A "people and places" framework for public health planning and action

Resources through which to promote the health of the public are inherently limited. A pressing question is: How can we maximize the population health impact of the resources at our disposal? Contemporary ecological theories of population health provide a useful lens through which to examine this question. In this paper we propose a framework based on contemporary ecological models of health that links population health, and population health behavior, to the attributes of the people in the population (as individuals, as social networks, and as communities or populations) and to the attributes of the places, or environments, in which those people live. These people-based “fields of influence” (i.e., the attributes of individuals, social networks, and populations) and place-based “fields of influence” (i.e., local places and distal places) can be used to understand the dynamics of health behavior in, and the health of, populations. Perhaps more importantly, they can be used by public health organizations to identify their most important intervention opportunities. Such opportunities are determined by identifying which changes in the attributes of people and places will have the largest putative impact on population health, and by triangulating this information with judgments about which of these attributes the organization is best able to influence. We will make the case that public health organizations, including academic training programs, should strive to enhance the impact of their interventions through application of the People and Places Framework or similar approaches.