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- QUESTION
Objectives:
Compare and contrast the health outcomes of the US health care system with those of other developed countries
Discuss how the concepts of upstream thinking and social determinants of health relate to the emerging paradigm shift in this country from a narrow acute care focused biomedical perspective to the perspective of population health
Identify at least one working definition of population health
Differentiate the terms population health and public health
Analyze selected case studies to evaluate the differential impact of the social, economic, physical, environmental, and individual characteristics or behaviors upon the health of individuals and families
Describe new approaches to assessments and interventions that are prescribed by this new population health paradigm
https://www.ctleaguefornursing.org/event/introduction-to-population-health-free-course/100?fbclid=IwAR16nOPLV2KJaH2bBrNG3q2NTvT7jjrU5r5NvoWy4Qgd15a13Buyp8eDBxI
Link to Youtube video
https://youtu.be/yIuxjAaYln0
In the parable, those rescue teams, the sophisticated infrastructure that has been built to house the teams, and the ever-increasing sophistication of their skills and interventions, remind us of where most of us work every day – the acute care facilities of our health care delivery system that do a great job of caring for those people that get “pulled out of the river”. We feel rightly proud of our accomplishments but, as the parable suggests, we rarely stop to consider what is going on upstream.
The raft in the parable represents the important primary care system which is effective but also has some gaps in services to address whatever is going on upstream to land all these people in the water.
In the real world there is a new sense of urgency to address those missed upstream factors highlighted in the parable. In the real world, there is evidence that the health outcomes of the rescue and primary care systems in this country, even with higher expenditures, falls far behind other developed countries. The following two graphics demonstrate this:The first graphic is an example of the cost/benefit of one measure of health - life expectancy at birth
Surprising isn’t it? Even with twice an investment per person, the life expectancy at birth in this country is lower than that in other developed countries such as Canada, Germany, France, Japan, Italy and the UK.The second slide compares the outcomes of our health care system to those of other countries on several other indicators of health:
Again, even though we perform well on heart attack mortality, in all other areas we fall far behind the performance of other countries in the other areas of health reviewed.
A new paradigm of health care is emerging in this country in which multiple entities work together to better address these upstream factors, or the upstream determinants of health, as they are called in the real world. The new paradigm calls for action to improve the health outcomes for all Americans despite their gender, race/ethnicity, socioeconomic status, disability status, lesbian, gay, bisexual, and transgender status, or geography.
On the way to understanding this new paradigm, we need to delineate and examine the determinants that play a role in affecting the health of the population.
Determinants of Health
Health determinants are factors that affect the health of individuals. These determinants are in the social and economic environment, the physical environment, and within individual characteristics or behaviors. Many cannot be directly controlled by the individual (Fabius et al., 2016).
Health determinants can include the availability of employment in a community, the availability of public transportation; affordable health insurance;access to health care providers; affordable and safe housing; the presence or absence of air pollution; crime; full-service grocery stores supplying fresh fruits and vegetables; and more.Upstream determinants of health may be common to all populations, such as in laws and regulations governing health care that pertain to everyone. Health determinants may also be specific to only some populations.
2nd link to YouTube https://youtu.be/dJEwC4wCM70
Consider Fred and Mark. Fred and Mark live in Anytown, a geographic area that is culturally and economically diverse.Fred came from an upper middle class family, attended college and graduate school, and is employed as an accountant for a local high-tech company. Fred lives in an upscale gated community, his wife is similarly employed, and the family owns two cars. Fred has private health insurance from his employer and the family grocery shops 12 miles away at an organic grocery store. Fred belongs to a gym and works out 4 or 5 times a week. He sees his physician once a year for an annual physical, and has good dental care and vision care. Fred’s children attend summer camp every year and the family vacations twice a year.
