Population health is “the health outcomes of a group of individuals, including the distribution of such outcomes within the group. …The field of population health includes health outcomes, patterns of health determinants, and policies and interventions that link these two.” 

David Kindig and Greg Stoddart

Resources for Population Health Training and Education

The Division of Community Health partners with the Department of Community and Family Medicine in creating materials for population health training and education.

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What is community health?

Community is defined as a group of people linked by social ties sharing common perspectives or interests who may or may not share a geographic location. Community members have characteristics in common, such as common culture or ethnic heritage, where they live, similar age, speaking the same language, religion. Communities are not homogeneous and seldom speak with one voice.

Community health is fostering system integration that implements indigenous solutions to end the pathology of chronic (i.e. disease, environmental or social) conditions. Duke’s Division of Community Health strives to improve integration of social and health delivery systems. Residing in a resource challenged community for the past 20 years; the division acts as organizer, researcher, educator, integrator, and facilitator enhancing capacity and capabilities of neighbors, learners, providers, caregivers, institutions and communities.

Global Framework

The division strives to improve social and health delivery systems in the acute and ambulatory setting by following the The Institute for Health Improvement (IHI) Triple Aim goals:

  • Improving the patient experience of care (including quality and satisfaction);
  • Improving the health of populations; and
  • Reducing the per capita cost of health care.

Access to Care

To reach vulnerable populations in Durham, the Division of Community Health expands access to medical care by operating neighborhood clinics, home-based primary care initiatives, and school-based clinics and wellness programs.

Care Management

The Division of Community Health offers care management services to multiple populations of all ages, insured and uninsured, serving roughly 100,000 residents of Durham, Granville, Vance, Warren, Person, and Franklin counties in North Carolina through Northern Piedmont Community Care (NPCC), Local Access to Coordinated Healthcare (LATCH) and LATCH Rural Health.

Health Promotion and Disease Prevention

Northern Piedmont Community Care, Local Access to Coordinated Healthcare, and six county health departments collaborate on a variety of activities such as health fairs that check participants’ hemoglobin A1c for diabetes and Body Mass Index (BMI) to annual prostate screenings with Lincoln Community Health Center and the Duke Cancer Institute.

Medical Home Networks

Since 1997, the Division of Community Health has operated two medical home networks.