What Is Precision Population Health? Here’s Why It’s Needed

The Covid-19 pandemic has once again shown that “one-size-fits-all” or even “a-limited-number-of-sizes-fits-all” doesn’t really work when trying to protect or improve the health of a population. The spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and the responses to the pandemic have clearly affected different people in different ways. But this current pandemic certainly hasn’t been the first time that simply telling everyone in a population to do the same thing hasn’t been the best approach. After all, as Buffy once sang to Big Bird on the TV show Sesame Street, “Different People, Different Ways.” And when making a decision that may affect many different lives differently, it’s important to consider a word that rhymes with decision. That word is precision, which brings up the concept of “precision population health.”

People are different with different circumstances

The term “precision population health” may be reminiscent of the term “precision medicine” that’s become more and more popular over the past decade. These two “precision” terms are related and can help each other, sort of like a cake and chocolate chips. But they are not the same.

So, how precisely are they related yet different? Well, take a look at what the White House said when then-President Barrack Obama mentioned the impending launch of the Precision Medicine Initiative in his 2015 State of the Union address. It was described as “Health care tailored to you.” The White House announcement indicated that this Initiative would move away from the fact that historically “most medical treatments have been designed for the ‘average patient.’”

Indeed, going for the average could result in, well, some very average results. That’s not great since not too many coaches tend to tell teams during their half-time speeches, “All right everyone, let’s go for something really average.” The musical group Queen sang the song, “We are the Champions” and not “We are the Average.” The 2105 White House announcement went on to explain that, “Precision Medicine, on the other hand, is an innovative approach that takes into account individual differences in people’s genes, environments, and lifestyles.”

Precision means more accurately tailoring approaches to better match these differences

Accounting for differences in people’s bodies, environments, and lifestyles does make sense. After all, if you give 100 different people the exact same medical treatment, food, living situation, piece of advice, pick-up line, music, thong, or anything for that matter, there’s a decent chance that they are all not going to respond the exact same way. Instead, it’s much better to really understand how specifically different people may differ from one another and then tailor what you give or do to each of them accordingly. This sort of exactly embodies what’s meant by the word “precision,” which Dictionary.com defines as “accuracy; exactness.”

Accuracy and exactness are certainly important in decision making. Naturally, when making important decisions—such as ones that involve something like, you know, life and death—it’s probably not great to say, “Let’s try to be as inaccurate and non-exact as possible.” For example, when buying clothes, you probably wouldn’t simply tell the salesperson, “Just give me something made out of some kind of fabric. The specific size, color, and style do not matter.” After all, there is no such thing as a phosphorescent pink velour tracksuit for all people and all occasions. No, instead, you probably want something better tailored to your body shape and size, your interests, your fashion sense, your mood, and your purposes. So, why oh why, do we not do more such tailoring when it comes to something a whole lot more important than what clothes you wear—namely, health?

Precision population health means being more proactive and not waiting until people reach clinics and hospitals

While precision medicine is a step forward to achieving better health, it by itself can fall short in several different ways. First of all, precision medicine has focused on what happens in traditional healthcare settings, such as in a medical clinic or a hospital. However, by the time a person has reached a clinic or hospital, it may be a little too late to prevent bad health outcomes. That person may have already developed some kind of medical condition, making it more about trying to mitigate damage rather than maintaining good health.

Cher may have sang about turning back time, but doctors and other healthcare professionals can’t do that for you without a time machine or access to the Quantum Realm. If you’ve already gone through years of being exposed to unhealthy conditions and situations such as poor diets, lack of physical activity, work and social stress, loneliness, air, water, and noise pollution, and discrimination, the damage in many ways has already been done and accumulated. It can be like trying to rescue a piece of pizza after you’ve discovered it in the crevices of your sofa weeks after it fell there. Or telling your ex after being dumped, “OK, now I am ready to do something about our relationship. Perhaps I can stop doing that whole cheating thing. Would that help?”

When it comes to most preventable medical conditions, it’s much more effective and less expensive to intervene earlier before problems arise. All of this was clear with the Covid-19 pandemic. Imagine how many lives, how much suffering, and how much money could have been saved had our society done more in 2020 and the preceding years to prevent the pandemic or at least detect and contain the virus earlier.

The same could be said about a multitude of other current public health problems such as the obesity epidemic, the loneliness epidemic, and the opioid epidemic. Yet, historically, there’s been a tendency to wait until the proverbial poop has hit the fan to finally say, “Oh yeah, we should probably do something about that. But first, let’s find someone to blame.”

