Debbie Stark: ICS will help us improve population health after Covid
Having directors of public health as key members in new structures will help us make the right investments for local communities, writes the regional director of public health for the South West NHS.
Different subsets of the population have experienced different Covid outcomes. Some of these differences have become apparent in relation to geography or underlying health conditions, ethnicity or occupation.
How are we using our knowledge of the pandemic to strengthen our understanding of population health vulnerabilities? Can we increase the resilience of targeted population groups to give everyone the best chance of coping with future health or other shocks?
It seems like a huge task. How do we solve everything? Where to start ?
The first piece of good news is that the pandemic has brought to light differences in health outcomes and the need for us to address these disparities. There is political, organizational and public interest in doing something different to address it.
The second piece of good news is that public health directors have been studying disease trends for many years in order to promote good health. They understand their local populations and the drivers of ill health.
Key role of DPHs
The advent of integrated systems of care (ICS) and advances population health management (PHM) offers us a great moment to capitalize on working in partnership to tackle the underlying issues that lead to these differences in health outcomes.
Knowledge can also be used to assess and improve care for an entire population now and for the next generation.
Having worked in this space for 20 years, I’m thrilled to see how the excitement in my area is blossoming around this opportunity.
ICS and the new structures under them deliberately bring the NHS and councils together, and having DPHs as key members of these new structures gives ICS the best expertise on how to make the right investments for local communities. .
Working together goes beyond bridging bridges between the NHS and social services. Local authorities are already working with the voluntary sector, developing their economies and improving housing. They are in the best position to maximize the PHM approach.
Population Health Management Explained
A quick crash course in PHM for beginners: Current approaches to linking data and using analytics allow us to better understand the outcomes and behaviors of communities and individuals. Once we know why and which citizens end up in the GP chair or the hospital ward, we can look back to offer interventions to address the circumstances contributing to their poor health.
These can be physical, mental or holistic. Knowledge can also be used to assess and improve care for an entire population now and for the next generation.
On Covid, it is recognized that certain geographic areas or subsets of the population have experienced periods of “sustained transmission”. They have consistently had higher infection rates for longer than other regions. So how can we use MPS to help us understand the causes and what we could do differently together?
We could start with an underlying risk for Covid, like being a smoker. Current smokers are more likely to go to hospital for Covid and report more symptoms than non-smokers. Smoking is also a major cause of cardiovascular disease, which is the leading cause of death worldwide. The evidence on smoking and lung cancer is clear, and cardiovascular disease remains one of the areas where preventive interventions can improve health and well-being within five years.
But if you are a young smoker, this disease may not develop for 30 years. Children whose caregivers smoke are four times more likely to start smoking themselves. Among regular smokers, 98% have friends who smoke, compared to 42% of non-smokers, and 78% of regular smokers have family members who smoke, compared to 64% of non-smokers. It should come as no surprise, therefore, that tobacco use and the diseases resulting from it are concentrated in certain population groups.
Invest in life chances
We can do a lot for that person with lung cancer today. From an NHS perspective, we often focus on the end result – the person sitting in the consultant’s office talking about the operation they need and the best treatment for their illness.
But could we do more for these individuals and communities to help those who already smoke to quit and those who haven’t started to never take up the habit? This should be seen as a long-term investment in the life chances of those who need this support the most.
What can data linking tell us about these people? What community do they live in? What is it about this community or peer group that inspires more of its citizens to start smoking? What is the route of connections with previous points of contact with the NHS or other agencies? What is already on offer and what can we do differently now? Can we use reverse pathway mapping via PHM to ask ourselves, how did this person get to this situation?
To continue the smoking analogy, we may not be able to cure the person with lung cancer today, but we may be able to improve the interventions offered to their community to reduce lung cancers from the future. What statistics can we use to give us an indication of the impact on services in the next 10, 20 or 30 years? And what about the wider benefits?
A healthier population will benefit the economy as well as individuals, who will have the opportunity to maximize their working and earning life expectancy.
Population health management can help us understand the pattern of disease. Working in partnership can help us prevent it.
For more information on how you can use Population Health Management join the PHM Academy free.
Debbie Stark, Regional Director of Public Health, South West NHS