July 2010 - Hot Topic

How does working with Priority Populations relate to Population Health?

by Daniela Seskar-Hencic, Chair of Access Equity and Social Justice Workgroup and Manager, Population Health Planning and Evaluation, Region of Waterloo Public Health

What do we really mean when we say we want to address and improve population health?

Population health simply means what it says — the health of the overall population. In Public Health we believe that our interventions reach and create change at the population level. Many public health practitioners are debating these days how the new Ontario Public Health Standards may affect their practice by inviting attention to the priority populations. Moreover, some are asking if this approach actually means moving away from universal interventions.

Not at all.

Addressing the needs of priority populations actually happens within the universal approach. Some of the confusion may come from the term “general population” which we use commonly in our practise. We often use “general population” to talk about who our universal interventions are for.

But who is the “general population”? Does that term even make sense? I’m suggesting that there is no such thing as health promotion for the general population. In fact, when we think we are addressing the general population, we are most likely reaching the segments of the overall population that are interested, ready, capable, and have easy access to what we have to offer. Those people are not the “general population”, they are simply the segment of the population that is most likely to receive and perhaps respond to our interventions. We need to be aware that there are other segments of the population that we may be missing and perhaps it is those very segments that carry a disproportionate burden of poor health outcomes. If they carry a disproportionate burden, reaching out to those segments will have a greater impact on overall population health.

This lack of a “general population” has been well known in the fields of marketing and social marketing. No responsible social marketing expert would advise their client to advertise to the general population because they know that they would not reach a large number of people, and also because they know they would not successfully reach anyone in particular. They target their messages to certain segments of the population. So how can we change our approach and stay away from the term “general population” while trying to achieve overall population health goals? This is where priority populations come in.

Priority Populations

The OPHS directs public health units to identify “priority populations through surveillance, epidemiological analysis, research, community and other stakeholder consultations”. Then practitioners are invited to look at either adjusting universal interventions to increase their accessibility and appropriateness for these sub-groups, and/or develop specific strategies to address the existing health inequities. In other words, this approach invites the practitioners to find the right balance between universal and priority population-focused interventions to increase impact and improve overall population health.

Here is an example of how this may happen. If all women over the age of 50 are a population whose health outcomes we want to improve by promoting breast cancer screening, then perhaps women who do not have a family doctor, are recent immigrants, or live in rural areas may be priority populations for this intervention. By balancing our resources for promotion of breast screening between universal promotion activities and those that are tailored to these sub-groups, we will increase their screening rates while at the same time still reaching the overall population of women over 50.

The Region of Waterloo Public Health has recently posted information about this important public health topic: How does Work with Priority Populations Relate to Population Health? [PDF]