Diving into Intervention Impact
"Interventions will need to target not just individuals or groups but their social circles." The Public Health Perspective
The main goal of the field of public health is to improve the health of as many people as possible. Public health scholars focus on what proportion of people can benefit from interventions actually benefit. A public health program usually will have a higher likelihood of success if they can work in cooperation with government and society on addressing social risk factors. To achieve this public health must work with not only health care and clinical medicine but multiple other sectors.
Thomas Frieden speaks about a five-tier impact pyramid. Improving the base of this pyramid will typically have the greatest potential amount of impact for more people versus improving the top. As you scale the pyramid more individual time & effort is needed. A great program should also take steps in each category of the pyramid because each level is important. While not impossible, it is implied that it's hard to try to change the behavior of an individual if their social circle doesn't comply but changing a societal behavioral norm can have a larger impact.
"The Health Impact Pyramid. Public health focuses on denominators — what proportion of all people who can benefit from an intervention actually benefit. Improvements at the base of the pyramid generally improve health for more people, at lower unit cost, than those at the top.” - Thomas Frieden M.D., MPH
The Pyramid Structure
At the base (tier 1) of the pyramid are socioeconomic factors like poverty and education. The mechanism is not necessarily apparent but across countries these factors are correlated with overall health. Improving housing options, providing realistic health insurance coverage are some ways of tackling this. Above the base (tier 2), are traditional public health interventions. Some of these interventions are credited for potentially dramatically increasing the average life span in the past century. Changing the context of the default decision to a healthier one is a form of preventative medicine. Huge health improvements have arisen from interventions in this category such as fluoridated water, smoke-free workplaces, and sodium reduction in food. The next level (tier 3) consists of typically one-time efforts to promote health such as immunizations, a single procedure, or a brief counsel. The following level (tier 4) are clinical interventions in which require long-term care such as treatment for chronic diseases such as HIV or treatment of hypertension and hyperlipidemia. The final level (tier 5) contains counseling and education efforts to educate people on eating healthy and exercise.
Interventions of the future need to be broader and more multidimensional. Fields with the similar goals such as public health and clinical medicine can help each other maximize overall population health. The interventions will most likely outstep boundaries and involve as many parts of society as possible. Interventions will need to target not just individuals or groups but their social circles. Changing the context of societal decision-making will help the change of promoted health behavior easier. But there will be some backlash because change is controversial for some. The best interventions will change the status quo and they’ll be hard to categerozie because their actions will blend the different levels of the pyramid.
If interested in reading more on this topic click the two references below:
Frieden, T. R. (2015). The Future of Public Health. New England Journal of Medicine, 373(18), 1748–1754. doi:10.1056/NEJMsa1511248
Frieden, T. R. (2010). A framework for public health action: the health impact pyramid. American Journal of Public Health, 100(4), 590–595. doi:10.2105/AJPH.2009.185652