Population Health – The Unfinished Journey Podcast with David Kindig: Episode 2, The Story Behind the Book “Purchasing Population Health”

In nine podcasts, David Kindig MD, PhD, a population health thought leader, is interviewed by Sanne Magnan MD, PhD about his 50-year population health scholarly and policy journey, including many stories, anecdotes and takeaways. In our corresponding blog posts, we highlight some of the key moments and take-aways as a reminder for you to tune into previous and future podcasts. You can listen to the Episode 1: “Once Upon a Time,” here.

Overview
In Episode 2, Dave explores the influence of the Canadian Population Health Program, in his conversation with Sanne.  He also talks about how his sabbatical in York, England did not produce the book that he was hoping to write. And he reminds us of the only italicized sentence in the seminal Evans and Stoddart (1990) paper: “A society that spends so much on health care that it cannot or will not spend adequately on other health enhancing activities may actually be reducing the health of its population.”

Click to enlarge. 
Evans and Stoddart 1990 Field Model – Used with permission
Evans RG, Stoddart GL. 1990. Producing Health, Consuming Health Care. Soc Sci Med 31(12):1347-1363.

Dave explains how connecting with the Canadian Population Health Program helped to expand his thinking to consider multiple determinants of health. The Evans and Stoddart paper quickly became a guidepost for him, and one that he still uses today.

During his six-month sabbatical in York, England to study outcome measurement and to work on his book, Dave found himself intellectually stymied. He realized that European health economists focused on resource distribution, rather than simply on supply and demand. When he returned back home to the U.S., he realized that the book he needed to write remained out of his grasp, because he knew less than when he’d started the sabbatical. Later, in Vancouver BC, he finally found his way to a working draft for each chapter of his book, Purchasing Population Health: Paying for Results.

Episode Highlights

• Producing good population health takes more than medical care. In other words, everything Kindig has done in population health research and advocacy has its origins in the Evans-Stoddart 1990 paper “Producing Health, Consuming Health Care.”
• Population health needs a clear outcome measurement definition. It’s not enough to only study determinants. This idea led to the initial “health-adjusted life expectancy definition,” which we will return to in the next podcast, #3.
• Population health improvement needs appropriate financial incentives designed for these outcomes.
• An “investment balancing function” across determinants is critical – one that encompasses fairness.

Click Here to Listen to Episode 2

References 

1. Evans RG, Stoddart GL. 1990. Producing Health, Consuming Health Care. Social Science & Medicine 31(12):1347-1363.

2. Evans RG, Barer ML, Marmor TR, editors. 1994. Why Are Some People Healthy and Others Not? The Determinants of Health of Populations. Aldine de Gruyter.

3. Kindig DA. 1997. Purchasing Population Health: Paying for Results. University of Michigan Press.