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

Objectives: To describe the reasons for the formation of divisions of popul ation health in NSW, their functional units, how they might be evaluated, a nd some future challenges; to stimulate critical appraisal of the divisions . Methods: Personal observation; review of documentation and organisational c harts. Results: Area health services (AHSs) were established in NSW in 1986; there are now 17. Divisions of population health attempt to overcome the margina lisation and fragmentation that often characterise population health worker s within AHSs. Divisions aim to strengthen an AHS's capacity to meet its le gislated responsibility to protect and promote the health of the local popu lation. Each of the 13 divisions established since 1994 contains a differen t mix of services. Public health, health promotion and health services plan ning units are most commonly included in divisions. Formal evaluations of o rganisational structures are not common in health services. Evaluations of divisions of population health should focus on their success at: creating o rganisational structures and processes which are conducive to the implement ation of population health strategies; improving health outcomes; and impro ving the personal, social and environmental pre-conditions for health. Conclusions: Establishing divisions of population health has highlighted th e lack of evidence regarding the effectiveness of different organisational structures for delivering population health services. Implications: Greater effort is needed to evaluate existing organisational structures and to develop and implement optimal structures for population h ealth services.