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Challenges to an integrated population health research agenda: Targets, scale, tradeoffs and timing

by Laura Gottlieb, M. Maria Glymour, Ellen Kersten, Elizabeth Taing, Erin Hagan, David Vlahov, & Nancy E. Adler

Keywords

  • Population health; 
  • Causal inference; 
  • Multilevel; 
  • Health policy; 
  • Inequalities.

“’But if I ran the zoo,…I’d make a few changes. That’s just what I’d do….’“

(Giesel, 1950)

Applied to the context of population health research, Dr. Seuss’ book, “If I Ran the Zoo” provokes an important question about health care resources allocation. If given the opportunity to ‘run the zoo,’ do population health researchers have the evidence needed to make decisions that will maximize positive health outcomes for all people? The answer is, “Not yet.” Although translating the existing evidence on social and behavioral determinants of health and health inequities into effective action could achieve large population health gains (Commission on Social Determinants of Health, 2008) – Galea et al. estimated that eliminating excess deaths associated with limited education would save 245,000 lives annually in the United States (2011) – evidence gaps hamper the development of a coherent strategy for improving population health and achieving health equity. In this commentary, we discuss issues challenging the development of a unified strategy for population health research that can inform policy and practice.

This paper emerged from discussions with two interdisciplinary working groups convened to advise a new National Program of the Robert Wood Johnson Foundation (RWJF) on research priorities. Evidence for Action: Investigator-Initiated Research to Build a Culture of Health (E4A) is designed to develop the evidence base aligned with RWJF’s vision of building a national “culture of health” ( RWJF, 2015). E4A supports innovative, rigorous research on the impact of programs, policies, and partnerships on health and well-being, with a particular focus on research that advances health equity. The focus of the new national program reflects the growing relevance of individual and community-level determinants of health to multi-sectoral stakeholders in health research and an emphasis on bridging initiatives related to population health and health care.

The working groups included scholars and practitioners from health services, public health, social and behavioral determinants of health, and health policy. Participants discussed existing evidence and evidence gaps related to policies, programs, and systems with the greatest potential to advance population health and health equity, and how the evidence could be best applied and disseminated. Reflecting the diverse perspectives of the working group members, discussions coalesced around tensions and dilemmas in four areas: the relative effectiveness of interventions targeting individuals versus systems (target debates); whether intervention models are most useful when developed for local, state, or federal jurisdictions (scale debates); accounting for unintended consequences, spillovers and tradeoffs; and determining when there is sufficient evidence to inform action (timing debates).

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