Domain 3 Population health and the context of general practice

Population health considers how to improve the wellbeing of a group, not just the individual. With 85% of the Australian population seeing a general practitioner (GP) at least once a year,¹ GPs are well placed to have a wide impact on healthcare for both individuals and communities. Health promotion enables people to have control over the factors that influence their health, and involves activities that support healthy behaviours, environments and health literacy.²

Preventive health aims to prevent disease or mitigate its impact.³ Primary prevention aims to prevent disease before it happens through measures, including health promotion, vaccination programs and the use of preventive medications, such as chemoprevention of cancers.^3–5

Secondary prevention aims to minimise the impact of existing disease. This includes screening to reduce morbidity and mortality through early detection.^3,6 Patients might be able to undertake these programs directly, such as bowel cancer screening,⁶ but GPs still have an important role in encouraging uptake. Other programs operate primarily in the general practice setting, including cervical screening tests.⁶ Screening programs are not without harms; these include overdiagnosis, health anxiety and complications of testing procedures.¹ It is important that GPs understand the specific patient groups for which the benefits of screening have been shown to outweigh the harms. Other examples of secondary prevention include medications after an illness to prevent recurrence, such as aspirin after acute coronary syndromes,⁷ or antibiotic prophylaxis for rheumatic fever.⁸ Later stages of preventive care include tertiary and quaternary prevention, which aim to reduce levels of impairment from disease and reduce the impacts of harms from treatment.³

Patients might not present for preventive health advice, so it is important that GPs are proactive in identifying opportunities for health promotion according to Australian general practice guidelines.³ Common areas for promotion include advice on smoking, nutrition, alcohol and physical activity (known collectively as ‘SNAP’).⁹ Current data show that one in seven Australian adults smoke daily.¹⁰ More than half of Australian adults do not meet physical activity guidelines, and most people do not eat the recommended amounts of fruits and vegetables.¹⁰ Preventive health is also important for children, with one in four children being overweight or obese, while two in three children do not meet physical activity guidelines.¹⁰ There is a strong evidence for brief interventions under three minutes for smoking cessation, which can be conducted even during a short patient encounter.¹¹ Assessing readiness for change and motivational interviewing are other techniques that can be used in this space.¹²

Social determinants of health are factors outside of medicine that influence population and account for 30–55% of health outcomes.¹³ These include housing, education, environment, income and social inclusion. Some population groups also experience disparities in access to healthcare and health outcomes. This includes patients experiencing socioeconomic disadvantage, Aboriginal and Torres Strait Islander peoples, people from culturally and linguistically diverse backgrounds and rural and remote populations. GPs should be aware of recommendations for preventive health for specific populations, such as the National guide to a preventive health assessment for Aboriginal and Torres Strait Islander people.¹⁴ GPs have an important role in their community to advocate for access to healthcare and improvements in the social determinants of health.

Population health also includes the detection and management of public health risks, including communicable disease outbreaks, such as the COVID-19 pandemic. As frontline health workers, it is important that GPs can recognise transmissible and potentially reportable disease.¹⁵ There are nationally notifiable diseases, as well as specific lists in each state and territory.¹⁶ Advice about time out from school and workplaces is important to prevent spread of infectious diseases within the community.¹⁷ GPs might also be involved in contact tracing related to infectious disease, such as for sexually transmissible infections.¹⁸ This includes an awareness of professional, legal and ethical principles for managing sensitive information and mandatory reporting requirements.

Climate change is an emerging public health risk that poses a significant and urgent threat.¹⁹ This will present new direct and indirect challenges for many groups, including an increase in morbidity and mortality from higher temperatures, as well as groups who live in areas at risk of worsening natural disasters as a result of climate change.¹⁹ It is important for GPs to understand their role in identifying, reducing and managing adverse health effects of climate change on Australians.¹⁹ GPs also have an important role in addressing sustainability within their own practices, as well as being advocates within the community for broader mitigation strategies.²⁰