‘What has population health got to do with me, an eye surgeon?’ I asked myself this after a long day working in the extra corneal clinic set up on a Saturday to cope with the backlog of patients created during the Covid-19 pandemic.
Other clinicians may be pondering the same question, feeling uncertain about their role in and relevance to population health (a whole-systems approach that aims to improve health and care for populations). Some may feel that it should be left to public health specialists. Others may not have thought about it at all. Clinicians’ reservations about getting involved may be further compounded by heavy clinical workload.
However, perhaps there is a way for clinicians to step into this work purposefully without feeling completely overwhelmed. In 2018, The King’s Fund published a vision for population health (see figure) that can help clinicians to make sense of the interconnecting factors that determine a population’s health.
The four pillars of a population health system
I found this framework incredibly useful in helping me understand the factors that fall beyond the immediate reach of the health and care system, but still affect health, e.g, employment, housing, education, or surrounding community, and how these factors have an impact on the health outcomes of my patients. Reflecting on these determinants and mapping them to my own clinical observations has given me a useful insight into my role and agency in population health, and the opportunities for innovation and improvement.
'As clinicians, our focus can often be on our clinical care-giving role, and risk overlooking other important aspects of patient care...'
Using the framework also reminds me of the challenges facing my diverse patient population: the patients who do not speak English, for whom there is no accessible post-cataract surgery advice available; the lack of accessible appointment for patients with physical disabilities; people with severe diabetic eye disease whose financial circumstances mean it is challenging to change their diet and lifestyle; the socially isolated older people with severe visual impairment who are reluctant to move around for fear of falling over – and so many other examples that highlight the deep-rooted health inequalities within our clinical practice. As clinicians, our focus can often be on our clinical care-giving role, and risk overlooking other important aspects of patient care – including health promotion, risk factor modification and community engagement – that we could employ to improve population health and shift to a more proactive and sustainable type of care outlined in the NHS Long Term Plan.
Pausing and taking time to meaningfully evaluate the context of a particular health care setting and the needs of a particular patient group or population before planning change can be daunting. In fact, it is often the hardest step in creating change and transforming practice. Clinicians may first explore their own skills and expertise by reflecting on their experience in relation to population health to understand what their strengths and weaknesses are; as well as consider using a framework to help them explore relevant population health improvement practice examples. This will in turn empower them to work towards turning their aspirations for change into meaningful transformations at a population level.
'...being familiar with the work means I can signpost patients to other relevant services and support groups based on their needs...'
But as clinicians we don’t need to do this work alone. Building relationships and partnerships with people working in the public health system and beyond, including those working in local authorities, commissioners, charities, voluntary organisations, and being familiar with the work means I can signpost patients to other relevant services and support groups based on their needs, as well as linking them to the resources that could help them overcome some of the barriers in health and care linked to the wider determinants of health.
Using the framework as a lens to view my work from a different perspective has enabled me to think about both the needs of all my patients, my role in population health and my role in addressing health inequalities, which have widened as a result of the Covid-19 pandemic. The challenge of addressing these inequalities will not dim in the aftermath of the pandemic and as clinicians we can contribute to and lead work on population health to help shape the health of the populations we care for.