module 2
Lecture 12
Understand the concept of the ‘causes of the causes’ and how these operate at different levels
So basically causes of causes so if something causes an disease, what is the cause of the cause. So smoking cause lung cancer, but what causes people to smoke in the first place which is determined by socioeconomic factors. So an individual may get sick so you treat the individual, but if a whole population is getting sick, you do not just treat the sick people, you see why are people getting.
2. Define the components of the ‘Dahlgren & Whitehead Model’ and use this framework to identify the causes of the causes of dis-eases
It is split into 4 levels with the middle part which are age,sex etc which are non modifable and not changeable, the other levels are are all working together and not an in individual level. So if you look at a the fuel crisis you can break it down in the model and see what causes what in each level and implications of the crisis in population health. So the most outer layer is things that are more government level, socieeconomic factors. Then it slowly comes down to your environment and what you surrounded with, Then the next layer is the family/social circle and how that causes you as an individual to make bad/good choices. Then comes to individual where all the outer layers shapes your choices as a person
3. Define the difference between ‘upstream’ and ‘downstream’ levels of action
Upstream is government level and downstream is affecting individuals. So basically the distal determinants is something that is occuring government level e.g. policies or rules that will affect the determinant. Distal also referred as upstream factors.
Proximal determinant is basically what occurs at individual level so like the determinant causing a change in health status like excessive sugar --> type 2 diabetes. It is also mainly downstream factors as it affects more in an individual level.
4. Briefly describe the 3 high-level components of the Living Standards Framework and ‘The Four Capitals’ used by the NZ Government
The 4 capitals are Human, Social, Nature, and financial capital so Human is the individual so a persons education, job status etc which can influence their decision making and have better health. Then its Social capital which is how the society is held together by instituations, social norms and how they all function together and how we all trust the government. Then next is natural capital which is how our environment shapes our health in the population e.g. polluted air means more bad outcomes in population health. Then next is financial captial which is if our money is being put into good uses and development of useful infrastructure like schools,roads etc
The 3 High level components are first the individual which is what we do as a person and things that we cannot change. Also is the choices we make as an indivudal leading to a good or bad outcome. Then next is ocmmunity which is who you were brought up along with e.g. family and friends and whetehr they have good infleunce or bad which shapes you as a person. Lastly it is the environment which is how the general environment the population is in like is our population very poor due to lack of government care, or our water being safe to drink, if we can successfully prevent diseases in our population and what we doing to mitigate climate change
5. Define and distinguish between ‘structure’ and ‘agency’
Structure is basically how the physical or social environment influences the population to make choices e.g. more cigarettes available in low-income area so people more likely to buy due to stress. whereas agency is individuals being indepentand and making free choices
Agency is individual and social in the model and structure is the environment, scoeioeconmic factors e.g. and social.
Lecture 13
Describe the key sources of population (health) data and their main strengths/weaknesses
The key sources are IDI which uses data from multiple different government agencies to link it all in one. and Census and the main strengths for IDI are that it can help understand the household better from multiple causes which you can link together. Its put in a way where you can't determine who a data is about as its de-identified and strict measures are put in place to ensure confidentiality. Main risks are that you don't know which people may be abusing the system and you basically can’t track indviduals becausee patterns are seen in population and not indivudals. Also it doesn't include people that do not use health system or not in electrol roll so those people are left out in IDI. You also cannot help individuals who would benefit from a certain intervention.
Create population pyramids and interpret dependency ratios
Ethnicity question response maori vs european in 2023. So knowing how to interpret dependency ratios.
Understand how to calculate demographic measures and what they are used for
EDR is the elderly dependant ratios, Young dependant ratios are kids aged 0-14. both groups are dependant on people working between 15-64. So you calcualte elderly by the number of elderly and divide by the working age x 100. same for youth. Total is youth+ elderly/ working age x 100. They are all used to see social and economic requirements like more schools or more rest-home facilities
Describe the effect demographic changes are having/ will have on New Zealand’s population
More emigration where people from NZ are moving to other countries for better pay/oppurnties so the older population will be higher as more younger people are emigrating. Fertility rates would be higher if wanted to meet the projected dependanct ratios so births would outnumber deaths so more YDR and less EDR. Or there was no migration, People stayed where they wud be a massive spike in population and more deaths occur in NZ outnumbering births. But EDR would still remain high.
Lecture 14:
Identify the key measures of socioeconomic position for individuals
Socieo economic factors are what position an individual holds in society. So basically important to see inequality between scoeities and also see change sin population structures over time during every census. The key measures are education, assets and wealth, occupation, income and housing. Education will always find its way to link to health and all other measures will also link to health somehow.
