title: Population health in New Zealand 2000-2013: From determinants of health to targets.
abstract: OBJECTIVE
  To determine how 'population health' has been understood in practice and policy and has influenced health system restructuring in New Zealand since 2000.
  
  
  METHODS
  Interviews in 2007-2008 with managers, clinicians, government policy advisors and academics were undertaken to explore the relationships between population health, determinants of health, and health system restructuring. This was augmented by a review of major government health policies from 2009 to 2013 to establish which notions of population health were reflected.
  
  
  RESULTS
  Population health shifted from a broad notion of health determinants to focus on a small number of quantifiable health targets driven by financial incentives. Meantime, an emphasis on 'quality and safety' impeded population health activities. District Health Board programmes to identify high risk individuals, by disease or hospital service utilisation, diverted attention from broader population health outcomes. District Health Boards were not held accountable for integrating a population health approach in service planning and did not initiate or lead intersectoral work. Community consultation was limited. Primary Health Organisations, although mandated to address population health, typically aligned with the small-business model of general practice making service integration difficult to achieve. In policy, 'population health' dropped from favour in the mid-2000s, although many documents, outside the health sector, carried forward these values.
  
  
  CONCLUSIONS
  A progressively narrower focus on a small number of health targets and on organisational processes undermined earlier policy intentions and health system restructuring that sought to improve broader population health outcomes.
authors.affiliation: School of Nursing, Faculty of Medical and Health Sciences, University of Auckland, Auckland, New Zealand.
authors.forename: Nicolette F
authors.initials: NF
authors.lastname: Sheridan
authors.affiliation: Department of Medicine, South Auckland Clinical School, University of Auckland, Auckland, New Zealand.
authors.forename: Timothy W
authors.initials: TW
authors.lastname: Kenealy
authors.affiliation: Counties Manukau District Health Board, Auckland, New Zealand.
authors.forename: Jacqueline Ig
authors.initials: JI
authors.lastname: Schmidt-Busby
authors.affiliation: Department of Medicine, South Auckland Clinical School, University of Auckland, Auckland, New Zealand.
authors.forename: Harold H
authors.initials: HH
authors.lastname: Rea
keywords: Population health; health system restructuring; health targets