BMJ publishes article on how to accelerate population health improvements

The British Medical Journal (BMJ) recently published an article that considers how accelerating population health improvement could help reduce health equity gaps.

Entitled, ‘Accelerating population health improvement’, the article by Pedro Delgado and colleagues focuses on ‘improvement methods’ usually reserved for healthcare but which could be used across a wide range of distinct but interlinked sectors, such as “education, local government, law enforcement” to “improve social determinants of health”.

The authors expect that population health improvement learning is “likely to exponentially increase in months and years to come” and suggests an early definition as being “concerted, intentional, and systematic efforts by those working together towards measurable improvement of health and wellbeing outcomes, co-produced with and for the population in their locality.”

Echoing the early moves towards a more joined-up and localised, place-based healthcare system from ICSs, the authors discuss how “health economy actors” working together could include healthcare providers, citizens , the voluntary sector and councils, as well as schools, businesses, housing associations, social services, police and fire services – imagining a broad scope of collaboration.

These would benefit, it says, from a “shared method” that includes a “common language and tools” that “can be applied across four areas: defining the system, describing shared aims and the work required to achieve them, measuring systematically over time, and acknowledging that change happens.”

Among the literature’s suggested strategies for population health improvement is the idea to ask “Who is not thriving?” to identify and then narrow down the populations in need of support, to “focus improvement efforts by identifying an aim and changes to test.”

The article also focuses on co-design and co-production, thereby “activating the agency of the population” to “design and adopt the changes needed to improve” and make individuals and services users “protagonists” rather than “passive”.

“Improving population health starts and ends with each citizen. Making improvement everyone’s business will create the opportunity to put improvement knowledge in their hands,” say the authors.

The publication also notes that “there is no quality without equity” and goes on to suggest that integration will only “move forward at the speed of trust”.

It’s also recommended that the “jargon” of improvement literature be tackled to make it more accessible to everyone and that “clearly defining population health improvement as a field of learning” can “help those working towards better population health share lessons, successes, and opportunities from their efforts.”

“We foresee a future in which health systems will start to include other aspects in their measurement efforts: relationships between partners in the health economy and the environmental effects of the carbon footprint resulting from more home based health and care models,” the article states.

To view the publication and its suggestions in full, visit

Citation: BMJ 2021;373:n966

BMJ 2021; 373 doi: (Published 08 June 2021)