The Perils of Medicalization for Population Health and Health Equity

The World Health Organization defines health as the “state of complete physical, mental and social well-being, not merely the absence of disease or infirmity.”¹ Anchored in this broad view of health, population health is a long-standing multidisciplinary science that examines the patterns and distributions of health outcomes and their causes in populations, primarily defined by geopolitical spaces and social characteristics such as age, gender, race/ethnicity, and socioeconomic position.² Significant attention in the field of population health is devoted to understanding the upstream (structural and macrolevel), midstream (meso- or community-level), and downstream (micro- or individual level) social determinants of health, and the limits of medical care in both producing health and reducing socially driven health inequities within populations.^2,3 An important focus of population health science is understanding the ways in which upstream structural factors—such as macroeconomic forces, cultural factors, social systems and institutions, and public policy and law—are the fundamental drivers of socioeconomic stratification in society, which in turn shape the more proximate psychosocial and material conditions for health, including food, shelter, safety, clean environments, and medical care.

Public health, a sister discipline, is also concerned with the causes of health, illness, and injury in populations, the unequal distributions of outcomes within them, and opportunities for prevention and other interventions at upstream, midstream, and downstream levels.⁴ As a field of practice and policy, public health is primarily grounded in the role of the government and partnering organizations in preventing disease and injury, prolonging life and health equity, and protecting, assuring, and improving the health of populations in geopolitical units at the local, state, regional, and national levels.⁵

References

1. Solar O, Irwin A. A conceptual framework for action on the social determinants of health. World Health Organization. https://apps.who.int/iris/handle/10665/44489. Published 2010. Accessed January 23, 2023.
2. Lantz PM. Population health: definitions, tensions, and new directions. In: Boulton ML, Wallace RB, eds. Maxcy-Rosenau-Last Public Health & Preventive Medicine. 16th ed. New York, NY: McGraw Hill; 2022.
3. National Academies of Sciences, Engineering, and Medicine; Health and Medicine Division; Board on Population Health and Public Health Practice; Committee on Community-Based Solutions to Promote Health Equity in the United States. Communities in Action: Pathways to Health Equity. Baciu A, Negussie Y, Geller A, et al., eds. Washington, DC: National Academies Press; 2017.
4. Castrucci BC. Meeting individual social needs falls short of addressing social determinants of health. Health Affairs Blog. January 16, 2019. https://debeaumont.org/news/2019/meetingindividual-social-needs-falls-short-of-addressing-socialdeterminants-of-health/. Accessed January 23, 2023.
5. Banta HD, de Wit GA. Public health services and cost effectiveness analysis. Annu Rev Public Health. 2008;29:383-397.