ICS – the economics of population health

GGI webinar: Wednesday 25 November 2020

Briefing paper to prompt discussion

Integrated care systems (ICSs) are required to take a more proactive role in population health and prevention. A key priority of the NHS Long Term Plan (2019) is for ICSs to embed and use population health management approaches. The ICS is expected to prioritise this at the level of the neighbourhood (c. 30,000- 50,000 population) and the place (c. 250,000 to 500,000 population).[1]

The King’s Fund defines population health as:

“An approach aimed at improving the health of an entire population. It is about improving the physical and mental health outcomes and wellbeing of people within and across a defined local, regional or national population, while reducing health inequalities. It includes action to reduce the occurrence of ill health, action to deliver appropriate health and care services and action on the wider determinants of health. It requires working with communities and partner agencies.”[2]

This is not to be confused with population health management, which is a narrower reference to approaches to the use of data to identify population segments for specific strategies to improve health outcomes.

ICSs are expected to enable both.

It has long been recognised that effective public health interventions rank very high in terms of value for money, even when seen through the narrow lens of the health and social care economy. A recent review of the international literature found a return on investment of 14:1 when considering benefits to the wider health and social care economy.[3]

Recent estimates from the Centre for Health Economics at York supported these findings (they found a return of 15:1); they went on to conclude that expenditure on public health interventions is between three and four times more productive than health treatment expenditure.[4]

It has also long been accepted that population health is influenced by wider social determinants, often way beyond the traditional influence of public health. Differences in social and environmental factors such as employment, housing or transport account for 40-50% of variation in health outcomes; a greater influence than genetics, individual behaviour or health treatment.[5]

In this context, the importance of place has become a cornerstone of population health, extending beyond the behaviours of individuals to the area and characteristics of the local community[6]. The concept of ‘health in all’ policies, which looks at the health effects of wider policies affecting place and community is an important complement to ‘health for all’, which underpins public health programmes.

The emerging role of the anchor institutions in driving place-based interventions is an acknowledgement of the role played by local large employers geographically sited within a community, normally non-profit organisations[7]. ICS partners and particularly local NHS institutions are potential candidates as anchor institutions[8].

This is only a one-directional perspective however, namely the impact of a range of policies on population health. In fact, there has been growing evidence over recent decades of a strong causal relationship the other way. Namely that a healthier population drives wider downstream economic benefits, which themselves enable greater levels of investment in population health programmes: a virtuous circle.[9]

There are likely to be many studies of this phenomenon as we examine the consequences of the COVID-19 pandemic and its economic aftermath.

In this webinar we will explore how an ICS might be able to drive value from population health programmes at the level of the place.

Questions to consider include:

i. What is meant by the economics of population health?

ii. What factors are likely to influence the level of investment in population health, relative to other system priorities?

iii. How might priorities be set across the partner agencies?

iv. Why will things be different this time?

Full details about each event in our webinar series is available on the GGI events page: www.good-governance.org.uk/events

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[1] NHS England: Designing integrated care systems (ICSs) in England: An overview on the arrangements needed to build strong health and care systems across the country; (June 2019)[2] Kings Fund: A vision for population health Towards a healthier future (November 2018)
[3] Masters R, Anwar E, Collins B, et al. Return on investment of public health interventions: a systematic review. J Epidemiol Comm Health Mar 2017. doi:10.1136/jech-2016-208141.
[4] Stephen Martin, James Lomas, Karl Claxton: Is an Ounce of Prevention Worth a Pound of Cure? Estimates of the Impact of English Public Health Grant on Mortality and Morbidity CHE Research Paper 166
[5] Prof. Sir Michael Marmot, Dr Angela Donkin, Prof. Peter Goldblatt: Inequalities Update (2017)
[6] Yvette C. Cozier: Invited Commentary: The Enduring Role of “Place” in Health—A Historic Perspective American Journal of Epidemiology, Volume 185, Issue 11, 1 June 2017, Pages 1203–1205, https://doi.org/10.1093/aje/kw...
[7] https://ukces.blog.gov.uk/2015...
[8] The Health Foundation: Building healthier communities: the role of the NHS as an anchor institution August 2019.
[9] Alsan, M. Bloom, D. Canning, D and Jamison, D: The Consequences of Population Health for Economic Performance: Harvard, October 2006