The Target Model of Population Health Improvement

By Bill Winfrey -

Not too long ago, it was cherry blossom season in Washington D.C., and I had several family members visit me. My family is still based in the Midwest, and so in some ways, we live in different worlds- size of living spaces, modes of transportation, etc. But we all have one thing in common: when we need something, we shop at Target.

We found ourselves at Target at 10:30 pm on a Friday night with my sister, buying a memory card for her camera to prepare for an early photoshoot the next morning. With my parents, we went to Target to buy shorts for my dad who had not anticipated bike rides in 80 degree temperatures. And at the same time, my girlfriend and I loaded up on groceries to get us through until- you guessed it- our next trip to Target.

The Target shopping experience provides for all of your needs. From memory cards and khaki shorts to groceries and medications—if you need it, they’ll have it. Target has asked, “How can I meet all of the consumer’s shopping needs?” and answered that question in its offerings.

So when I think about my work and how to improve the health of populations, I can’t help but to think of the Target model. Their comprehensive approach works for the consumer shopping experience, and I see a comprehensive approach working in the population health improvement model. In this model, organizations practicing population health improvement are asking- “What do our citizens need to stay healthy?” And they go beyond the obvious answers of doctors, pharmacies and hospitals. They think of street lights to improve community safety. They think of bike lanes to support safe and active transportation. They think of bus systems to ensure accessibility to good jobs and grocery stores, which are also essential. In short, they think of the social determinants of health.

The conversations on population health improvement over the last few years have focused on identification of the right models, the right partners, the right funding mechanisms for population health interventions. National Public Health Week took place not too long ago, and similar conversations took place. While these are crucial to have, what I don’t hear enough about is how groups are succeeding with population health improvement actions. While caught up in all of the complicated process questions, I think the question of, “How can I meet all of the community’s health needs?” is missing. And I think it’s worth focusing on this question for a minute.

The Administration for Community Living (ACL) is a federal agency dedicated to supporting individuals with disabilities and the aging. ACL has improved population health by supporting organizations that provide transportation, nutrition, exercise, personal care programs and more to individuals to aid in their care transitions. They have taken the Target approach and made their care transition program a one-stop shop for everything that their constituents need to make a healthy transition from Point A to Point B.

But this program wasn’t born from extensive discussions on what a successful population health model is, or how it should look. Agencies like theirs don’t have the time to conduct years-long studies of care transition models or any other population health initiative. They succeed in these efforts when they are able to work with their constituents, identify their needs and then develop programs that can meet those needs.

Another example is the Manhattan Plaza housing complex in New York City. This complex has long been a friendly home to artists and others living in the city and is federally subsidized to support their housing needs. What started as a residence supporting the housing needs of its population blossomed into a health facility when its residents were disproportionately struck by the AIDS crisis of the 1980’s. And when the AIDS crisis came under control, the facility turned its focus to supporting the aging population who lived in the residence by locating social service providers on-site.

Again, a population health model born out of an emphasis on providing for all of the needs of the individual.

Just like Target takes care of your shopping needs, so have the ACL and Manhattan Plaza found ways to deal with the myriad needs of their populations. My intellectual side loves to investigate methods of different sectors collaborating to finance population health interventions. But my practical side, and the one I speak from here, likes to see successful interventions in practice. And I realize that oftentimes, these happen not from fully-developed concepts but from simply looking at the person in front of you and addressing his or her needs.

As the field of health shifts towards a population health improvement model, let us keep the Target example in mind and remember that we can move this field forward by simply looking at how to address the needs of those individuals right in front of our eyes.

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