Transcript National Health Services Planners Forum, Melbourne

www.med.monash.edu
National Health Services Planners Forum,
Melbourne, Thursday 7 April 2011
Population health planning:
prospects and possibilities
Professor Helen Keleher
Joint Chair in Health Equity, Monash University/Inner
South Community Health Service
www.med.monash.edu
Population health aims
– to improve the health and well-being of
whole populations and
– to reduce inequalities and inequities among
and between specific population groups (ie,
health equity)
These are not ‘either-or’ aims
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Health equity
State population health plans:
health equity not always defined, and often in
less than robust terms
Commonwealth reform documents also weak
in defining health equity
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NSW Health on health equity
• Pursuing equity in health involves all efforts
both within and beyond the health system
aimed at improving life opportunities for
people who are most disadvantaged, so
that they have the best chance of achieving
and maintaining good health. It implies a
need for the redistribution of existing and
new resources towards redressing these
inequities (NSW Health 2004).
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Commission on Social Determinants of
Health on health equity
• The unequal distribution of
health-damaging experiences
is not in any sense a ‘natural’
phenomenon but is the result
of a toxic combination of poor
social policies and
programmes, unfair economic
arrangements, and bad politics
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Population health
Some see population
health as the
aggregate of highrisk individuals results in prevention
strategies
Population health is about
determinants of health
among populations and
their characteristics
The determinants of individual differences in risk are different to the
determinants of differences between social groups.
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Health systems and
population health
Health systems show variable capacity to
determine how they impact on population
health
– Little effect in reducing inequality
– Little capacity to show impact on most
vulnerable
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Social and health inequity are intertwined
•
•
•
•
•
Housing stress
Childhood poverty
Family poverty
Food insecurity
Intergenerational
unemployment
• Social exclusion –
marginality
• Literacy
• Chronic disease
• Poor selfmanagement
• Poor nutrition
• Lack of money
for health care
• Stress
• Low health
literacy
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Population health planning
• PHP is a strategy for integrated and
responsive reforms in order to deliver better
health outcomes in a defined catchment
with a focus on social disadvantage.
• PHP is more than health service planning
and much more than ‘reaching the
unreached in primary care’
• Population health plans are a type of master
plan
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Goals of population health planning
Primary: to provide comprehensive plans to
inform health improvement from a
determinants approach
Secondary: to improve the efficiency and
effectiveness of the way that the health sector
works with the other sectors that influence the
determinants of health.
Ultimately, PHPs should service the work that
will reduce demand on hospitals
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Examples of population health plans
Statewide population health plans – to
guide investment
Community health profiles – to steer
program work and intersectoral
collaboration
Others:
Municipal Public Health Plans – specific to
local government sphere
Divisions of General Practice – specific to
general practice
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Indicators that count…
• We have a critical need for population
health indicators that can actually
measure progress on health and social
equity at catchment/community level
• Meaningful indicators need to make
sense to:
– Policy makers, program managers
– Community organisations, providers
– Inter-sectoral partners
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DATA: usually comes in a
form of interest to
researchers, but when
analysed and interpreted,
it becomes:
INFORMATION, which is
of value to policy
makers, program
managers and other
decision makers. But
when information is
translated into a form
that is useful to the
community it becomes:
KNOWLEDGE, and the
process of acquiring and
using that knowledge is
empowering for
communities so then we
all acquire:
WISDOM in making the
right choices (even
about expenditure and
resource allocation)
and the right use of
knowledge, not just for
ourselves but for the
next generation.
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Top-down or bottom-up planning?
Planning should be as close to communities as
practical involving local agencies, supported by
governments
Partnerships are critical:
• Population health planning requires a wide
range of sectors working together to
address issues faced by their communities
and meaningful engagement with those
communities.
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Medicare Locals - Healthy Communities
Plans
• ‘decisions and processes based on evidence
and strong population health data will enable a
stronger focus on prevention and early
intervention, result in more appropriate service
utilization, improved patient access and greater
clinical and administrative efficiency’ (DoHA
2010, p 5).
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Opportunities for Medicare Locals or
catchment wide partnerships
•
•
•
•
Leadership in population health
Catalysts for knowledge brokerage
Knowledge translation
Learning how to build a multi-point knowledge
network
• Learn how to undertake comprehensive
planning
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Role of governments
• Enabling of local efforts through policy and
funding – find vehicles for implementation
and pooled funding
• Provider of data and guides to what data is
available
• Supporter of training of key staff
• Set benchmarks in collaboration with the
field of planners
• Reward great efforts
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What are the risks of we don’t do this?
• Bad policy
• More of the same
• Widening inequities