PROF. Patience Edoho Samson-Akpan
(B.Sc. (NURSING), MPH, PhD, FWCN)
Department of NURSING SCIENCE, UNIVERSITY OF
CALABAR , CALABAR
Outline of presentation
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Introduction
WHO definition of health
Other definitions of health
WHO commitment to the principles set
out in the preamble to the Constitution
Population health
Components of population health
Key elements of a population health
approach
What Is Health?
• Most of the cultures have health as a common theme.
• Most communities have their concept of health as
part of their culture.
• In some cultures health is seen as being in harmony
with oneself, the community and the gods.
 Modern
medicine is so much preoccupied with the study
of diseases at the expense of health.
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Therefore, people tend to be ignorant about health and
its determinants.
 There
is no yardstick for measuring health. Individual
normally takes health for granted until it is lost.
 One
of the oldest definitions of health is that “health is the
absence of disease”.
 This
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definition is unacceptable.
Although individuals, communities, government are aware
of health but it is often neglected for other needs for
example power, prestige, political benefits, security among
others.
Nevertheless, in the past decades there has been a
reawakening that health is a fundamental human
right and a should be a world-wide social goal.
It is essential for the satisfaction of basic human
needs and a channel to an improved quality of life,
which must be attained by all people irrespective
of race, colour, creed among others.
In 1977, the 30th World Health
Assembly declared the main social
target of government and WHO in the
coming decades should be “the
attainment by all citizen of the world
by the year 2000 (which beyond has
been added) of a level of health that
will permit them to lead a socially
and economically productive live.
This is normally tagged “health for all”.
United Nations in 1979 adopted health as an integral
part of socio-economic development.
Health is seen as an end by itself it is also a major
instrument of overall socio-economic development
and the creation of a new social order.
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World Health Organization (1948) defines health
as a state of complete physical, mental and
social well-being and not merely an absence of
disease or infirmity.
Spiritual well-being had been added.
This is the most widely acceptable definition of
health, although it is being criticized as being
utopic, idealistic or not achievable.
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This definition was an acknowledgement
that health is more than non-disease.
However, this definition did not propose a
measureable goal for which strategy for
achievement can be devised.
Health is not a “state” but a dynamic
process, adjusting to changing demands of
living and of the changing meanings we
give to health.
WHO Definition of Health
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Therefore, WHO (1986) altered health as a “state”
to reflect health as a “resource.”
Thus “heath is the extent to which individual or
group is able, on one hand, to realise aspirations
(goals, objectives) and satisfy needs and on the
other hand to change or cope with the
environment.
Health is seen as a resource for everyday life,
not the objective of living, it is a positive
concept emphasizing social and personal
resources as well as physical capacities.”
Pender (1987) provides an excellent definition
overview of the historical development and
evolving nature of the definition of health as it’s
relates to individuals, family and community.
Health is the “actualization of inherent and acquired human
potential through goal directed behaviour, competent selfcare, and satisfying relationships with others while
adjustments are made as needed to maintain structural
integrity and harmony with the environment.”
Today health is viewed as a dynamic, ever changing
condition that enables a person to function at an optimum
potential at any given time (Smeltzer, Bare Hinkle &
Cheever, 2010).
WHO remains firmly committed to the principles set
out in the preamble to the Constitution
• Health is a state of complete physical, mental and social
well-being and not merely the absence of disease or
infirmity.
• The enjoyment of the highest attainable standard of
health is one of the fundamental rights of every human
being without distinction of race, religion, political
belief, economic or social condition.
WHO remains firmly committed to the principles set out in the preamble to the
Constitution
• The health of all peoples is fundamental to the attainment of
peace and security and is dependent on the fullest co-operation
of individuals and States.
• The achievement of any State in the promotion and protection of
health is of value to all.
• Unequal development in different countries in the promotion of
health and control of diseases, especially communicable disease,
is a common danger.
WHO remains firmly committed to the principles set out in
the preamble to the Constitution
Healthy development of the child is of basic importance; the
ability to live harmoniously in a changing total environment
is essential to such development.
The extension to all peoples of the benefits of medical,
psychological and related knowledge is essential to the
fullest attainment of health.
WHO remains firmly committed to the principles set out in the
preamble to the Constitution
Informed opinion and active co-operation on the part of the public
are of the utmost importance in the improvement of the health of the
people.
Governments have a responsibility for the health of their peoples
which can be fulfilled only by the provision of adequate health and
social measures.
