Care Systems (ICS) offer an important opportunity for the NHS and its partners to work together to achieve this. This is why we must all be out and about influencing system leaders with important safeguarding intelligence and this is why we should try to collaborate with STPs / ICSs with joint projects, matrix working or stretch objectives. Remember, if you don’t have a seat at their table, you can also take your own chair. 

Maybe we cannot influence the political decisions made by Government for example, on welfare spending or housing policy, which have a major impact on people’s health but we can each work to influence care system leaders to use their public health budgets at a national and regional level to improve population health.

What inspired you to write this blog?

to inspire population health

What is your role?

Head of Safeguarding

What are your nursing and/or midwifery qualifications?

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