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Electronic Letters to:
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eLetters: Electronic letters published:
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Population Health: A New Paradigm for Public Health
- Richard K. Riegelman M.D., Ph.D. (17 May 2004)
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Richard K. Riegelman M.D., Ph.D., Professor of Epidemiology and Medicine George Washington University School of Public Health and Health Services
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sphrkr{at}gwumc.edu Richard K. Riegelman M.D., Ph.D.
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Awofeso1 usefully frames the history of public health into six eras each with its own paradigm for public health (1). He recognizes the need for a new 21st century paradigm but fails to recognize that one is already emerging that of population health. Population health asks us to look broadly not only at the role of health promotion and disease prevention but at the need for and interactions between interventions at the individual, high risk group and community or population levels. The Population health paradigm, as defined by its Canadian advocates(2,3), differs from health promotion, the current paradigm described by Awofeso, in at least the following 5 ways. Population health recognizes the essential linkage between medicine and public health. It sees public health goals ranging from disease eradication, control of the impact of globalization, and the environmental impact on disease as requiring organized community action and not merely individual behavioral change. Second, population health recognizes the key contribution of research and the need to ensure that basic behavioral, environmental and socio-economic research is supported along with basic science research. Third, the concepts of population health force us to address the demographic issues of society from the impact of health disparities to the impact of reducing birth rates to the consequences of an increasingly aging society. Fourth, population health brings us face to face with the trade-off we make everyday between social investments in individual medical care and the social investment in the health of current and future populations. Finally population health requires an interprofessional or ecological approach (4) in which the interacting impacts of multiple interventions at multiple levels are seen as potentially greater than the sum of the specific interventions. Population health is a paradigm that can bring public health back to its roots as a social movement built on a scientific base. Population health can help us tackle the increasing complicated and interacting causes of morbidity and mortality. Population health may even allow us to see medicine as a very important component of public health. 1. Awofeso N. What’s New About the “New Public Health”? Am J Public Health. 2004:94:705-709. 2. Frank J. Why Population Health? Canadian Journal of Public Health 1995:162-64 3. Health Canada: Population Health Approach http://www.hc- sc.gc.ca/hppb/phdd/whatsnew.html viewed 5/12/2004 4. Institute of Medicine, Who Will Keep the Public Healthy? Educating Public Health Professionals for the 21st Century. Washington D.C. National Academy Press 2003. |
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