A population health approach integrates multiple interventions and strategies across the health continuum.
What are multiple interventions and strategies?
A population health approach calls for multiple and complementary interventions and strategies across different levels. Currently, resources and attention are heavily focused on one-to-one interventions within the health care system, aimed largely at the restoration of health. The challenge is to move beyond the individual to the family, community, and society.
Strategies are broad approaches, and often are linked to specific agents of change and settings. Strategy examples include:
- policy development and coordination
- regulatory actions
- community action
- capacity building
- education and public awareness
- organizational and administrative reviews.
No one action is effective on its own; it is the combination of actions that produces results.
Resources to Increase Understanding:
What broad types of interventions and strategies can be considered when planning a health promotion strategy?
- The Ottawa Charter for Health Promoton –
- Health Promotion 101: Online Course – Ontario Health Promotion Resource System
- Publications on Behaviour Change and Social Science Theory: List of Resources – The Health Communication Unit
- Hamilton and Bhatti Integrated Framework for Population Health Promotion
- Which interventions and strategies will be implemented?
- What types of resources and supports are needed?
A) WHICH INTERVENTIONS AND STRATEGIES WILL BE IMPLEMENTED?
A successful mix of interventions and strategies will:
- Produce incremental and comprehensive change.
- Address the broad determinants of health in complementary ways.
- Reduce inequities.
- Be comprehensive across the range of health actions.
- Integrate across health outcomes.
- Deal with the entire lifespan.
- Work within multiple settings, such as the home, school, workplace and community.
Produce incremental and comprehensive change
An “incremental approach” implies a step-by-step process where only one or a few health determinants are acted upon initially. A “comprehensive approach” implies action on multiple determinants of health. The choice of where an intervention mix falls on the incremental-comprehensive change spectrum depends upon the answer to the following question: “How much should we take on?”
Address the broad determinants of health in complementary ways
Because the determinants of health interact with and influence one another, interventions which focus solely on one determinant of health are likely to be less effective. A population health approach recognizes the interplay between determinants, and addresses both those that have historically been viewed as under an individual’s control (such as personal health practices) and those that are farther removed from the individual or his immediate environment (such as income or working conditions).
An underlying principle of a population health approach is equity, i.e. that all people have an equal opportunity to develop and maintain their health. The population health approach strives to achieve greater equity in health outcomes between and within populations while recognizing differences in needs, characteristics and health resources. This is usually best done through actions and policies that generate social and economic environments which can create higher standards of health for the population as a whole.
Be comprehensive across the range of health actions
A population health approach acts along the entire range of health actions: from health care to prevention, protection, health promotion and action on the broader determinants of health. These actions are interconnected, complementary, and, in some areas, overlapping.
Integrate across health outcomes
Because many health issues are related through common risk/protective factors, actions to address them can be integrated. This sets the stage for interventions that can address a number of health problems at the same time and provide multiple benefits. It is known, for example, that diabetes, cardiovascular disease and cancer share many of the same risk and protective factors, and therefore a concerted effort to address these common factors may protect against all three diseases and will probably be more effective than three uncoordinated, disease-specific prevention programs.
Deal with the entire lifespan
Life experiences and episodes, such as the transition from childhood to adolescence, employment changes, marriage, parenthood, retirement, and bereavement, can influence health and well-being. It is important, therefore, to encourage interventions that meet the health challenges of these transition periods across the life span. While a population health approach focuses on the collective more than on the individual, it acknowledges that life events and transitions are influenced by social status, economic considerations, gender, community supports, and other health determinants.
Work within multiple settings, such as the home, school, workplace, and community
A population health approach considers settings, and the contribution each can make. Programs and policies can be developed where people live, learn, work and play, to create health-enhancing physical and social environments in everyday life. Examples include promoting legislation for safe, supportive workplaces, improving school design and operations for better student/teacher health, supporting healthy cities initiatives through sound urban planning and management, increasing public awareness of safe built environments, and instituting regulations to protect the natural environment.
B) WHAT TYPES OF RESOURCES AND SUPPORTS ARE NEEDED?
Interventions require a variety of skills and resources, including:
- technical assistance
- leadership and promotion
- political support.
How are multiple strategies chosen and implemented?
Select list of strategies and interventions
Bearing in mind, the general decision-making criteria established in Key Element One, and the seven specific considerations noted above, identify the combinations of interventions that will be most effective.
Establish a coordinating mechanism to guide interventions
A coordinating mechanism with carefully thought out structures and procedures should guide the development and implementation of multiple interventions. Coordinating mechanisms must be supported to be effective.
- a. capacity, i.e. individuals with relevant knowledge and expertise who are assisted by competent support staff
- b. political support, i.e. endorsement from political and community leaders
- c. autonomy, i.e. the authority to make decisions about courses of action
- d. sound management principles
- e. responsibility for core functions, such as funding, technical assistance, organization, management, education, communications, leadership and promotion.
Evidence to Support Decision-Making:
What sources of data can inform decisions about the ideal intervention/strategy combination to impact on a given health issue?
Resources that Build Capacity:
What decision-making frameworks or guides can help facilitate decisions about the best intervention/strategy combination to impact on a given health issue?
What do you have at the end of Key Element 5?
- A finalized list of interventions and strategies.
- An understanding of your resource requirements, including a budget.
How does this Key Element relate to the others?
- It uses data gathered on health status and determinants (Key Elements 1 and 2)
- It helps to prioritize the good interventions (Key Elements 3.5 and 4)
- It identifies when involvement and partnership with other sectors is needed (Key Element 6)
Why is this Key Element important?
- It is a way to take a set of seemingly separate interventions and use them strategically toward a common purpose.
- It adds in extra considerations of factors like time, other partners, and other strategies.
Examples Illustrating Application:
What are some examples of efforts that integrate multiple interventions and strategies to address a given health issue?