Starting in 2018, the French Hospitals Federation (FHF) has launched a large-scale Integrated Care/Population Health Program called “Responsabilité populationnelle” (Shared accountability for a population).

Built around five “Pioneer” regions and two “target populations” (people at risk or suffering from Type 2 diabetes and Heart failure) it aims at joining all healthcare stakeholders in a given territory to create together shared clinical programs ranging from primary prevention to management of complex patients. Local stakeholders rely on health needs stratification and clinical decision-trees developed by FHF as well as local knowledge and lived experience to develop detailed health pathways and specific actions aimed at preventing diseases.

Mobilizing local communities and assets is key for the success of these population health program. We illustrate our point with three examples from our Pioneer Territories, each representing a dimension of a community: health at work, voluntary sector and local business community, all of which play a key role in population health.
1) Working with occupational health services, our teams were able to organize screening and referral inside the workplace, making access easier for at risk professionals. 2) Working with local foodbanks: our teams are embedded in these structures, allowing early detection and inclusion of severely deprived population that lacked access to HC services, 3) Working with local businesses: our teams have set up operations inside supermarkets to offer preventive services, health advice, and inclusion in the program for those who need it.

Taken together, our Five Pioneer Territories have carried out more than 950 outreach actions in 22 months, screening 15 000 at risk individual. More than 5 000 patients are enrolled in personalized health pathways.

In these Territories, the share of ER admissions for diabetic patients has decreased by 33%, share of ambulatory stays has increased by 25% and share of long stays decreased by 50%. Average hospital costs for diabetic patients is 6% inferior to the national average, while our territories “find” 4% more diabetic patients than national average.

The ”Responsabilité populationnelle” model was designed to be scalable. 4 new Regions have joined the program in 2023 and have now completed their clinical programs. We will illustrate how these “new” Territories plan to leverage community resources in their environment.

Background: YiPEE (Youth co-Production for sustainable Engagement and Empowerment in health) is a collaborative research initiative focusing on improving young people’s mental health through a co-designed multi-level school-based intervention, with inner, social, and environmental components, in urban settings in India (Chennai), Kenya (Nairobi), South Africa (Cape Town), and Sweden (Stockholm). Successful co-creation is known to generate highly contextualized, locally relevant and feasible solutions. However, little is known on how and why co-creation works, under which conditions and for whom. We aim to unravel these aspects by evaluating the co-design workshops organised across all four urban settings, in which the multi-component school-based intervention is collaboratively developed by adolescents, teachers, and stakeholders from the broader school environment.
Approach: We adopt a realist approach to test an initial programme theory (IPT) based on the Normalization Process Theory (NPT) and Self-Determination Theory (SDT). The IPT will be tested and refined, for each site, using data from multiple workshop participants, including observers, facilitators, and participants in the workshops. Information from the different sources is triangulated and synthesized into the Intervention-Context-Actor-Mechanism-Outcome (ICAMO) configurational framework.
Results: In the realist approach, the program theory consolidates causal explanations in the form of ICAMO configurations, which explain how interventions (I) within/and contexts (C) allow (or not) the emergence of mechanisms (M) in actors (A) that produce outcomes (O). The overarching goals of the workshop sessions were linked to the four constructs of the NPT: coherence (youth as interpreters), cognitive participation (youth as co-designers), collective action (youth as participants and implementers) and reflective monitoring (youth as researchers). We anticipate identifying multiple contextual factors (C) that facilitate engagement (O) of participants (A) by triggering NPT- and SDT-related mechanisms such as coherence (M), cognitive participation (M), collective action (M) and reflective monitoring (M), as well as perceived autonomy/agency (M), social connection/relatedness (M) and competence (M). Co-creation will be phased across the different study sites, allowing for iterative learning, theorizing on theory consolidation, and eventual scale-up.
Implications: We expect this study to provide new understanding of how and why co-creation works, for whom, and under which real-world conditions. The study aims to offer fresh insights into the study of co-creation by integrating implementation science theory and realist evaluation.
 

Background
This paper presents early findings from a co-design project led by the HSE National Health Service Improvement in Ireland and the School of Population Health at RCSI.
Ireland’s healthcare policy framework Sláintecare places population health at the centre of health planning and delivery, aimed at addressing health inequalities and reorienting the health system towards prevention and population health needs. Despite this growing emphasis, there is currently no nationally or internationally agreed definition or set of core principles for population health. This project therefore aims to create a collectively agreed, cross-sectoral definition and core principles driving population health for Ireland. These outputs are oriented to improving population health across the Irish population and bringing a cohesive and consistent approach to population health planning and improvement in the context of the new Health Regions and the drive for integrated service and care delivery in Ireland. The overall aim is to support the emergence of an ecosystemic approach to health, wellbeing and care in Ireland and internationally.

