The inaugural issue of The Milbank Memorial Fund Quarterly Bulletin published in March 1923 was the first in a series of quarterly reports on the Fund’s work with the New York State Department of Health to build a public health infrastructure by establishing county health districts and local boards of health to undertake a tuberculosis case-finding survey. Over the next century, the journal that is today The Milbank Quarterly broadened and evolved along with the field of population health.
Some of its classic articles include Avedis Donabedian’s 1966 landmark paper that set the standard for evaluating the quality of medical care, and Barbara Starfield and colleagues’ analysis of primary care’s contribution to health systems and population health.
For the Quarterly’s centennial anniversary issue released today, The Future of Population Health: Major Challenges and Opportunities, we—as the issue editors—aimed to honor the journal’s enduring legacy by asking a diverse set of multidisciplinary leading and emerging scholars to contribute articles that looked ahead to our biggest challenges and offered policy solutions. We convened the authors in an editing workshop that elicited valuable peer review and a collegial exchange of ideas that improved each article.
We also agreed on a definition of population health as a long-standing multidisciplinary science that focuses on understanding the patterns and distributions of health outcomes and their causes in populations primarily defined by geopolitical spaces and social characteristics such as age, gender, race, ethnicity, immigration status, and socioeconomic position. (See our editors’ introduction to the issue for a more complete definition.)
As the definition of population health makes abundantly clear, health is inextricable from the conditions and forces that create and shape the world around us. The responsibility of the population health scholar is to engage with the broader world by valuing both evidence and the pragmatic goal of achieving better health and narrowing health disparities.
Several cross-cutting themes emerged from the issue’s articles that reflect this role for population health scholarship. Articles are organized in six sections:
- Macro and Structural Drivers of Population Health.
- State-Level and Municipal-Level Policies and Strategies
- Key Issues in Population Health Equity
- Major Population Health Challenges
- Public Health Systems and Structures
- U.S. Health Care System
As you dive into the rich collection of articles addressing a wide range of issues, from climate change to policing as a social determinant of health to alternative payment models, we would like you to keep four points in mind.
First, the consensus in the field about the importance of macro or structural drivers of population health is at odds with the focus of most U.S. empirical scholarship, which is individual-centric research emerging from the biomedical orientation of the country’s research-funding enterprise. If the health of populations is to be improved through changing the context within which populations live, nothing short of paying more vigorous attention to this context will substantially “move the needle” on health.
Second, there is a need for greater emphasis on intervention scholarship, or work that documents the effects, and unintended consequences, of policy interventions, to create a body of literature to guide policy implementation across different contexts.
Third, the work of population health scholarship is far from complete. While the papers in the centennial anniversary issue capture the state of the science, and while a review of what has been published during the past 100 years illustrates how far the science has progressed, we need to go much further to ensure that the science advances the health of populations as much as it should.
Fourth, and finally, the needs and imperatives of population health scholarship are continuing to evolve, much as they have done over the past 100 years. It is our hope that this special collection of papers in the Quarterly serves as a marker along the road to ever-stronger scholarship, more effective public policies and other interventions, and ever-better population health.