Understanding Population Health Terminology
David A. Kindig,
The Milbank Quarterly Volume 85 Issue 1 Page 139-161, January 2007
Available online at: http://www.blackwell-synergy.com/doi/full/10.1111/j.1468-0009.2007.00479.x
PDF file [23p.] at: http://www.blackwell-synergy.com/doi/pdf/10.1111/j.1468-0009.2007.00479.x
“….Population health is a relatively new term, with no agreement about whether it refers to a concept of health or a field of study of health determinants. There is debate, sometimes heated, about whether population health and public health are identical or different.
Discussions of population health involve many terms, such as outcomes, disparities, determinants, and risk factors, which may be used imprecisely, particularly across different disciplines, such as medicine, epidemiology, economics, and sociology. Nonetheless, thinking and communicating clearly about population health concepts are essential for public and private policymakers to improve the population's health and reduce disparities. This article defines and discusses many of the terms and concepts characterizing this emerging field…” (au)
Categories of Determinants
The following categories of specific determinants follow the general field model of Evans and Stoddart (Evans, Barer, and Marmour 1994), but because the model offers no precise definitions, I have supplied them myself.
| | Social determinant: A proposed or established causal factor in the social environment that affects health outcomes (e.g., income, education, occupation, class, social support). |
| | Physical environmental determinant: A proposed or established causal factor in the natural and built environment that affects health outcomes (e.g., air and water quality, lead exposure, the design of neighborhoods). |
| | Health care determinant: A proposed or established causal factor in health care that affects health outcomes (e.g., access, quantity, and quality of health care services). |
| | Genetic determinant: A proposed or established causal factor from the genetic composition of individuals or populations that affects health outcomes. |
| | Behavioral determinant: A proposed or established causal factor based on individual personal choices of lifestyle or habits (either spontaneously or in response to incentives), such as diet, exercise, and substance abuse. |
| | Biological determinant: Often, a biological mediator variable between a determinant and an outcome, such as the role of endocrine and immunologic processes in stress. In any case, all determinants must have biological mediator variables in order to affect the organism to produce the health outcomes. |
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