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2 - The Population Health Approach in Historical Perspective

from PART I - History as Critique: Debating the McKeown Thesis and the Postwar Policy Consensus

Published online by Cambridge University Press:  12 September 2012

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Summary

There is no definitive history of the population health approach. In living memory, the important epidemiological research published during World War II by Jerry Morris and Richard Titmuss is invoked as a seminal model of population health analysis. Morris and Titmuss carefully demonstrated that the incidence of such “individual” afflictions as juvenile rheumatism, rheumatic heart disease, and peptic ulcer all varied according to changing social conditions, such as the rate of unemployment. Along with others, they sought to widen the scope of traditional public health beyond disease prevention toward social medicine, anticipating to some extent the philosophy of the Lalonde Report and the World Health Organization's concept of positive health. However, social medicine never successfully institutionalized itself and instead an academic and clinical epidemiology tended, if anything, to diverge from practical public health work during the postwar decades.

The recent resurgence of the population health approach has developed from dissatisfaction with some of the limitations of a strongly individual-oriented methodology, which has characterized recent clinical epidemiology. This is a paradigm that has scored notable successes in identifying risk factors such as smoking and hypertension but that, it is argued, has become too rigid and all-pervasive, partly because of its convenience for the administrative and accounting approach of the managerial regime politically imposed on the health service sector during the 1980s. However, from a longer-term perspective, the claims of each of these methodologies can perhaps be helpfully located within a much wider-ranging debate over the relationship between economic growth and human well-being, which provides the historical context for the emergence of a concept of population health.

Type
Chapter
Information
Health and Wealth
Studies in History and Policy
, pp. 23 - 45
Publisher: Boydell & Brewer
Print publication year: 2005

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