Population Health

Traditional health care policy was based more on the health of individuals than on the
health of populations (Wolfson, 1994b). This type of health care policy has a stronger focus upon responding to illness through direct patient care, rather than methods that looked at a population as a whole. The latter philosophy has become known as “population health.”

Population health primarily differs from traditional medical and health care thinking in two ways. First, population health strategies address the entire range of factors that determine health, while traditional methods focused on risks and clinical factors related to particular diseases. Second, population health strategies are designed to affect the entire population, instead of the traditional one-patient-at-a-time approach {Federal/Provincial/Territorial Committee on Population Health 1994 39 /id}. Basically, population health concentrates on elements that amplify the health and well-being of the overall population. Traditionally, risk assessment has focused on the analysis of biological, chemical, and physical data. More recently however, the discipline has broadened to include study of the effect of various determinants on levels of risk experienced. For example, risk levels could be assessed in those of differing socio-economic status. As well, attention has been shifting from regulatory and non-regulatory risk mitigation strategies traditionally employed in the field of risk management to strategies more characteristic of the population health approach (e.g. community action). In addition, greater recognition has been given to the impact of various determinants on the effectiveness of risk mitigation strategies, and efforts are being made to design and implement strategies in a way that takes into account these impacts. Increased effort to include input from stakeholders throughout the course of the risk assessment/risk management process is also being taken, as is done in the realms of health promotion and population health. In opposition to traditional thought, it can be noted from the discussion above, that “risk management” and “population health” are intrinsically linked. In essence, they provide different viewpoints for examining the same issues. Integrating the tools and approaches used within the two fields can provide a more effective framework for dealing with health issues. Integrating the fields of population health and risk assessment/risk management allows agencies to analyze and respond to risks using a broader perspective, and to do so in a consistent and comprehensive manner. Incorporating a population health approach into risk assessment/risk management strengthens the basis for collaboration with other programs (i.e. health care, health promotion and health policy), with other jurisdictions and with sectors other than health. By engaging a broader range of partners with objectives that complement risk assessment/risk management, health issues can be addressed that no single program, jurisdiction or sector could tackle on its own. Using an integrated approach ensures that: the risks that are most important from a population health perspective are identified; risks are assessed in a comprehensive manner; effective and innovative risk management strategies are developed and implemented, and resource allocation is performed appropriately. A broader approach also implies increased consultation with experts, the general public and other stakeholder groups, which will ensure that their valuable input and perspectives are taken into consideration early in the risk assessment/risk management process.

Emerging Population Health Risks
The increasing rate at which new products and new technologies are being introduced into commerce raises other concerns about the potential for other types of population health risks to emerge. Cellular telephones, which became available to the general public in Canada in 1986, have proliferated rapidly since then and in half of Canadians own a cellular phone and there are more than 18 millions subscribers in Canada in 2007. Such wireless communications devices emit radiofrequency field which, although weak, have the potential to interact with biological systems. Concerns about the potential for cellular phones to increase the risk of brain cancer have resulted in the initiation of a multi-country epidemiological case-control study of cellular phones and brain cancer coordinated by the International Agency for Research on Cancer (IARC). The Centre for Population Health Risk Assessment will be one of two Canadian sites participating in this important investigation.

Another emerging health risk issue is prion disease including bovine spongiform encephalopathy (BSE), more commonly known as mad cow disease which is a fatal neurodegenerative disease that affects the central nervous system of cattle.  The current belief is that the primary means of BSE transmission is through cattle eating feed contaminated by the rendered material from other BSE-infected cattle.  The majority of BSE cases have occurred in the United Kingdom, but the disease has also affected both European and non-European countries around the world including Canada. BSE is an important public health issue because it may be transmitted to humans through consumption of contaminated bovine products.  The human form of the disease, known as variant Creutzfeldt-Jakob disease (vCJD), is currently untreatable.  Important BSE risk management strategies have been implemented include banning ruminant protein in feed and the removal of specified risk materials (SRMs) known to carry a high risk of BSE. 

Not all emerging population health risks are predominantly environmental in nature. The history of terrorist events can be dated far back to the first century, but since then, especially since the beginning of the 20th century, with more advanced technology and scientific knowledge, such terrorist events have occurred with increased frequency and at more destructive magnitudes. CBRNE is an acronym that stands for chemical, biological, radiological, nuclear, and explosive.  Any of these agents may be intentionally used in a terrorist event.  In addition to the physical damages to civilians and properties, the psychological effects of a terrorist attack can outlast the physical symptoms and affect a much larger audience. Integrated action plan that can reduce or prevent both the physical and psychosocial effects these events have been well thought-out but terrorist events pose a new health risk to the general public.
Other immerging or re-immerging health risks are pandemic influenza, adverse drug reactions to pharmaceutical products, nanoparticles, genetically-modified foods (GMO), climate change to name a few.