The ideal health status is
one which people are
successful in achieving their
full potential regardless of
any limitation they might
have.
Population Health
What Is Population Health?
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Population health is defined as the health outcomes of a
group of individuals, including the distribution of such
outcomes within the group.
These groups are often geographic populations such as
nations or communities, but can also be other groups
such as employees, ethnic groups, disabled persons,
prisoners, or any other defined group.
Population health
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An ideal population health outcome metric should reflect a
population's dynamic state of physical, mental, and social
well-being.
Positive health outcomes include being alive; functioning well
mentally, physically, and socially; and having a sense of wellbeing.
Negative outcomes include death, loss of function, and lack of
well-being. In contrast to these health outcomes, diseases and
injuries are intermediate factors that influence the likelihood
of achieving a state of health. (Parish, 2010)
Parish (2010) recommends the following metrics for
population health outcomes:
1) Life expectancy from birth, or age-adjusted mortality
rate;
2) Condition-specific changes in life expectancy, or
condition-specific or age-specific mortality rates
3) Self-reported level of health, functional status, and
experiential status.
4) When reported, outcome metrics should present both the
overall level of health of a population and the
distribution of health among different geographic,
economic, and demographic groups in the population.
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Population health
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Health outcome metrics are standards for measuring
health outcomes.
Recommending a set of metrics for monitoring a
population's health outcomes — as opposed to a person's
health outcomes
The health outcomes of such groups are of relevance to
policy makers in both the public and private sectors.
• Kindig and Stoddart (2003), define population
health as “an approach [that] focuses on interrelated
conditions and factors that influence the health of
populations over the life course, identifies
systematic variations in their patterns of occurrence,
and applies the resulting knowledge to develop and
implement policies and actions to improve health
and well-being of those populations.”
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They propose that population health is concerned with
both the definition of measurement of health outcomes
and the pattern of determinants.
Determinants include:
◦ medical care
◦ public health interventions
◦ genetics
◦ individual behaviour
◦ components of the social (e.g., income, education,
employment, culture)
◦ physical (e.g., urban design, clean air, water)
environments.
According to the Federal and Provincial
and Territorial Advisory Committee in
Canada, Population health refers to the
health of a population as measured by
health status indicators and as influenced
by social, economic, and physical
determinants, personal health practices,
individual capacity and coping skills,
human biology, early childhood
development, and health services (ACPH,
1997).
As an approach population health
focuses on the interrelated conditions
and factors that influence the health of
populations over the life course,
identifies systematic variations in their
patterns of occurrence, and applies the
resulting knowledge to develop and
implement policies and actions to
improve the health and well-being of
those populations.
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Centre for Disease Control views population health as an
interdisciplinary, customizable approach that allows health
departments to connect practice to policy for change to
happen locally.
This approach utilizes non-traditional partnerships among
different sectors of the community – public health, industry,
academia, health care, local government entities, etc. – to
achieve positive health outcomes.
Population health “brings significant health concerns into
focus and addresses ways that resources can be allocated to
overcome the problems that drive poor health conditions in
the population” (CDC, 2020)
It an approach to health that aims to improve
the health of an entire human population.
It has the following components:
• Health outcomes
• Patterns of health determinants
• Policies and intervention
Population health is considered a priority to reduce health
inequities or disparities among different groups which are
affected by social determinants of health (SDOH).
These determinants include: social, environmental,
cultural, physical among others.
The different groups we are born into or grow up and
function throughout our lifetimes potentially have a
measurable impact on the health of human populations.
Policies and programmes produce changes in health
determinants or factors, and then produce the health
outcomes in the left hand box
This model was adapted from the original Evans and
Stoddart field model and expands on Kindig and
Stoddart
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The right hand side of the figure indicates that
there are many health determinants or factors,
such as medical care systems, individual
behaviour, genetics, the social environment, and
the physical environment.
Each of these determinants has a biological impact
on individual and population health outcomes.
For overall or mean population health, two
components are displayed mortality and health
related quality of life or morbidity.
Healthy People 2010 defined health-related
quality of life as "a personal sense of physical
and mental health and the ability to react to
factors in the physical and social environments"
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Simply put one goal of population health improvement is increase
years of life and quality of those life years.
Another goal is to reduce the difference or disparities on these
health outcomes among different subgroups in the population.
The figure indicates number of sub groups that are associated with
significant differences or disparities in mortality as health related
quality of life.