Mark lives 5 miles away from Fred in public housing. Mark dropped out of school in the 11th grade to work full time to assist his parents with expenses. Without a high school diploma and skills, Mark has had a hard time finding regular employment. Mark works as a day laborer, which is irregular, and provides no benefits. Mark’s wife is disabled, has diabetes, and cannot contribute to the family income. Mark does not own a car, and there are no full service grocery stores in his neighborhood. Public transportation does run as far as the closest full service grocery stores but requires three transfers. The family eats processed foods from a corner convenience market or fast foods.Mark’s family’s medical care is sporadic, involving ED visits or visits to a community health center which also requires public transportation and can have lengthy waits to be seen. Mark has high blood pressure, but does not fill any prescriptions for treatment because of cost. Mark’s children are overweight and suffer from asthma, as do many children in his high-rise unit. Mark is reluctant to allow his children to play outside, due to lack of appropriate play areas and a recent increase in crime and drug abuse in the area.
Question: Fred and Mark are nearly neighbors, geographically, but so different in their life stories. Apply the HealthBegins Upstream Risks Screening Tool and Guide to each of them and think about the following questions. Can you see the difference in their upstream determinants of health? What are some of the upstream determinants that are having a negative impact on Mark’s health?Think about one of them – what might be done to resolve this problem for him?
Why is this important to nurses? Is important for nurses to understand what has influenced their patients’ current state of health. We cannot help our patients regain or maintain health without helping them adjust for factors in their environment. We cannot assume that each patient in our care has the same resources available to them or the health literacy to navigate their own unique environment without assistance.
Name a population that you encounter in your practice. Can you list a few upstream determinants of health for that unique population?
Definition of Population Health in contrast to Public Health
Population Health is the study of well-being among defined groups. Populations can be defined by geography or grouped according to some common element, such as employees, ethnicity, or medical condition (Fabius et al., 2016). A population can be residents of a neighborhood, students in a school system, or workers in a factory. Populations can be even narrower: students in a school system with asthma, residents of a neighborhood who lack transportation, or factory workers with diabetes.
One commonly use dearly definition of population health is one presented by Kindig and Stoddart in 2003: Population health can be defined as the health outcomes of a group of individuals, including the distribution of such outcomes within the group and includes health outcomes, patterns of health determinants, and policies and interventions that link these two.
Many states who have initiated projects to improve population health have developed their own expanded operational definitions of the term. Here in a side bar is one such expanded definition of population health that was developed by the Nursing Collaborative in Connecticut to support their work. It shares common elements with the broader definition above, but is more detailed and specific to a nursing role.
Population health does not mean public health. Public health is a core element of population health that focuses on determinants of health in communities, preventive care, interventions and education, and individual and collective health advocacy and policies. The principal characteristic that differentiates population health from public health is its focus on a broad set of concerns rather than on just these specific activities (Fabius et al., 2016).
Further, population health differs from public health, at least perceptually, in at least two respects. First, it is less directly tied to governmental health departments. Second, it explicitly includes the health care delivery system, which is sometimes seen as separate from or even in opposition to governmental public health (Stoto, 2013)
Why is this important to nurses? Every person that a nurse cares for is a member of a population. In fact, people are members of numerous populations. What populations can you identify in your practice? What are the common factors that define the population you are thinking of? Identifying our patients with specific populations helps us understand their health needs and challenges.
Population Health
Is a proscriptive model that optimizes the strengths of communities and whole populations toward opportunities for health and wellness;
Is a framework for upstream thinking to address social determinants that impact health and healthcare;
Focuses on a broad range of community services that support health and wellness;
Ensures health promotion is accessible, equitable, efficient, timely, and focused on outcomes for all people;
Assumes a broad perspective of health inclusive of diverse populations in a variety of settings;
Maximizes the contributions of a broad range of collaborative partnerships toward achieving common goals of health with which or within which populations and communities can flourish;
Views nurses as key agents in the realization of population health at many levels within communities, schools, health systems, and is inclusive of policy making toward social justice in health and wellness
The emerging healthcare paradigm prioritizes health outcomes and takes into account the external factors outside of healthcare that have a profound impact on health and well-being. This includes expanding the perspective of healthcare to consider where in the disease process care is being provided and where it can be most effective. With the aim to expand the provision of care and bring about healthier outcomes.“A population health perspective is fundamentally concerned with the social structural nature of health influences, and, although it is embodied in the health outcomes experienced by specific individuals, the domains of influence that shape health experiences transcend the characteristics or circumstances of any one individual.” (Dunn & Hayes, 1999, p. s7)
Review Section
Module One introduced the basic concepts of population health including various definitions, the concepts of upstream thinking and social determinants, the implications of this new paradigm for improving population health outcomes, and how the concepts of population health and public health are differentiated.Students will register for free course, upon completion. 2- pages reflection on the course. Paper must follow all APA guidelines and include at least 2 scholarly sources.