Approach
The project is grounded in its first phase with a scoping review of international definitions and a comparative analysis of population health principles in action. Building on the review stage the co-design collaboration is progressed through a series of in-person and online workshops that bring together patients, local government, community advocates, public health practitioners, and other cross-sectoral partners in an emergent conversation; building understanding, recognition and ownership of a definition and principles of population health that make sense in many local contexts. Project outputs, outcomes and learning are captured in a series of co-designed deliverables including process reports, technical and evaluative reports and two academic papers. Robust governance and implementation arrangements are in place to ensure meaningful engagement, ownership and dissemination of findings assuring outputs are accessible and user-centred.

Results
Given the timing of ICIC25 results from the literature review of population health definitions, principles in action and the comparative analysis of population health framing for action in different health systems will be presented; additionally we will present the results of our stakeholder mapping and initial findings from collaborative workshops. These findings will constitute a substantive body of evidence-based community engagement with core concepts currently driving system reform.

Implications
This project will generate a working definition and guiding principles for a standardised population health approach in Ireland. As such, project outputs will frame and guide the ongoing design of population health interventions and integrated care delivery as the new health regions embed. This paper speaks to several Integrated Care Pillars including 'population health and local context' (no 2), and 'people as partners in care' (No 3). The project has a system wide scope and is aimed at building local leadership, competence and new alliances (Pillars 4 & 6). Findings speak to the ICIC25 conference themes of 'inclusive health' and 'collaborative approaches to integrated care' by socialising a core concept driving current health system reform (population health) in a specific health system undergoing significant change.

Since 2017, the Ukrainian health sector is undergoing a continuous reform process starting
with the creation of the National Health Service of Ukraine (NHSU) as the single payer for
health care services and the administrative decentralisation moving the responsibility to
organise and manage health services to the district level. Despite the Russian military
aggression, the reform agenda focussing on strengthening primary care and on increasing
the resilience of local populations continues to be implemented. Starting in August 2023 a
group of national and international actors jointly worked on the development and
implementation of territorial integrated care for Ukrainian districts using the WHO IPCHS
standards and a “healthy community” approach based on a Population Health Management
(PHM) platform. Implementation partners were selected from districts, which were affected by
the first wave of Russian warfare.
Five districts were identified based on letters of interest and interviews with the applicants.
Healthy Hromada Dashboards were prepared with basic data provided by local authorities.
Managing PHM systems requires a local integrator function and to mobilise diverse
community actors and resources. Sensitization and capacity building of local public
authorities (LPA) let to setting up a local interdisciplinary expert group to bridge sectoral
boundaries, which would function as a local integrator: Five selection criteria were used to
district project proposals: a good mix of actors, a strong vision towards healthy communities,
access to relevant data, ability to agree on priorities and ability to attract financial resources
for the planed interventions.
The Bucha district local integrator group of community professionals was officially recognized
as the executive body to the city council. The Bucha Health Fair, organized by joint efforts of
the members of the local integrator team was a one-day event in the local city park
promoting health and wellbeing in the community. Bucha Health Trails were created to
encourage physical activity and promote wellbeing among residents. The trails were initiated
by family physicians to create a health and preventive care offer for district outside of the
healthcare clinic setting. Some doctors “prescribed” doses of healthy steps to patients, who
needed to increase their physical activity levels.
The Mukachevo district local integrator team chose to work on improving early detection of
Diabetes type 2 and educating high risk populations. Awareness raising through health fairs,
offering preventive care consultations, changing procedures to provide more access to blood
sugar testing also outside physician cabinets and counselling of identified diabetes patients
were key interventions. The intervention let to a significant increase of detected cases and
related visits to endocrinologists
The current health sector reform and the administrative decentralization leaves most Ukraine
districts and their LPAs ill equipment to manage related tasks and to coordinate ICPHs
services. The creation of local integrator platforms established an instrument for information
exchange, priority setting and managing joint interventions. Although most healthcare data
are currently available thanks to NHSU dashboards, very few data points are suitable for
strategic planning, management and the measurement of patient outcomes at district levels

