| Defines health primarily as an individual and biologic phenomenon that is diagnosed and treated by clinicians |
Frames health in context of individual disease, disability, and injury Obscures the fact that both “health” and “illness” are socially, economically, and politically produced Gives physicians and others trained in clinical care assumed expertise and authority Creates conflation of “health” with “health care,” “health disparities” with “health care disparities,” “health policy” with “health care policy,” and “social determinants of health” with “patient/individual social needs”
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| Directs majority of public policy, interventions, and resources for improving population health to the health care delivery system and the individual level |
Gives health care delivery system primary responsibility for addressing population health and health inequity Directs primary focus of research and interventions to individual‐level risk factors while ignoring their social determinants Denominator shrinkage: Diverts attention and resources from a global population/community focus to the “population health management” of patients within insurance plans or health care delivery systems Ignores basic principles in population health science regarding shifting risk distributions, structured nature of opportunities/ resources/benefits, and importance of life course exposures Leaves macro‐/structural‐ and meso‐/community‐level drivers of health and health inequity unchecked, including structural/systemic racism and the macroeconomic/commercial and political determinants of health
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| Focus on individuals and the worthiness of health interventions and investments gets reinforced in media, culture, and public opinion |
Reinforces narratives regarding health as the primary result of individual behavior or choices and individual responsibility Places health care delivery system as primary institution for addressing or fixing societal health issues When downstream interventions and services do not “work,” reinforces notion that socioeconomic and racial/ethnic health inequities are intractable, unavoidable, and/or deserved Fuels growth in attitudes regarding personal responsibility and deservedness in public opinion, policy design and discourse, and clinical care
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| Gives strength to political notions of health and personal health choices as autonomous and individual right |
Contributes to increased pushback against the purpose and authority of public health laws and regulations Results in changes that weaken public health system design and infrastructure, workforce, and policy Contributes to serious challenges in the US response to public health crises including the rising rates of diabetes, the opioid epidemic, and the COVID‐19 pandemic
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