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Population vs Public Health: A False Dichotomy?

2016-12-25T14:30:29+00:00

Screen Shot 2014-02-13 at 7.12.30 AM

My department chair recently forwarded me a provocative little video regarding how we should conceptualize “population health.” The video encapsulates a number of hot topics in public health, labeled here as “population health”.  It appropriately emphasizes the importance of addressing not just prevention among healthy populations, but also improving the health outcomes of high utilizers.

Our own emergency medicine researchers have been in the forefront of discussing this connection (e.g., special issue in Health Affairs). We have helped to establish that providing ill patients with behavioral health and social services helps to improve long-term outcomes and decrease the cost of illness.

My perspective on population vs public health

This video is WRONG in saying that we can’t avoid so-called “one time” costs, which they cite as “accidents and childbirth.” Data shows that both injuries and unintended pregnancy are eminently preventable. For instance, we have decreased the incidence of fatal crashes from 1.73/million miles driven in 1994 to 1.10/million miles driven in 2012 (through a combination of legislation, better trauma care, and improved car engineering). In 2012 alone, 21,000 lives were saved due to use of child restraints, motorcycle helmets, and seat belts. Similarly, contraception works!

So perhaps these one-time, expensive, life-altering events are not preventable by doctors as we know them; but they are certainly preventable in general.

As described in this video, “population health” ignores its traditional roots: things like smoking cessation, decreasing risky alcohol use, identifying and preventing violence, screening for cancer.   These are all areas in which emergency physicians have traditionally been leaders… and in which we HAVE made a difference.  For instance, we know that a brief in-ED intervention with risky drinkers results in significantly lower rates of drunk driving.

That said, the video highlights that those of us in the trenches – who see the acute injuries, as well as the long-term consequences of risky behaviors on a daily basis – need to become better advocates for our own role. YES, it is important to take better care of our high utilizers. But that doesn’t mean that we can abdicate our role in helping people to NOT become high utilizers, in the first place.

What do you think?

Megan L. Ranney, MD MPH

Megan L. Ranney, MD MPH

ALiEM Featured Contributor
Assistant Professor of Emergency Medicine
Alpert Medical School, Brown University
Injury Prevention Center of Rhode Island Hospital
Megan L. Ranney, MD MPH

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  • njoshi8

    Thanks Megan for your opposing view! These sexy and cool illustrated videos are so enticing! It makes it hard to not believe their content and the arguments they present. Its like when I listen to a TED talk in my car.. I always find myself nodding my head in agreement! And then later on feeling confused as to why I felt so aligned with their points..

    Regardless, I am glad that there are people out there like yourself that can counter to eloquently! I only wish this post was also a crafty illustration! 🙂

    • Megan Ranney

      Thanks Nikita! If only I knew how to draw ;).

      Ultimately this video tells a half-story. Paying attention to existing high utilizers is important, but not sufficient. It should not translate into ignoring traditional public health/prevention (which DOES work).