The following Twitter conversation underscores the problems with use of a population health model in an occupational therapy context:
Framing a conversation about the need for older drivers to consider their abilities underneath a context of population statistics is in direct conflict with the profession's Core Value of respect for patient autonomy and individuality.
Although it may be true that there are descriptive statistics about driving safety, numbers of accidents, and other factors associated with elderly drivers, when we lead our conversations with talk about the broad population we are adopting a potentially ageist stance that restricts the freedom of many drivers who are not falling within those normative ranges.
This is the problem with use of a population health model for meeting the needs of individuals. To describe this problem within a general systems theory framework, consider the following chart:
Within this traditional framework of intervention, the correct focus and domain of concern is centered around the individual person. Due attention is given to levels above and below the person because of their contextual relevance, but the focus of concern is the person.
Now consider a shift toward a population health model, where the focus and domain of concern is centered around the community:
In this type of public health framework the ability to focus attention on the individual and their abilities and their autonomous choices is lost. This is why people state that public health models are inherently paternalistic and are not considerate of the needs of individual people.
The ethics required for supporting action in each scenario are radically different, and you can't populate a health care profession with a competing set of ethics where one focus respects patient autonomy and the other focus promotes paternalism and concern for a 'common good' that might not respect individuals.
Population health models are focused on broad community needs and frame concerns in broad population statistics. It is philosophically incorrect to lead into an issue citing population statistics and then follow up with statements that individual assessments need to be considered.
What is the message? Based on current life expectancies in the US, do people hand in their car keys when they are 70 because our population statistics indicate that this is when the elderly population statistically begins demonstrating concerns? Will occupational therapists become the gatekeepers for driving, based on their assessment of abilities? Will they solve those problems by paternalistic messaging that once you are 70 you are automatically placed in that high risk pool?
Occupational therapy was a profession that was established to help individual people when they had illness, disease, or disability so that they could productively engage in their lives. Now there are some therapists who are trying to be gatekeepers to population health, wielding statistics and clipboards to make broad recommendations about when people need to start giving up their freedoms and autonomy.
It is a disturbing philosophical turn that breaks our social contract with the people who would come to us for help.