Preventing Chronic Disease: July 2010: 10_0005 / Measuring Population Health Outcomes

SPECIAL TOPIC
Measuring Population Health Outcomes

R. Gibson Parrish, MD
Suggested citation for this article: Parrish RG. Measuring population health outcomes. Prev Chronic Dis 2010;7(4). http://www.cdc.gov/pcd/issues/2010/jul/10_0005.htm. Accessed [date].

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Abstract
An ideal population health outcome metric should reflect a population’s dynamic state of physical, mental, and social well-being. Positive health outcomes include being alive; functioning well mentally, physically, and socially; and having a sense of well-being. Negative outcomes include death, loss of function, and lack of well-being. In contrast to these health outcomes, diseases and injuries are intermediate factors that influence the likelihood of achieving a state of health. On the basis of a review of outcomes metrics currently in use and the availability of data for at least some US counties, I recommend the following metrics for population health outcomes: 1) life expectancy from birth, or age-adjusted mortality rate; 2) condition-specific changes in life expectancy, or condition-specific or age-specific mortality rates; and 3) self-reported level of health, functional status, and experiential status. When reported, outcome metrics should present both the overall level of health of a population and the distribution of health among different geographic, economic, and demographic groups in the population.

By far, the most fundamental use of summary measures of population health is to shift the centre of gravity of health policy discourse away from the inputs . . . and throughputs . . . of the health system towards health outcomes for the population. This is not to imply that the resources used and activities undertaken by national or regional health systems are unimportant; quite the contrary. But our understanding of their roles and importance is more appropriate if guided by the real “bottom line,” namely their influence on population health.

Michael C. Wolfson (1)

Definitions and Introduction
The World Health Organization defines health as “the state of complete physical, mental, and social well-being and not merely the absence of disease or infirmity” (2). To achieve this vision of health for its members, a healthy society must establish and sustain conditions, including a healthful natural and built environment, and equitable social and economic policies and institutions, that ensure the “happiness, harmonious relations, and security of all [its] peoples” (2,3). Positive health outcomes for people include being alive; functioning well mentally, physically, and socially; and having a sense of well-being.

The level and distribution of health outcomes in populations result from a complex web of cultural, environmental, political, social, economic, behavioral, and genetic factors (Figure). In this causal web, diseases and injuries are intermediate factors, rather than outcomes, that may influence a person’s health. Lung cancer, for example, has a substantial effect on physical function and lifespan, while first-degree sunburn has little effect. Health outcome metrics are standards for measuring health outcomes. Recommending a set of metrics for monitoring a population’s health outcomes — as opposed to a person’s health outcomes — is the objective of this essay.


Figure. A causal web that illustrates various factors influencing health outcomes and interactions among them. Solid arrows represent potential causal relationships between factors, diseases, and outcomes. Dashed arrows represent potential feedback from outcomes and diseases on proximal and distal factors. Distal and proximal factors operate through both intermediate factors and directly on health outcomes. For example, a person’s level of education can directly influence his or her subjective sense of health and level of social function and also influence intermediate factors, such as diet and exercise. Similarly, the understanding that death or loss of function may occur as the result of a person’s lifestyle or social and economic factors, such as education and poverty, may influence those factors through either behavior change or changes in social or economic policy. Examples of factors, diseases, and injuries were chosen to provide a sense of the breadth of available factors. To improve readability, the relationships among proximal factors, physiologic factors, diseases and injuries, and health outcomes have been simplified. Adapted from references 4-6. Abbreviation: ASCVD, atherosclerotic cardiovascular disease.


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Preventing Chronic Disease: July 2010: 10_0005