Population Health Improvement

What is Population Health?

Population health is “the health outcomes of a group of individuals, including the distribution of such outcomes within the group” (Kindig and Stoddart, 2003). While not a part of the definition itself, it is understood that such population health outcomes are the product of multiple determinants of health, including medical care, public health, genetics, behaviors, social factors, and environmental factors. (Institute of Medicine’s Working Definition of Population Health, http://www.nationalacademies.org)

1 Population Health Model

The model of population health (pictured above) was adapted by the University of Wisconsin’s Department of Population Health Sciences from Kindig & Stoddart’s original figure, published in 2003 in the American Journal of Public Health.


Policies and programs are the focus of population health work, shaping the many aspects of health. These aspects of health (like individual behavior and the physical environment, referred to as “determinants and factors” in the model above) interact with one another in dynamic, complex ways, and ultimately drive health outcomes such as morbidity, mortality, and quality of life.

For population health purposes, groups can be defined in many ways: by geography, demographic factors, disease diagnoses, health behaviors, and so on. Disparities within populations must be considered, and policies and programs tailored accordingly, to ensure that population health approaches are both effective and just.


Population Health Improvement at HealtheConnections

HealtheConnections serves the Central New York region by convening and connecting a diverse group of stakeholders in a transparent and neutral manner, for the ultimate purpose of supporting the Triple Aim of better population health, better care, and lower costs.

We provide community health and quality of life data, best practices, resources, and strategies to build the capacity of those working on health improvement in the Central New York region. Our approach allows HealtheConnections to add value to each of the individual counties with which we partner, and facilitates county partners’ adding value to one another’s work. Together, we aim to make progress on both county and regional priorities, in alignment with the New York State Department of Health’s Prevention Agenda.

Reducing health disparities and advancing county, regional, and state population health goals are foundational to all of our efforts. Our work emphasizes improved health outcomes for both the general population and for high-risk populations.

HealtheConnections is a contractor for two Population Health Improvement initiatives through the New York State Department of Health (NYSDOH). Click here to read more about NYSDOH Population Health Improvement Program (PHIP) and NYSDOH Local Initiatives for Multi-Sector Public Health Action (Local IMPACT).