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Those indicated here are: race/ ethnicity,
socioeconomic status (SES), gender and
geography.
Many other sub-groups included are associated
population health disparities.
Health Status Indicators
 A population health approach recognizes that any
analysis of the health of the population must
extend beyond an assessment of traditional health
status indicators like death, disease and disability.
A population health approach establishes
indicators:
 mental and social well-being,
 quality of life,
 life satisfaction,
Others population health approach indicators include:
 income
 employment and working conditions
 education
 other factors known to influence health.
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Population health is not just the overall health of a
population but also includes the distribution of
health.
Overall health could be quite high if the majority of
the population is relatively healthy—even though a
minority of the population is much less healthy
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Ideally such differences would be eliminated or at
least substantially reduced.
Isn't this so broad to include everything?
 Population health, as defined above, has been
critiqued as being so broad as to include
everything—and therefore not very useful in
guiding specific research or policy.
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The truth is, no one in the public or private sectors
currently has responsibility for overall health
improvement.
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Policy managers, for example, tend to have responsibility
for a single sector while advocacy groups likewise focus
on a single disease or factor.
The inherent value of a population health perspective is
that it facilitates integration of knowledge across the
many factors that influence health and health outcomes.
For population health research, specific investigations
into a single factor, outcome measure, or policy
intervention are relevant, and may even be critical in some
cases--but they should be recognized as only a part and
not the whole.
How is Population Health Different from Public
Health?
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The distinction between public health and
population health deserves attention since it has
been at times both confusing and even divisive.
Traditionally, public health has been understood
by many to be the critical functions of state and
local public health departments such as preventing
epidemics, containing environmental hazards, and
encouraging healthy behaviors.
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Governmental public health activity does not have such a
broad mandate even in its “assurance” functions, since
major population health determinants like health
care, education, and income remain outside public health
authority and responsibility.
Similarly, current resources provide inadequate support
for traditional-let alone emerging-public health functions.
Yet for those who define public health as the “health of the
public,” there is little difference from the population health
framework already discussed
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Public health works to protect and improve the health of
communities through policy recommendations, health
education and outreach, and research for disease
detection and injury prevention.
It can be defined as what “we as a society do collectively
to assure the conditions in which people can be healthy”
(Institute of Medicine, 1988)
Examples of interventions include policy interventions and
programs (e.g., smoking cessation and immunization
campaigns).
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Public health is concerned with the health of a
community as a whole likewise Population health
has a focus on the health of the entire population
or a select sub-population.
Public health prevents disease and protects the
health of communities through organized efforts
to keep people healthy and prevent injury, illness,
and premature death
Population health provides “an opportunity for
health care systems, agencies and organisations
to work together in order to improve the health
outcomes of the communities they serve”.
Summary of
differences
between
population
health and
public health
• Population health helps to
improve the health
outcomes of the
communities
• Population health is not
directly tied to government
health department
• It includes health care
delivery system
• It is broad and encompasses
more than public health
• The goal is to reduce health
disparity among groups
(holistic focus)
Summary of differences between
population health and public health
More determinants of health are covered than in
public health
Population health recognizes shared
responsibility for population health outcomes
but accountability is diffuse
It has an emphasis on the societal structures,
attitudes, and behaviours which influence health.
Summary of
differences
between
population
health and
public health
•The differences in
health status
between groups are
examined using the
social determinants
of health to see the
potential causes
•To diminish
inequities and
improve the health
of populations,
population health
designs interventions
using system level
Summary of
differences
between
population
health and
public
health
• It acts as a basis
for allocating
health resources to
health protection
and promotion
efforts before
illness prevention
and treatment are
necessary.
• A population
health approach
tackles health
issues in a broad
context
The Future of the Public’s Health
in the 21st Century, calls for
significant movement in “building
a new generation of intersectoral
partnerships that draw on the
perspectives and resources of
diverse communities and actively
engage them in health action.”
(Institute of Medicine, n.d)
These are the key elements of a Population Health
Approach commonly, called determinants of health:
1. Economic and social status
2. Social support networks
3. Educational and literacy
4. Employment and working conditions
5. Social environment
6. Physical environment
7. Personal health practices and coping skills
8. Healthy child development
9. Biology and genetic endowment
Other determinants of health include:
10.Health services
11. Gender
12. Culture (Public Health Agency of Canada, 2011)
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The list is evolving as population health research
progresses