Population Health

6/4/14
 
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By Greg Scandlen,

from NCPA,
6/4/14:

I’ve been wanting to write about “Population Health” for some time now. It is a huge new trend that has risen under the radar of almost the entire population. Nearly every medical school now has a Department of Population Health or a Center for Population Health.

The concept is kind of creepy, but it is getting even creepier.

One of the reasons it is hard to write about this is there is no settled definition of what it is. …[they] define it as “the health outcomes of a group of individuals, including the distribution of such outcomes within the group.” They go on to explain –

We support the idea that a hallmark of the field of population health is significant attention to the multiple determinants of such health outcomes, however measured. These determinants include medical care, public health interventions, aspects of the social environment (income, education, employment, social support, culture) and of the physical environment (urban design, clean air and water), genetics, and individual behavior.

In other words: Everything under the sun.

Such an all-inclusive definition is not very helpful, so people keep trying.

They interviewed 17 “leaders” of the population health movement and found that each one has a different definition.

Now this is very peculiar. Vast resources are being invested into something that cannot be defined. What’s going on here?

It is chilling. First, it seems to be a raw power grab. The Kindig/Stoddard definition would place virtually every human activity under the management of “population health” experts — food, education, the arts, architecture, even “individual behavior” — all must bend to the demands of the new “population health” system. … we get a tiny elite anointed to manage the behavior of the entire population, all in the name of improving their health whether they want it or not.

Clearly these people are bored with the idea of treating one patient at a time. That is far too messy, and actual people are not very pleasant to deal with.

Even more chilling is the realization that in dealing with the health of a “population,” the needs of any individual are simply unimportant. Things become measured by averages. The average result will improve if we eliminate the outliers who bring down the average. This is sometimes known as thinning the herd. If we could rid ourselves of those people with serious disease, we would have a much healthier population, on average.

This calculation becomes even more compelling when costs are considered.

This is how the sickest people get left behind. Spend a little bit of money on “preventive care” to improve the health of the majority by a small margin, but forget about expensive organ transplants. The result is an improvement in the health of the population at very low cost.

The mathematics of population health drive these conclusions. And the current adoration of Zeke Emmanuel and Peter Singer suggests that this is exactly what lies ahead as long as we keep empowering the elite rather than the people.

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