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April 5-11 is National Public Health Week and the COVID-19 pandemic has amplified the significance of this annual effort to help make communities safe and healthy. 

Harrisburg University Population Health and Health Equity Professor, Dr. Nirmal Ahuja, has written a timely essay on population health, which the Centers for Disease Controls and Prevention calls “an opportunity for health care systems, agencies, and organizations to work together to improve the health outcomes of all the communities they serve.”

The essay, titled, “Systems Thinking in Population Health – A collective Approach beyond the Traditional Healthcare System,” can be found below:

Systems Thinking in Population Health – A Collective Approach beyond the Traditional Healthcare System

Dr. Nirmal Ahuja

According to the Centers for Disease Control and Prevention (CDC), population health provides “an opportunity for health care systems, agencies, and organizations to work together to improve the health outcomes of all the communities they serve.” The upsurge of seemingly inevitable socioecological factors and geopolitical challenges are making population health even more challenging than ever before. Improving health outcomes and achieving health equity in present times will require a more holistic and broader approach that addresses social, political, economic, and environmental factors that influence health. One of the solutions to such a multidimensional problem is having systems thinking approach to population health.

With the emergence of a new public health subfield of health policy and systems research, there have been essential calls for a social and scientific perspective that challenges the biomedical and technocratic understanding of health system policies and practices. Today, population health faces a paradigm challenge that frames an understanding limited to the healthcare sector. However, there is a need to cross that limited boundary and have a paradigm shift in our approach, which may be essential to combat unintended consequences arising from other sectors. We must be aware that health policies and systems are complex social and political phenomena. Hence, it is essential to identify necessary leverage points beyond the health sector’s scope and collaborate with all involved to better population health.

Systems knowledge and thinking is a way of investigating and communicating complex public health issues. The core of systems thinking is seeking to understand how things are connected in the total system. Looking beyond the traditional healthcare system to address population health is what makes the concept collaborative, integrative, and simultaneously energizing and challenging. No longer can the responsibility for managing population health begin and end at the healthcare system’s doors. From healthcare settings to non-healthcare settings, industrialists to environmentalists, educators to community leaders, clinicians to paramedics and non-paramedics, researchers to policymakers, and the community themselves, we must all collectively understand the role we play in managing population health and wellbeing. We must think beyond our comfort of the healthcare ecosystem consisting mainly of the healthcare institutions and become proactive about engaging diverse sectors which address the socioecological and sociopolitical factors in one way or another. Managing population health requires an integrated ecosystem, one that puts a defined population of consumers and all the social drivers of health at the center of every decision being made.

On a broader level, systems thinking has huge and untapped potential, first in deciphering an entire health system’s complexity and then applying this understanding to design and evaluate interventions that improve health and health equity. It will help the health experts and leaders engage productively with the conceptual and theoretical roots of exploring health and other disciplines collectively. It holds a strong analytical focus on health systems’ social and political aspects, including social medicine and medical anthropology. Furthermore, systems knowledge and thinking enables population health leaders to change or modify their leadership paradigms and develop the intuitive skill that could help them identify necessary leverage points beyond the scope of the health sector and eventually collaborate with it to better the lives of all individuals. Overall, this integrated ecosystem-based approach sets the community at the center of every decision-making, upholds frequent interaction among stakeholders from diverse areas, including policymakers, and helps merge public health’s unclear identity into a comprehensible framework, which contributes towards reducing health disparities, fostering health equity, and eventually improving population health outcomes.

Nirmal Ahuja, DRPH, is Instructor – Population Health and Health Equity in the Master of Science in Nursing at Harrisburg University of Science and Technology. 


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