| Subject | Essay Writing | Pages | 4 | Style | APA |
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Answer
Reflection Essay
Looking back on this course, I have realized how much my knowledge about population health has improved. Prior to taking this course, I thought that population health and public health are the same. However, I have learned that although they are interrelated, there are fundamental differences between the two. Population health deals with the health of a particular group of persons. The population might be characterized by its location, for example, a town or a county. Scientists are most interested in the disparities of outcomes in a specific group, which they associate with such factors as income disparity, education levels, and the ratio of healthcare providers to patients in a particular population. In comparison, public health is concerned with community health as a whole.
As a healthcare provider, it is imperative to know about population health in order to better know my patients by learning and understanding more their lives outside the hospital. Moreover, the knowledge I gained from this course will be vital to my practice as a healthcare practitioner as I will now take an analytical approach to comprehend the health needs, inequalities, and outcomes of the community our hospital serves and align improvement initiatives to these health needs. Health IT devices, when integrated into electronic health records, will permit my department to involve in risk stratification, recognize gaps in routine care, computerize outreach to patients in need, and measure the quality of the intervention.
Furthermore, I have acquired a new understanding and a wider perspective on public health and have a greater appreciation for the social determinants of health. As a healthcare provider, my team sometimes engages in outreach programs like vaccinations and nutritional health to improve the health outcomes of the populace in need. The knowledge will also help me advocate for laws that promote methods to stay healthy and providing evidence-based solutions to challenges. Healthy People 2020 emphasizes the significance of tackling the social determinants of health by creating physical and social environments that encourage good health for all (Braveman & Gottlieb, 2014). Evidently, limited access to healthcare services makes it challenging for patients to get medical care. Access to all-inclusive and quality healthcare services is, therefore, vital for enhancing and upholding health, inhibiting and managing illnesses, reducing avoidable disability and premature death, and promoting health equity.
Health insurance makes a distinction in whether and when individuals get needed medical care, where they receive their care, and how healthy they are. Uninsured persons are more probable than those with insurance to defer healthcare or relinquish it altogether. The aftereffects can be severe, mostly when preventable conditions or chronic illnesses go undetected (Bharmal, Derose, Felician, & Weden, 2015). Since access to healthcare services is a significant social determinant of population health, the knowledge acquired from this course will change my approach to how I care for patients in the community. Individuals cannot access care if it does not exist in their location.
From this course, I have learned that there are various ways that healthcare provides can improve access to healthcare and improve health outcomes. For example, I intend to initiate mobile clinics programs at my workplace to offer clinical services to underserved locations. Additionally, I intend to share information concerning free preventive care services under the Medicare Improvements for Patients and Providers Act (MIPPA). When patients become aware of these services, they become empowered to proactively prevent or manage chronic illnesses, thereby reducing the entire healthcare cost both for the individual and the provider.
In conclusion, I have gained a new understanding that has broadened my perspective on population health. The skills learned from this course will help me enhance my practice as a healthcare practitioner so that I can deliver quality care as well as become more productive in discharging my roles.
References
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Bharmal, N., Derose, K. P., Felician, M., & Weden, M. M. (2015). Understanding the upstream social determinants of health. California: RAND, 1-18. Braveman, P., & Gottlieb, L. (2014). The social determinants of health: it's time to consider the causes of the causes. Public health reports, 129(1_suppl2), 19-31.
Appendix
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