A conceptual framework for selecting appropriate populations for public health interventions

Abstract

This article suggests a conceptual framework for choice of target populations for public health interventions. In short, who should benefit? Taking the seminal work of Geoffrey Rose on “individuals at risk” versus the “whole population approach” as a point of departure, we explore later contributions. Frohlich and Potvin introduced the notion of “vulnerable populations” applying relevant social determinants as the defining selection criterion. Other interventions focus on a “physical space” (spatial demarcations) such as a neighborhood as a means to define intervention populations. As an addition to these criteria, we suggest that the life-course perspective entails an alternative means of selecting target populations based on a “temporal” perspective. A focus on the various age phases ranging from fetal life and infancy to old age may guide selection of population segments for targeted public health interventions. Each of the selection criteria has advantages and disadvantages when used for primary, secondary, or tertiary prevention. Thus, the conceptual framework may guide informed decisions in public health planning and research regarding precision prevention versus various approaches to complex community-based interventions.

Settings, populations, and time: a conceptual framework for public health interventions

“…The original focus of the life-course perspective is to highlight the accumulation of risk during life trajectories thereby differentiating various age (population) groups ( 7 ). But it also serves as a reminder of change over time, which applies in other ways.…”

“…The notion of population is key to public health interventions and may be determined according to biomedical, social, spatial, or temporal criteria ( 7 ). Geoffrey Rose ( 8 ) juxtaposed two population-related concepts.…”

“…Geoffrey Rose ( 8 ) juxtaposed two population-related concepts. “On the one hand many programs focus a certain risk factor (e.g., smoking) or biomarker (e.g., elevated blood pressure identified through screening) thereby identifying a segment of the total population” ( 7 ), p. 2. On the other hand, the alternative ‘whole population approach’ describes interventions that in principle impact everyone (e.g., fiscal policies of tobacco taxation).…”

“…On the other hand, the alternative ‘whole population approach’ describes interventions that in principle impact everyone (e.g., fiscal policies of tobacco taxation). “According to Rose the overall sum of the impact on the “whole population” is larger than the total impact on the group of “individuals at risk” “( 7 ), p. 2 – which is likely to provide higher return of investment.…”

“…Based on Phelan and Link’s focus on ‘fundamental causes’ ( 9 ), Frohlich and Potvin ( 10 ) criticized this approach. They noted “that a whole population approach does not address the underlying determinants, and that it is likely to increase health inequalities due to uneven distribution of risk factors as well as in disparate ability to benefit from interventions” ( 7 ), p. 2. Instead Frohlich and Potvin recommended a focus on ‘vulnerable populations’, defined as a ‘subgroup or subpopulation who, because of shared social characteristics, is at higher risk of risks’ ( 10 ), p. 218.…”