Background: Health disparities closely correlate with social and economic inequality, and participatory strategies are increasingly adopted to address these issues. However, meaningful citizen involvement in policymaking remains challenging. Our research uses the Theory of Change (ToC) to co-create policy strategies that address health disparities in partnership with citizen-researchers. The ToC is a participatory method to visualize a step-by-step pathway to reaching a shared vision. By making explicit the contextual factors and underlying assumptions behind each step, the ToC provides a rationale why a certain pathway will lead to certain goals. In this study, we show how a ToC was co-produced with residents, demonstrating its potential as a collaborative tool for sustainable, community-driven health policy.
Approach: Our study focuses on single parents since they, and their children, are disproportionally confronted with health disparities. We collaborated with six single parent citizen-researchers, both single mothers and fathers, with a diverse background with respect to ethnicity, religion, education, occupation and employment status. They all live in a marginalized urban area in one of the major cities in the Netherlands. We conducted eight sessions to map the interrelated social and health issues underlying health disparities in the area. Building the ToC was an iterative process where we had group sessions or focused interviews with the citizen-researchers and the researchers translated the insights into a visualized ToC model; in each consecutive session, the step-by-step pathways, contextual factors and underlying assumptions were validated and refined by citizen-researchers until a final ToC was agreed upon.
Results: The impact of social and economic inequality on residents’ lives is overwhelming and resulted in a structural lack of trust in the government and formal institutions. Support for residents in vulnerable positions demands a completely new approach to care and support, centered around preventive action and informal care by residents as peer-experts. The ToC made explicit that the formal system, the complex of the municipality and the local social welfare and healthcare organizations, should collaborate with peer-experts and how the experiential knowledge and expertise of peer-experts should be protected from system forces. The ToC demonstrates that current initiatives in the neighborhood can be tweaked to better serve the needs of residents, demonstrating that improvements are feasible within current policy frameworks.
Implications: By visualizing residents’ needs and ideas in a structured and logically model grounded in the local context and current policy framework, feasible suggestions for immediate action can be established. By explicating the underlying assumptions, the logic behind each step becomes apparent, bridging the gap between community insights and policy expectations. This co-production process may offer a practical model for integrating resident perspectives into policy, addressing the need for meaningful, collaborative approaches in health and social care.

Introduction. Singapore’s ageing population, rising chronic disease burden and escalating healthcare expenditure has prompted a nationwide shift to an integrated, population-based approach to health system management. Any such approach is inherently complex with many moving parts, creating a challenge in design, implementation, monitoring and evaluation, or, for that matter, even simply comprehending the tectonic transitions.
This presentation, entitled “Explorations in Population Health in Singapore”, introduces a conceptual framework for population health management, based on the critical elements necessary for successful population health management, and illustrated by examples from Singapore’s rapidly evolving health system.
Methodology. This conceptual framework draws on systems thinking and complexity management theory to create a comprehensive and coherent model for population health management. We consider not just the basic components — long term goals, medium and short term outcomes, system outputs, activities, inputs and resources, and assumptions and external factors — for population health management but also the dynamic interactions of the components within a complex ecosystem. These interconnected elements must synergise to create a responsive healthcare ecosystem prepared for the challenges of an ageing population and shifting disease burden.
With systems thinking, we identify interconnections between healthcare, social services, and environmental factors that impact health outcomes. A mapping phase employing causal loop diagrams and system archetypes visualises key components, feedback loops and leverage points within the health system.
Next, complexity management theory guides the exploration of adaptive behaviours, emergent patterns and dynamic, non-linear interactions across the different stakeholders. Scenario planning and adaptive management techniques frame interventions for scalability and resilience under changing conditions.
Results. We illustrate aspects of this framework with examples from the various healthcare clusters in Singapore. This systems-based framework emphasises the importance of synergy in population health management. A key insight is that for effective population health management, the system must be intentionally designed for coordinated, continuous interaction across healthcare services, social care and preventive efforts.
Discussion. We consider the lessons learnt and the importance of transitioning from isolated interventions to a cohesive, systems-based approach. This framework provides a model to strengthen integrated care initiatives, ensuring that population health programmes are equipped to address complex healthcare needs while avoiding common pitfalls associated with unsystematic programme design.
Well-intentioned initiatives have in the past inadvertently led to adverse outcomes which were in truth foreseeable but unforeseen due to a lack of a systematic systems analysis. For example, we consider potential shifts in the disease burden resulting from the hoped-for success of Healthier SG, including how deferred onset of chronic diseases could lead to the relative increase of conditions like cancer and neurodegenerative diseases and the consequences thereof.
Conclusion. In sum, this conceptual framework bridges policy intentions with practical healthcare delivery, emphasising the role of interdependence in fostering a sustainable health system. As Singapore’s healthcare landscape evolves, this model might guide a cohesive, adaptable approach to population health, advancing health outcomes while preparing for the long-term shifts in health demands and system resilience.