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      On the relationship between individual and population health

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          Abstract

          The relationship between individual and population health is partially built on the broad dichotomization of medicine into clinical medicine and public health. Potential drawbacks of current views include seeing both individual and population health as absolute and independent concepts. I will argue that the relationship between individual and population health is largely relative and dynamic. Their interrelated dynamism derives from a causally defined life course perspective on health determination starting from an individual’s conception through growth, development and participation in the collective till death, all seen within the context of an adaptive society. Indeed, it will become clear that neither individual nor population health is identifiable or even definable without informative contextualization within the other. For instance, a person’s health cannot be seen in isolation but must be placed in the rich contextual web such as the socioeconomic circumstances and other health determinants of where they were conceived, born, bred, and how they shaped and were shaped by their environment and communities, especially given the prevailing population health exposures over their lifetime. We cannot discuss the “what” and “how much” of individual and population health until we know the cumulative trajectories of both, using appropriate causal language.

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          Most cited references78

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          Life course epidemiology.

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            Quantifying the burden of disease: the technical basis for disability-adjusted life years.

            C. Murray (1994)
            Detailed assumptions used in constructing a new indicator of the burden of disease, the disability-adjusted life year (DALY), are presented. Four key social choices in any indicator of the burden of disease are carefully reviewed. First, the advantages and disadvantages of various methods of calculating the duration of life lost due to a death at each age are discussed. DALYs use a standard expected-life lost based on model life-table West Level 26. Second, the value of time lived at different ages is captured in DALYs using an exponential function which reflects the dependence of the young and the elderly on adults. Third, the time lived with a disability is made comparable with the time lost due to premature mortality by defining six classes of disability severity. Assigned to each class is a severity weight between 0 and 1. Finally, a three percent discount rate is used in the calculation of DALYs. The formula for calculating DALYs based on these assumptions is provided.
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              The lasting impact of childhood health and circumstance.

              We quantify the lasting effects of childhood health and economic circumstances on adult health, employment and socioeconomic status, using data from a birth cohort that has been followed from birth into middle age. Controlling for parental income, education and social class, children who experience poor health have significantly lower educational attainment, poorer health, and lower social status as adults. Childhood health and circumstance appear to operate both through their impact on initial adult health and economic status, and through a continuing direct effect of prenatal and childhood health in middle age. Overall, our findings suggest more attention be paid to health as a potential mechanism through which intergenerational transmission of economic status takes place: cohort members born into poorer families experienced poorer childhood health, lower investments in human capital and poorer health in early adulthood, all of which are associated with lower earnings in middle age-the years in which they themselves become parents.
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                Author and article information

                Contributors
                +31-20-5664607 , +31-20-6972316 , o.a.arah@amc.uva.nl , arah@ucla.edu
                Journal
                Med Health Care Philos
                Medicine, Health Care, and Philosophy
                Springer Netherlands (Dordrecht )
                1386-7423
                1572-8633
                24 December 2008
                August 2009
                : 12
                : 3
                : 235-244
                Affiliations
                [1 ]Department of Social Medicine, Academic Medical Center, University of Amsterdam, PO Box 22700, 1100 DE Amsterdam, The Netherlands
                [2 ]Department of Epidemiology, University of California, Los Angeles, School of Public Health, Box 951772, Los Angeles, CA 90095-1772 USA
                Article
                9173
                10.1007/s11019-008-9173-8
                2698967
                19107577
                658090a4-02b6-4ad3-a13e-2c503b21285a
                © The Author(s) 2008
                History
                : 7 July 2008
                : 21 November 2008
                Categories
                Scientific Contribution
                Custom metadata
                © Springer Science+Business Media B.V. 2009

                Medicine
                ethics,theory of health,causality,context,population health,life course,individual health
                Medicine
                ethics, theory of health, causality, context, population health, life course, individual health

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