Chronic illness is closely intertwined with population health, a term defined as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” by David Kindig, MD, PhD and Greg Stoddart, PhD, in their seminal article for the American Journal of Public Health.
An emeritus professor of Population Health Sciences at the University of Wisconsin-Madison and co-chair of the Institute of Medicine Roundtable on Population Health Improvement, Kindig carefully notes that healthcare isn't the only system responsible for improving population health, but plays a key role nonetheless.
In a model Kindig helped create for County Health Rankings & Roadmaps, a program developed through the University of Wisconsin Population Health Institute, the means to improving population health are broken down into four distinct factors:
- Healthcare accounts for 20 percent of population health improvements
- Physical environments account for 10 percent
- Behaviors account for 30 percent, and
- Social determinants – such as housing, income, social support, etc. – account for 40 percent.
“Healthcare systems have important but limited roles to play in improving population health,” Kindig said. “They need to focus on their primary roles of improving quality and reducing costs to contribute as much to health outcomes as they can.”
For health systems to reduce the burden of chronic illness through better management of population health, they have to broaden their reach. According to Rosemary Frasso, PhD, CPH, associate professor and director of Public Health at Thomas Jefferson's College of Population Health, this begins with acknowledging the limitations of care for chronic conditions within hospitals themselves and extending a health system's impact into the community.
“It involves considering the context in which patients come to the hospital, where they go home to and how all of that affects their health,” Frasso said. “Context matters, and when it comes to how much it costs to take care of someone, you have to think about how you keep them well.”