Divisions of population health: quantum leap forward or rearranging the deckchairs?

To describe the reasons for the formation of divisions of population health in NSW, their functional units, how they might be evaluated, and some future challenges; to stimulate critical appraisal of the divisions.

Personal observation; review of documentation and organisational charts.

Area health services (AHSs) were established in NSW in 1986; there are now 17. Divisions of population health attempt to overcome the marginalisation and fragmentation that often characterise population health workers within AHSs. Divisions aim to strengthen an AHS's capacity to meet its legislated responsibility to protect and promote the health of the local population. Each of the 13 divisions established since 1994 contains a different mix of services. Public health, health promotion and health services planning units are most commonly included in divisions. Formal evaluations of organisational structures are not common in health services. Evaluations of divisions of population health should focus on their success at creating organisational structures and processes which are conducive to the implementation of population health strategies; improving health outcomes; and improving the personal, social and environmental preconditions for health.

Establishing divisions of population health has highlighted the lack of evidence regarding the effectiveness of different organisational structures for delivering population health services.

Greater effort is needed to evaluate existing organisational structures and to develop and implement optimal structures for population health services.