Preventing Chronic Disease: July 2010: 10_0018 / Using Metrics to Improve Population Health

ESSAY
Using Metrics to Improve Population Health

Robert M. Pestronk, MPH
Suggested citation for this article: Pestronk RM. Using metrics to improve population health. Prev Chronic Dis 2010;7(4). http://www.cdc.gov/pcd/issues/2010/jul/10_0018.htm. Accessed [date].

Introduction
The Mobilizing Action for Community Health (MATCH) project proposes an incentive system that would reward improved health at the population level. Such incentives depend on metrics, but how should metrics be selected?

A logic model with theoretical, philosophical, or political grounding is an essential first step. A model conceptualizes the production of population health, and metrics are chosen on the basis of that conceptualization. To achieve population health, for example, should we seek improvements in access to care, in medical or disease conditions, or in the social, political, and economic underpinnings of society itself? Metrics are the yardstick by which assumptions in the model will be tested. They measure evidence of actual inputs, outputs, and outcomes. When choosing metrics associated with incentives, we must decide what type or magnitude of change we seek.

What population’s health should improve? Metrics can be applied to many units of analysis: a random collection of people; a family; an economic class or racial group; a neighborhood, city, region, or country; a commercial enterprise; or a subpopulation in any of these populations. Data must be available for the unit of analysis.

Although we can envision models (and metrics) that account for the range of political, social, and economic constructs thought necessary to improve population health, we must decide whether metrics should be selected for all constructs — or whether it is even politically possible to apply incentives across a broad range of areas. American culture is highly pluralistic and politically resistant to such a large-scale, comprehensive approach. No single body controls all these aspects of American public, private, personal, and organizational life enough to hold accountable all entities to which potential incentives apply.

It may be wiser to choose metrics associated with better health for a specific economic, racial, or ethnic group, for example, than for all groups collectively. Even this narrower focus on one group’s health can be politically challenging if it is seen to be at the expense of another group or stigmatizes that group.

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Preventing Chronic Disease: July 2010: 10_0018