Population health approach for health systems: public health organization, workforce and governance

BACKGROUND: The health systems have been evolving based on solely individual care of diseases, which is no longer sustainable. A combination of a public health and individual approach is needed, although how to deliver those population health services remains a challenge. This study explores how population health outcomes are determined by the organizational model and workforce capacity of public health services at local level. METHODS: Using publicly available data on organizational, geodemographic and population health characteristics of the total 55 public health units (PHU) in mainland Portugal, a fixed effects panel regression of three models was performed. The analysis considered synergies between public health workforce (medical doctors and nurses), organizational (considering a Local Health Unit (LHU) group, that includes both primary and secondary care, and non-LHU) and infrastructure characteristics, and population health outcomes (premature standardized mortality rate and life expectancy at birth (LE)). Confidence intervals (CI) at 95% and odds ratio (OR) were calculated. RESULTS: A lower premature standardized mortality rate and a higher life expectancy at birth were observed when there is one public health doctor per between 22 319.4 and 24 616.7 habitants and 25 382.5 and 27 680.0 habitants, respectively. The regression models that were run showed that PHU under a LHU model or disaggregated services are associated with an increase in the premature standardized mortality rate (OR = 1.23 [CI 95% 0.21-15.24]) and a decrease in the LE (OR = 0.50 [CI 95% 0.17-1.41]). CONCLUSIONS: Health systems must promote public health services capable of delivering the essential public health functions, particularly at local level, where they must be concentrated and integrated at the same level of governance as individual levels of care, and equipped with a public health workforce adapted to the size of the population on which they must intervene. KEY MESSAGES: • Strengthening health systems resilience require a combination of public health and individual approaches to improve population health and tackle inequalities. • Essential public health functions require concentrated and integrated governance models and a public health workforce adapted to the size of the population.