Defining Population Health

Published Date

Steve Singer, ACCME Vice President for Education and Outreach, interviews Carolyn Lopez, MD, President, Chicago Board of Health, about defining population health.


>>SINGER: Hello, my name is Steve Singer, I'm the Vice President for Education and Outreach at the Accreditation Council for Continuing Medical Education. Today, we're  going to talk with Dr. Carolyn Lopez who is the president of the Chicago Board of Health. We're going to talk about addressing population health issues with CME.

>>LOPEZ: Good morning.

>>SINGER: Thanks for joining us today.

>>LOPEZ: My pleasure.

>>SINGER: So first, tell me a little bit about the role that you have at the Chicago Board of Health.

>>LOPEZ: Well, as President of the Chicago Board of Health, we as an advisory board do a number of things working closely with the Department of Public Health, so that we are giving them advice as we feel is appropriate and needed on matters that pertain to the general health of the people who live in our city. We also are responsible for passing regulations that are needed to implement the ordinances, health related ordinances, that are passed by our city council.

>>SINGER: Great, but could you help to define for our audience when you think of public health, population health, what they mean to you?

>>LOPEZ: Sure. Public health, population health, both look beyond what's happening in an individual doctor's office with an individual patient, and looks at the larger group, a larger community and tries to find a source and an explanation if there are patterns of problems that are appearing. So I think there are classic examples of this that are both very old and very new. The very classic old example is really the forebear of public health. It was a physician in London, who noticed an outbreak of cholera, studied the sources of it, and traced it back to a single water pump where people were...

>>SINGER: I've seen the map of all the dots, of all of the different. Right.

>>LOPEZ: Where people were drawing the water, and he solved the cholera outbreak by simply removing the handle from that water pump, so people could no longer draw the water. So again, individually people were getting sick, but there was a larger population that was getting sick as well. More currently, I think the classic example is the problem in Flint, Michigan, with the lead in the water and, again, individuals having symptoms, but the physician who is credited with having brought forward and really emphasized and made public the... what was going on was a physician who looked beyond the individual and just said, "What's happening with the lead testing that we're seeing in our community and is there a difference?" Because there were concerns that were being raised.

 >>SINGER: Right.

>>LOPEZ: And lo and behold looked at the available data and found that there was a difference.

>>SINGER: Okay.

>>LOPEZ: So those are examples.

>>SINGER: Okay, so great. So I'm hearing some themes; data driven, a frame that's larger than a single patient or a single group of patients. I've also heard in terms of models of factors that address population health. People talk about social determinants of health, and other factors. Clean air and water are an important fundamental. What other areas are sort of the facets of public health?

>>LOPEZ: Sure. Other facets of public health include a variety of things. When we look at issues of homelessness, when we look at issues of inadequate access to food. Whether it's simply a limited access of fruits and vegetables and the so-called food deserts.

>>SINGER: The nutrition and...

>>LOPEZ: The nutrition, the so-called food deserts that exist in too many of our communities, or other issues around food that people are not making appropriate choices and it happens for many reasons, oftentimes they're financial, they're economic reasons. So those are some additional examples of social determinants of health. Poverty, in and of itself, will lead to many of these particular issues. And of course, we know that housing, I've talked about homelessness, and mentioned homelessness. But even poor housing will create potential problems. In Chicago in fact, that's the biggest source of lead poisoning, it's not in the water, but the age of the housing stock that we have in our city.

>>SINGER: Sure.

>>LOPEZ: But beyond things like that, we know that crowded living conditions, poor ventilation can all lead to other types of problems, whether it's, again, classically tuberculosis or more recently, other kinds of communicable diseases where close proximity makes easy transmission of infectious diseases.

>>SINGER: Okay, so that's helpful. It sort of gives us, what I'm sure is, the tip of an iceberg about all the different factors and determinants that factor into the health of populations.