Population Health: Behavioral and Social Science Insights
Health care is an important factor in improving health, but health outcomes are also strongly influenced by factors outside of the health care system. This volume brings together contributions from leading behavioral, social, and medical scientists to summarize what is known about the determinants of health outcomes and to outline directions for future research. I am gratified that the Agency for Healthcare Research and Quality (AHRQ) has been able to partner with the National Institutes of Health (NIH) in this effort.
AHRQ's mission is to produce evidence to make health care safer, improve health care quality, and make it more accessible, equitable, and affordable; a parallel goal is to work within the U.S. Department of Health and Human Services and with other partners to make sure that the evidence is understood and used. As an agency we have a strong commitment to disseminate the best available evidence to improve health outcomes from the patient perspective. AHRQ publishes reports that are relevant to improving population health, including the National Healthcare Quality and Disparities Report. This report focuses on factors within the health care delivery system, including where health disparities are improving and where they have stayed the same or gotten worse.
There are at least three ways to improve population health outcomes: first, by developing new treatments and therapies that will improve health for people suffering from illness (e.g., a cure for cancer; a treatment to slow or stop disease progression in people with multiple sclerosis [MS], a therapy to prevent the onset of Alzheimer's disease, and so on). Second, by assuring the technologies and therapies that are known to produce benefit are more uniformly delivered to all Americans. And third, we need to tackle the systemic problems that continue to negatively affect health, such as poverty and low educational attainment. AHRQ concentrates on the second of the three mechanisms for improving population health. NIH and the industry tend to focus on the first, and the chapters in this volume remind us of the importance of paying attention to the third.
Health care is limited in its capacity to remedy the national challenge of reducing racial and ethnic disparities in health outcomes. Population Health: Behavioral and Social Science Insights broadens our perspective by helping us understand the context in which health problems develop and the environments in which health care is delivered. As more information becomes available to clinicians, patients, and communities alike, AHRQ's goal is to help improve health and well-being and contribute to better health outcomes for the Nation overall.
Richard Kronick, PhD Director
Agency for Healthcare Research and Quality
My good colleague, Russ Glasgow, taught us that Reach X Efficacy = Impact. The vast majority of behavioral and social science research efforts to improve health have targeted the individual. These efforts have resulted in numerous efficacious interventions to change behaviors and improve health, but the field has struggled to implement these interventions with sufficient scalability or reach to have a large population impact. In contrast, this book focuses on population health and the targeting of large population groups with common systemic risks to their health. Although we may have less control of the levers of change in population health than in individually-based interventions, even small systemic shifts or "nudges" have considerable reach that produce large population impacts.
Over the last generation, we have witnessed the impact of increased tobacco taxes and indoor smoking bans on the prevalence of smoking. Of course, these population-based interventions do not occur in a vacuum, and the availability of viable individual cessation interventions, as well as changing attitudes regarding smoking, provided the basis for acceptance of these population-based interventions. As evident from the chapters in this book, tobacco use is but one of many population-based targets for improving health, and population health extends beyond policies that influence behavioral risk factors to include demographic and social influences (e.g., education, income), health care access and quality, and the interaction of these population influences with genetics and neurobiology.
Population health is a growing and diverse research area. Much of the early work in this area was primarily descriptive, focusing on the distributions of various health indexes within certain populations. Much of the recent research has focused on the mechanisms that produce these distributions of population health. This research is complex and is often limited by the mechanisms that can be gleaned from epidemiologic studies. The final section of this book on emerging tools for studying population health is an important contribution for improving the methodology to advance this science. Advancing population health methods is critical if we are to understand and target these mechanisms to develop population-based interventions that are empirically-based and have the potential to impact population health.
The National Institutes of Health's Office of Behavioral and Social Sciences Research (OBSSR) has an extensive history of advancing research on population health. This book is an outgrowth of work begun at OBSSR when Robert Kaplan, the co-editor of this book, was Director of OBSSR. Along with his co-editors Michael Spittel and Daryn David, Dr. Kaplan has drawn together in one book the work of many of the leaders in population health. It is the hope of OBSSR that this book stimulates rigorous and relevant research in population health that will improve the health of the Nation.
William T. Riley, PhD
Director, Office of Behavioral and Social Sciences Research
Page originally created August 2015