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Population health is complicated but worthy of your attention

George Lundberg, MD
Policy
August 5, 2012
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Healthy, wealthy and wise. Or is it wise, wealthy, and healthy, or perhaps healthy, wise, and wealthy, or even wealthy, wise and healthy? Which came first, the chicken or the egg? Is there cause and effect?

The question matters a lot because, these days, we are constantly talking about bona fide disparities in health — by gender, race, ethnicity, geography, age, status of citizenship, and type or absence of insurance. But, who could disagree that in addition to disparities in health, there are also major disparities in wealth and, if measurable, wisdom.

Certainly a person could be wealthy even if unhealthy; or wise even if not wealthy; or healthy even if not wise.

This puzzle is best thought of not as an individual effect but as a population effect. Not causation but association.

Among the many elements of confusion amongst the general public, the media, and even the medical establishment, understanding the difference between causation and association, the difference between relative risk and absolute risk, and the difference between statistical significance and practical clinical significance are the greatest.

Far be it for me to think that I can solve that knowledge gap in this little piece, but I can, and have, called it to your attention and waved red flags, suggesting that you follow this up with some study on your own.

If you want to buy an inexpensive book to help you understand this, try News and Numbers by the late Victor Cohn, available to order electronically in three different temporal versions, including very cheap, used.

But if you mostly want to track how your own county, or the county to which you anticipate moving, or the county where your kids live is faring in comparative health, wealth, and (possibly) wisdom click to County Health Rankings brought to you by the Robert Wood Johnson Foundation and the University of Wisconsin Institute for Population Health.

And for a physician interpretation of and proposed actions to take, KevinMD.com provides some helpful insights.

Population health is complicated but very worthy of your attention and your actions. For example, in order to improve the health of a person, a wonderful way to begin is for that person to get a decent job that pays decent money. Health can then follow.

George Lundberg is a MedPage Today Editor-at-Large and former editor of the Journal of the American Medical Association.

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