Joining the dots for population health

Population health is one of the top priorities for integrated care systems, the NHS, us at The King’s Fund, at a global level and increasingly for anyone in health and care who recognises that many of the current challenges facing the health and care system in England are often linked to the lack of earlier and more concerted focus on population health.

We define population health as 'an approach aimed at improving the health of an entire population. It is about improving the physical and mental health outcomes and wellbeing of people within and across a defined local, regional or national population, while reducing health inequalities.'

In short, it means ensuring the best possible health and care for all.

Delivering this requires an understanding and joining up of component areas of population health into a comprehensive approach. For example, public health, population health management, tackling health inequalities, personalised care, engagement and experience, system transformation (a broader agenda often focussed on structural improvements and others also). In practice, while population health is an aspiration for the health and care system in England, focus often remains on one or a handful of these component areas rather than a joined-up population health approach as a whole.

Over the past 18 months, we have been working with five national leaders in NHS England, their teams, and leaders for population health in 12 integrated care systems to understand what is needed to join the dots for population health. We found three key themes.

A clearer narrative is needed for population health

There is a shared common purpose across the areas outlined above for improving population health and tackling health inequalities. But it is often not articulated clearly in communication (for example strategy coming from central government and national bodies). Instead, the starting point of such communication is often component areas – which are important, but without a clearer narrative centring around this shared purpose, can look like disparate initiatives competing for focus. This prompts people at a local level to prioritise one area over the other, rather than develop a comprehensive approach to population health based on local needs and evidence of best practice, and with co-ordinated action in all the key areas to fit together to form a bigger whole. The latest NHS operating framework published in October 2022 does attempt to better do this, but turns focus rapidly to delivery components and approaches rather than taking time articulate the shared common purpose in depth and clarify the fit of the constituent parts into a comprehensive approach for population health. Even with this clarified, there will still be significant constraints to face in terms of practical delivery. But as a starting point, a clear and joined up narrative rooted in purpose (population health) remains crucial.

'But as a starting point, a clear and joined up narrative rooted in purpose (population health) remains crucial.'

Numerous green shoots exist and we should learn from their experience

There are numerous examples of good practice that exist across the country contributing towards population health: a Population Health Academy in Lancashire and South Cumbria, health inequalities efforts across West Yorkshire and Harrogate, ICS leadership for population health in North and North-East England, a population health management roadmap in South West London, public health systems coming together across Cheshire and Merseyside for population health, cross-systems working from Oldham in Greater Manchester, and more. While this impressive array of experience exists, there is potential for a bigger national role to help share the learning on how areas are joining the dots for population health, and to facilitate areas like these to better connect as a powerful force for positive change. There is also potential to understand more about the realities facing people trying to work more in this way. Even if areas are doing well, the lack of strategic narrative about how policies relating to population health cohere from central government and national bodies means that competition between key areas makes it harder for local leaders to do this in practice. Especially given the backdrop of economic and workforce challenge, it is important to clarify the shared ambition, remove barriers and to make it easier for people join the dots in practice.

Focusing on population health is not an optional extra

The final theme serves also as a stark warning. In the face of increasing pressures, there is a risk of health and care leaders choosing to prioritise immediate issues (for example A&E waiting times, elective lists, finances) over a sustained focus on population health. The reality is that the two are part and parcel of the same. ‘Immediate pressures’ are often the longer-term consequences of, or have been exacerbated by, inadequate focus on population health previously. Even under pressure, focus is therefore still needed on both. Population health is not an optional extra but a core focus that is needed to create a sustainable model for health and care. We know that the national directors we worked with understood this and will do their best to ensure the long-term doesn’t drift in terms of priority or voice. But we also recognise the challenges leaders face in doing this in practice. To truly have impact, this message is one that others at a national, including political, level will need therefore also to heed.

'Population health is not an optional extra but a core focus that is needed to create a sustainable model for health and care.'

This work has helped to surface important themes for strengthening population health efforts in England. The aspiration for population health is clear. Exploring these themes and agreeing practical action will increase its chances of becoming a reality. To help with this, we have dedicated our November 2022 Population Health conference to continuing this conversation. We have invited many people and sites who contributed to this work to join us over the course of four days to share their insights and help take this conversation further to help join the dots for population health. We hope you can join us too and help turn population health aspirations into a meaningful reality.

With thanks to all those who contributed to this blog and who have been involved in this work to date.