摘要：Summary measures of population health, such as health-adjusted life expectancy, are increasingly being used to monitor the health status of regions and to evaluate public health interventions. Such measures are based on aggregated indicators of individual health and summarize health in a population. They describe population health status but have limitations in analytic studies of population health. We propose a broader framework for population health measurement. This classifies indicators according to their application (descriptive, prognostic, or explanatory), according to the conception of population (as an aggregate or a dynamic entity), and according to the underlying model of health. This approach extends the measurement repertoire to include indicators of the health of a population. THE EMERGING FIELD OF population health has been influenced by a variety of academic traditions, and this has led to a diversity of approaches and considerable debate over definitions and conceptual models, as reviewed in recent articles. 1– 5 At the same time, growing attention has been paid to measuring population health status, largely stimulated by the World Health Organization’s reviews of health system performance. 6, 7 Our thesis is that current approaches measuring population health do not adequately reflect the complexities of recent thinking in the field, and that a more detailed classification of population health measures is required. Any approach to measuring population health will reflect how it is defined. There are currently 2 contrasting approaches to definition, leading Kindig and Stoddart 2 to acknowledge that there can be no definitive measure of population health, arguing that “the development and validation of such measures for different purposes is a critical task for the field of population health research.” 2 (p381) Of the 2 approaches to defining population health, the first simply takes it as a shorthand for the health status of a population, sometimes also considering the equity of the distribution of health in the population. 2 We will refer to this as the descriptive model of population health. For this model, measures of health status such as health-adjusted life expectancy will be sufficient, supplemented by indicators of disparity in health status. However, this approach to defining population health is limited and does not adequately capture its scope as an academic field of study; it is akin to defining economics as the study of gross national product, without any theory of economic forces of production. Hence, a second definition views population health as a broad conceptual approach to understanding (and perhaps also intervening upon) the determinants of health status. 2 This analytic model of population health refers to a conceptual and analytic approach to explaining why some people are healthy and others are not 4, 8 ; at its broadest, it seeks to analyze not only how this occurs, but also why. 5 This conception demands a much broader measurement protocol that includes not only outcome variables in terms of morbidity and mortality indexes, but also direct measures of health processes within the population. We do not here argue for 1 model over the other, for both have merit. Instead, our argument is that we should set out a full array of measures, classifying them into those that fit the descriptive model and those that are relevant to the conception of population health as a broader, analytic field of study.
