Curriculum standards
Knowledge guides
LG19: Determinants of health
Key drivers
Advanced Trainees will have a comprehensive depth of knowledge of the determinants of health, and the effects of the social, cultural, and political environments on the health of populations and diverse population sub-groups, including public health initiatives to reduce inequities.
Epidemiology
Advanced Trainees will know the epidemiology of health disparities across population groups defined along social, economic, or cultural lines.
Health inequity assessment and management
Advanced Trainees will know how to explore, analyse and report on health inequalities
Important specific issues
Advanced Trainees will identify important public health issues relating to health inequities.
Understanding the broader determinants of health
- Social and economic environment influences on health, including:
- discrimination
- educational attainment
- income
- migration
- social injustice
- colonisation
- social support networks
- social status
- Digital determinants of health, including:
- direct and indirect ways by which digital transformation influences equity in health and wellbeing
- Commercial determinants of health, including:
- private commercial activities and their effect on health and health equity – directly and indirectly, positively and negatively, including across the industries of tobacco, food, fossil fuel, and alcohol
- Physical environment, including impact of health from:
- clean air
- employment
- healthy workplaces
- safe communities
- safer housing
- safe water
- Access and use of quality health care and health services for prevention and treatment, inclusive of all levels and types of care
- Individual characteristics and behaviours, including:
- gender
- genetics
- identity
- personal behaviours, including:
- nutrition
- physical activity
- outdoor activity / exposure to green space
- ameliorating factors, including spirituality and/or religion
Achieving equity
- The imperative for reducing health inequities, including:
- addressing poverty as a key driver of child mortality and morbidity, including relative deprivation, across all determinants of health
- translating public health knowledge into effective action, including political action
- Understand the concept of intersectionality and the interactions between different aspects that can amplify inequity of a group, such as:
- attitudes
- gender
- identity
- organisations
- race
- systems
- structure
- Understand syndemic theory, including:
- the concept of polycrisis
- adverse interactions between diseases and social conditions (social gradient)
- clustering of adversity by person, place, or time
- mitigating and aggravating factors, such as misinformation and disinformation
- Consideration of resource allocation in health care, with reference to ethical principles
Priority populations
- Aboriginal and Torres Strait Islander peoples
- Māori (tangata whenua)
- Pacific peoples
- Elderly, women, and children
- LGBTQIA+ people
- People of refugee and/or asylum seeker background
- Immigrants and people who do not speak and/or understand English
- People currently and recently incarcerated
- People living in unstable housing / with insecure shelter
- People living with a disability
- Relative socioeconomic disadvantage
- Rural and remote
- Underemployed and unemployed
Public health management
- Advocate for and implement community-led interventions and culturally responsive engagement with communities
- Advocate for health equity
- Build a public health workforce that is diverse and inclusive
- Model anti-racist and culturally responsive behaviours
For each presentation and condition, Advanced Trainees will know how to:
Synthesise
- relevant evidence, including from listening to communities, applying epidemiology, and reviewing literature from other populations where health inequities have been successfully reduced
- the differential impact of public health interventions on individuals, family, communities, and the wider population when developing implementation plans
Manage
- advise on public health management to mitigate inequitable social determinants
- involve multidisciplinary teams and effectively engage, communicate, and collaborate with relevant stakeholders
- recognise the necessity of communities advising on and leading initiatives to improve their health
Consider other factors
- identify the relative importance of different determinants for specific population and cultural groups
- identify legal and treaty responsibilities in management
- Drivers of health inequity across diverse population sub-groups
- Identification of population sub-groups, according to:
- ethnicity, race, and culture
- disability
- gender and gender identity
- geography, such as rurality
- sexual preference
- socioeconomic status
- Indigenous data sovereignty and shared access to data and information at a regional level
- Key demographic, social, and economic indicators by region and trends
- Key health statistics by region, population group, and trends
- Measures of deprivation and socioeconomic status, such as the Socio-Economic Index for Areas (SEIFA) and Aotearoa New Zealand Deprivation Index (NZDep)
- Sources of health information and their quality, including for specific population sub-groups
Health equity impact assessment
- Needs assessment for priority populations
- Problems and objectives
- Research, analysis, and consultation
- Recommend options
- Implementation and operation
- Review and reassess, monitoring, and evaluation
- Structured approach for considering the potential impact of policies, programs, or other initiatives on health equity (can be applied prospectively or retrospectively)
Systems thinking
- Analyse and interrogate issues and situations using key concepts and tools of systems thinking, such as causality, influence, and interconnectedness
- Apply pattern recognition and systems mapping as tools to improve population and public health policy and practice
- Compare and select strategies based on risk, benefit, harms, and unintended consequences
- Select and change appropriate structures and systems for health improvement
- Solve public health issues using adept systems thinking
- Activities of international health and development agencies, such as World Health Organization
- Concept of proportionate universalism
- Health inequities (both emerging and exacerbation of existing) due to climate change and other global impacts
- Ethical tensions arising in the promotion of population health and reducing health inequities
- National and international public health policy and legislation and the direct and indirect impacts on health inequities