Precision medicine focuses on the individual while precision population health accounts for the whole system

A second reason why precision medicine alone is not enough is that it focuses primarily on one individual at a time, which is not the way to make larger scale changes. This can be a bit like focusing on one dust particle at a time when trying to clean your house rather than coming up with a broader strategy. It can take way too much time, miss the bigger picture, and ultimately not appreciate the fact that everything is connected.

Indeed, such a focus neglects the fact that people don’t live in isolation. Regardless of how many times you play the Bon Jovi song “It’s My Life,” like it or not, you are affected by other people and your surroundings in very complex ways. You are part of complex systems that constitute your neighborhoods, your towns and cities, your country, and your world. For example, when other people around you don’t take Covid-19 precautions, guess what happens to your risk of getting infected by the SARS-CoV-2. Yes, your risk goes higher, assuming that you aren’t wearing a concrete condom around your entire body at all times.

Similarly, those who pollute and treat their surroundings like a gigantic toilet bowl end up affecting the air that you breathe, the water that your drink, and the food that you eat. When a smoker lights up inside a room that you are in, guess where that smoke goes, assuming that he or she isn’t wearing a fish bowl around his head. When a boss is mean, discriminates against you, or even harasses you, guess what happens to your stress levels. When the stores, vending machines, and restaurants in your neighborhood and workplace serve mainly junk food, guess what is going into your trunk and the rest of your body. The list goes on and on.

Therefore, while precision medicine may be able to tell you specifically what you yourself may be able to do, it is less likely to change what others around you do or what your surroundings are doing to you. A doctor can tell you to eat more fresh fruits and vegetables until he or she is blue in the face, which, by the way, would be a medical emergency. Yet, if you can’t regularly buy fresh produce without traveling a great distance or setting up an OnlyFans account or GoFundMe page to make more money, you aren’t going to be able to heed that advice very well. You are instead gonna need some more help from others—many others.

Population health is more about seeing the big picture and considering the whole population rather just the individual—hence the name population, because that’s how words work. Otherwise, it would be called “just the individual health” or “me, myself, and I health.”

Precision population health is about finding the real determinants of health and root causes of disease

It is difficult if not impossible to enact real change in a population when the big elephants are still in the room—meaning the major root causes of the health problems in the population rather than animals with tusks and floppy ears. The Centers for Disease Control and Prevention (CDC) emphasizes that many factors influence health and these factors can be “organized into five broad categories known as determinants of health: genetics, behavior, environmental and physical influences, medical care and social factors. These five categories are interconnected.” When you don’t address or even recognize such determinants of health and the root causes of diseases, any proposed solutions can end up being no more than band-aids that simply cover up rather than actually solve problems. In fact, such band-aids could even end up inadvertently worsening the situation.

That’s been happening over and over and over again in public health in recent years. For example, after obesity rates began rising in the 1980s, many food companies came out with these co-called low-fat or even non-fat versions of foods. However, this didn’t seem to make a dent in the rising obesity rates. In fact, various experts have argued that the focus on low-fat foods may have made the obesity situation worse. For example, Ann F. La Berge, PhD, an Associate Professor of Science and Technology in Society at Virginia Tech, penned an article entitled, “How the Ideology of Low Fat Conquered America” published in a 2008 issue of the Journal of the History of Medicine and Allied Sciences. In this article, La Berge argued that creating low-fat foods meant replacing the fat with sugar, which meant that these foods never became low calorie in any way. And that was not a sweet thing to do. Obesity and overweight rates have continued to rise despite the introduction of more and more fad diets and fad exercise regimens. It’s become clear that no single diet and no single exercise regimen alone will effectively curb the obesity epidemic.

Precision population health is about being more proactive than reactive

When you only really deal with problems after they emerge rather than addressing the determinants of health and real root causes of problems, you stay reactive rather than be proactive. That’s what’s occurred in the U.S. throughout the Covid-19 pandemic. Policies and interventions have dealt more with the consequences of Covid-19 surges after they have already occurred rather than prevent the surges in the first place. Again, that hasn’t been super surprising as such an approach has been used with many other health problems that have emerged plagued the U.S. since the early 1980’s. Were there proactive steps taken to prevent the spread of HIV and AIDS before it became a real national problems? How about the obesity epidemic, the opioid epidemic, and the loneliness epidemic? Again, the list could go on and on.

While the Covid-19 pandemic has dealt society a bunch of lemons the past several years, in many ways, it’s shown precisely what society has needed for a long time. It’s shown how everyone really needs to pay more attention to population health and that one-size-fits all or even a limited-number-of-sizes-fits-all just doesn’t work for population health. Just remember that any important decision needs precision and that there should be precision in an important decision.