Key Element 1: Focus On The Health of Populations

A population health approach assesses health status and health status inequities over the lifespan at the population level. It also considers this information within broader contexts.

What does it mean to focus on the health of populations?

It means the collection and analysis of population health data for planning, implementation and evaluation.

Population health status data highlights emerging health issues and long-term challenges and helps decide among competing priorities. It answers the questions:

  • “How healthy is the population and what is happening to their health over time?”
  • “Who is healthy and who is not?”
  • “What can be learned from health status trends to help prepare for the future?”

A population health approach considers health status and health status inequities of the population as a whole, as well as groups within it. These groups may be defined by geography, age, culture, or other defining features. The approach measures health over time, across jurisdictions, and across health issues. It captures not only illness and injury, but the positive dimensions of health as well, such as physical fitness levels of the population.

This is done by establishing and examining indicators. Health indicators are based on standard definitions and methods to provide comparable information between health regions and groups of people. They provide information about the environment and context within which the population lives and thus support the decision-making process.

Resources to Increase Understanding:

What are the different kinds of population health indicators?

Key questions

  • What are the health issues?
  • What are the key contextual factors to consider?

A) What are the health issues?

Priority health issues are determined through the use of indicators. The most common indicators of health status are mortality and, to a lesser extent, morbidity.

Some commonly used mortality indicators include:

  • infant mortality
  • life expectancy
  • cancer deaths
  • suicide rates
  • unintentional injury deaths
  • AIDS deaths.

Although these are important, they only provide part of the population health picture. The picture needs to be balanced with measures of morbidity, decreased quality of life, and the positive dimensions of health.

A new generation of indicators known as “aggregate health indicators” combine data on mortality, loss of function, and quality of life, so that very different issues can be compared in a consistent way. They also allow for the comparison of different strategies and a greater understanding of how various factors interact to strengthen or undermine health.

Some examples of aggregate health indicators include:

  • Disability-Adjusted Life Years (DALYs)
  • Health-Adjusted Life Expectancy (HALE)
  • Quality-Adjusted Life Years (QALYs).

Aggregate health indicators such as these paint a more complete picture of population health status. The information provided by the indicators is used to identify the priority health issues.

Final decision criteria should include:

  • Magnitude of the issue (What is the impact of the issue on the health of Canadians? What is the current or anticipated health and economic burden?)
  • Status of current response (What is being done? Is it effective? What remains to be done?);
  • Ability to effect change (Are there changeable health outcomes? What is the potential impact? Is there the potential to address several health issues at once? Is there the possibility that investment might do harm? Are there potential interventions supported by evidence? Is it technically, fiscally and politically workable? Are the key players ready to act? Is there readiness among Canadians for change? Is it likely to bring benefits other than health benefits?)
  • Appropriateness for involvement (Does it fit the mandate/roles of the organization? Are levers (i.e., situations where action will have greater than normal effects) available? What is the extent of the value added? How easy will it be to implement? Is there public support?)
  • Cost effectiveness (What is the potential health improvement relative to the investments made?).

B) What are the key contextual factors to consider?

Human populations exist within contexts that influence health and effect which health improvement approaches may work best. Types of contextual factors include:

  • Demographic: size, distribution, diversity, gender, age, etc.
  • Political: political ideology, political will, policy-making processes, political agendas and priorities, interest group lobbying, political participatory traditions, federal/provincial jurisdictional issues, etc.
  • Socioeconomic: economic growth, fiscal policies, and social cohesion, etc.
  • Physical: natural environments, built environments, etc.
  • Health sector conditions: the current level of consumer satisfaction with the health system, the degree to which the system is undergoing evolution or reform, wait times, etc.
  • Cultural: values, beliefs, preferences, traditions, etc. How is focusing on the health of populations achieved?

How is a focus on the health of populations achieved?

1.1 Choose indicators for measuring health status

Choosing which indicators to measure is an important decision. They must be relevant to initial concerns, the populations of interest, and the intervention settings. Practical issues must also be considered, in terms of the availability of quality current and local data.

Choosing indicators can be done in two ways. In one approach, key stakeholders generate lists of what they want to know; in the other, stakeholders review a comprehensive list of indicators and identify those that they find most relevant. In practice, both methods complement each other.

1.2 Measure and analyze health status to identify inequities and priorities

In Canada, a wide variety of population health indicators are measured nationally, provincially, regionally and locally. This data can often be analyzed for specific geographic areas or subgroups of the population. In some cases, new research may be needed to answer specific questions about health status. When more detailed information is not yet available or it is not possible to collect it, health management or administrative data can at least provide useful surveillance information, which highlights current health problems within communities. The setting of priorities can be undertaken once all the available data has been analyzed.

Evidence to Support Decision-Making:

What sources of population health data can inform decisions about whom and what issues or risk factors to focus on?

1.3 Assess contextual environments, conditions and circumstances

Information about the contextual factors affecting health can be accessed through existing datasets, case studies, ethnographies, published and grey literature, etc. These can come from a broad variety of sources, including government and voluntary sector planning departments, libraries, polling companies, and private sector companies. New information can also be collected, through interviews, consultations with key stakeholders and other structured exercises.

Once gathered, there are a number of ways to organize and present information of this nature for planning purposes. A PEEST analysis (an assessment of the political, environmental, economic, social and technological factors affecting a situation) can be organized into a SWOT review (internal strengths and weaknesses, and external opportunities and threats) or a Force Field analysis, where each factor identified through the PEEST analysis is shown visually as either a helpful or hindering force.

Resources that Build Capacity:

What decision-making frameworks or guides can help incorporate indicators into the process of making decisions about who and what risk factors to focus on?

What do you have at the end of Key Element 1?

  1. Clearly identified priority health issues.
  2. An assessment of various factors, which may impact on your intervention, perhaps represented in the form of a SWOT or PEEST analysis.

How does this Key Element relate to the others?

  • It shows how health status interacts with the determinants of health (Key Element 2).
  • It provides a wealth of data and information to support decision-making about types of initiatives in which to invest (Key Elements 3.5, 4, and 5).
  • It identifies further research needs (Key Element 3).
  • It provides the foundation for an accountability framework (Key Element 8).

Why is this Key Element important?

  • It allows for the rational selection of priorities for intervention.
  • It is useful for uncovering health inequities between groups.
  • It allows for the measurement of change or progress in real terms.

It can help to determine the ideal timing for an intervention by assessing what the conditions are for its implementation.

Examples Illustrating Application:

What groups, organizations or governments have examined a broad range of health indicators to develop and continually adjust the focal audiences and risk factors of their health promotion strategy?