How do population health, public health, community health differ?

POPULATION HEALTH

Discussions of the meaning of population health in the United States often build from a definition of the term proposed in a March 2003 article published in the American Journal of Public Health, which asserts that “[population health is] the health outcome of a group of individuals, including the distribution of such outcomes within the group.”

The authors noted that health outcomes and patterns of health comprise the field of population health, which also focuses on the policies and interventions that connect the two components.

However, they further indicated that defining a population presents a challenge, as “populations are often geographic regions, such as nations or communities, but they can also be other groups, such as employees, ethnic groups, disabled persons, or prisoners.”

Individuals can belong to multiple overlapping population groups depending on their various attributes, and they may move in and out of given subpopulations quickly, adding extra complexity to the issue of defining populations.

On top of this, the word “health” can also have multiple meanings. 

Health can be considered at a single point in time or as improvement or decline over several months or years. The term can mean a full return to wellness after an acute episode with a defined treatment pattern, such as a broken leg, or an individual's highest level of wellness while suffering from one or more chronic diseases.

Further, health touches on the physical, mental, behavioral, and socioeconomic aspects of well-being. Measuring these factors and their impact on health remains a persistent challenge.

Stakeholders also often add another dimension to population health by tacking on the word “management” to the phrase. 

The American Hospital Association (AHA) defines population health management as “the process of improving clinical health outcomes of a defined group of individuals through improved care coordination and patient engagement supported by appropriate financial and care models.”

The scope of such efforts has made them difficult to pursue in the past, but the digitization of the healthcare industry has made it easier for providers to define specific populations by relevant criteria and recognize patterns in the care and wellness of their patients. 

Data analytics tools for population health management, whether stand-alone or integrated into EHRs, allow providers to engage in risk stratification, identify gaps in routine care, automate patient outreach, and measure the quality of their interventions.

Public health shares many of these strategic goals but remains distinct from population health in various ways.

PUBLIC HEALTH

The Centers for Disease Control and Prevention (CDC) emphasizes that public health works to prevent disease and promote health through organized, combined efforts from society, public and private organizations, communities, and individuals.

The CDC Foundation expands upon this idea further, providing an initial look into some of the potential nuances that separate public and population health, noting, “Public health professionals try to prevent problems from happening or recurring through implementing educational programs, recommending policies, administering services and conducting research — in contrast to clinical professionals like doctors and nurses, who focus primarily on treating individuals after they become sick or injured. Public health also works to limit health disparities. A large part of public health is promoting health care equity, quality, and accessibility.”

The CDC indicates that public health focuses on efforts to ensure that the conditions in which people live are healthy, whereas population health focuses on how healthcare systems and organizations can collaborate to improve the health of the specific communities that they serve.

Policy development is a core component of public health initiatives. Further, public health approaches often leverage epidemiology — the study of the origins and causes of diseases — to guide evidence-based approaches to prevent and control disease.

However, public health also aims to tackle health threats that aren’t always directly related to disease outbreaks, such as air pollution, racism, and nutrition, according to the American Public Health Association (APHA).

In this way, public health can take a broader approach than population health in some cases. The COVID-19 pandemic underscores this, highlighting the role of public health efforts at the national level. However, public and population health can work to improve well-being in big and small populations.

Does that make public health a facet of population health, or is population health a subset of public health?

Both population health and public health can include very narrow or large groups of individuals — some public health initiatives encompass entire countries or regions of the world — and both increasingly rely on digital data assets to identify patterns and aid workers as they address critical wellness needs.

Population health is typically associated with the clinical sphere, while the phrase ‘public health’ tends to be favored by government officials and the stakeholders who work closely with them.   

Often, the difference between the two comes down to the origin of the health-related service, the tools used to conduct the initiatives, and the stakeholder’s preference.

COMMUNITY HEALTH

Community health shares similar goals and strategies to population and public health, but it is primarily organized around a geographic area and may be more heavily involved in local government and policy than other approaches.

“Community health refers to non-clinical approaches for improving health, preventing disease and reducing health disparities through addressing social, behavioral, environmental, economic and medical determinants of health in a geographically defined population,” the AHA states.

Health equity and socioeconomic disparities are a primary concern for community health organizations, requiring stakeholders to move far beyond the clinical sphere with their efforts. 

Projects may address the underlying socioeconomic challenges and disparities in urban or rural environments, such as access to healthcare, nutritious food, safe and reliable childcare, after-school programs, transportation services, and the creation of shared outdoor and indoor spaces that promote physical activity and community-building.

These initiatives require a collaborative approach that includes community members, school systems, social workers, local government, and the healthcare provider system. As community health falls under the umbrella of public health, public and community health workers are critical to fostering these collaborations.

Tulane University notes that “the public health worker’s goal in community-focused care is to enhance healthcare services and patient outcomes in targeted populations. By applying public health theory on a local, personalized level, community health providers can cater services to a specific demographic and bring a sense of wellness to communities that would otherwise lack proper access to care.”

By developing strong bonds with citizens, healthcare workers, and social services providers, community health professionals can complete critical tasks, including health education for residents and community health resource development.

Community health professionals are frontline workers who liaise between the community and essential services. Often, community health workers are members of the community they serve, giving them in-depth knowledge of the priorities and concerns affecting the health of that population.

This knowledge is invaluable to building collaborative approaches that unite community members, healthcare providers, public health professionals, governments, and others to facilitate evidence-based, health-promoting initiatives that meet a community’s needs.

Ideally, population health management and public health initiatives should all include collaboration across the care continuum that translates to improved health outcomes at the national, regional, and local levels.

Healthcare providers may have a significant business imperative for ensuring that they do their best to reduce the impact of chronic diseases and cut spending for avoidable conditions, but their patients have perhaps an even more significant stake in creating healthy, welcoming, and comfortable communities for themselves and their loved ones.

No matter the terminology or who spearheads the initiatives, population, public, and community health must align to take responsibility for patients’ long-term wellness through technology, improved processes, and proactive care. 

Without enlisting the help of policymakers, healthcare providers, civic organizers, patients, and other key members of the community, no single member of the care continuum will be able to achieve their goals of reducing costs, improving health, and creating healthy living conditions for populations in need.