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