Demonstrate the association between socio-economic position and population health
The association between those two are that socio-ecnomic refers to your position and status in the society and this determines your health. So people in more wealthier neighbourhoods have better access to health/likely to afford health.
Define and demonstrate your understanding of the ‘social gradient’
Social gradient is basically something that looks at how low socioecnomic means worser health outcome. Its a linear relationship.
Understand how the Dahlgren & Whitehead Model can be used to describe measures of SEP and the causes of the causes
The model can be used to see how SEP can fit on there. So socieo-ecnomic looks at it at a more population way so we look at things like why certain areas are less deprived of essential needs that other people have and if the environment or something else ie casuing it. So you always start at the outcome and then look at what causes the outcome and then the cause of the cause. Government policies, soceioecnomic factors and environment all are parts of the model which SEP has as it it is focused mainly on socioeconomic. So at a community way you consider why people have less income, less access to basic needs and access to health. You can group similar groups with same SEP levels together. Then you look at it family and friends so your parents income and things determine your social status in the economy as if you’re a minor your status is defined by your parents. If you have rich parents you are more likely to be rich and vice versa. Then you look at individual way to see if your education, occpuation and income where that fits on the model. It is influenced by our own decisions making skills.
The Dahlgren and Whitehead model provides a framework for understanding the social gradient, illustrating how health outcomes improve in a linear, step-wise fashion as one moves up the socio-economic ladder. At the core of the model are individual factors like age and sex, but as we move outward to distal/structural layers, we see how Socio-Economic Position (SEP) determines health through access to Financial, Physical, and Social Capital. While individuals exercise agency in their lifestyle choices, these choices are heavily constrained or enabled by the structural environment, such as housing quality, education, and employment opportunities.
In the New Zealand context, tools like the IDI and NZDep allow researchers to measure this association objectively. By linking de-identified administrative data, the IDI reveals how "the causes of the causes" (upstream factors) result in the health disparities we see across different neighborhoods. NZDep specifically highlights the social gradient by showing that those in Decile 10 (most deprived) areas face significantly higher health risks than those in Decile 1 (least deprived). Ultimately, this demonstrates that health is not merely a result of individual "choices," but a reflection of the broader social and economic structures that shape a person's life-course.
Lecture 15:
Not al government have the same approach for improving health and wellbeing of society.
Equalities is everyone given the same thing despite not acknowledging it doesn’t fit everyone and some may not even need. E.g. watching a sports game, the adult, teen and child will be given a stool but the child needs more stool it still cannot see the game.
In equities, the same thing is given to everyone but it accomadates the needs of the individual. So a stool will be given to those who need it e.g. the kid watching a game will get one and the child will get two stools so he can see the game.
Define the terms ‘inequalities’ and ‘inequities’ in the context of population Health
Inequalities are basically what affects certain groups to be at a disadvantage compared to another which is an measureable difference between two groups. Inequities branch from inequalities and it is more of the difference that is observed that is unfair,unjust to a group of people and avoidable.
Outline the major arguments for to reduce inequalities in health
Identify the components of the PROGRESS statement and how this can be used in population health
Place of residence, race/culture/language, occupation, gender/ sex, religion, Education, social capital and socioecnomic status. This is used in population to show that everyone is diverse, so the same appraoch and same things will not work for everyone as that would be inequity? So differetn resouces and appraoch is needed to ensure everyone has equal rights and not disadvantaged.
Describe the influence income inequities have on health and society
Someones income status should not cause people to rethink about accessing healthcare services. Because its shown in low socioecnoic groups, peoplpe are less likely to access healthcare as they cannot afford it or prioritise other things over it. Another reason is the inequity in income of male vs female, this is unfair and unjust and avoidable. Everyone should be paid equally not because of biological differences.
Recognise the influence privilege has in contributing to inequities
Some people are born in wealthier environments so they may contribute to rules or policies that they think benefit everyone, but since they never grew up in a low soceioeconomic group they don’t understand their struggle. So they overlook it all. Wealthy born people live in that environment their whole life and think that is the norm, so they can afford private care, doctors, other advanced services that regular people cannot.
Lecture 16: Neighbourhoods and population helath
Different neighbourhoods have different access to healthcare so better neighbourhoods are
Describe the characteristics of the built environment
The characteritics of that is things that are built by humans such as buildings, schools, towns, hospitals etc Or parks and community centres for neighbourhoods, or roads, electrical stuff, lights etc.
– Describe the New Zealand Index of Multiple Deprivation (IMD) and explain how deprivation measures such as the IMD or NZDep differ from the traditional measures of socioeconomic position (SEP)
IMD is made of 7 different things employment, education,crime,housing, access,income and health IMD and NZDep both look at deprivation of neighbourhoods whereas socioecnomic position is more of an individual level and determien the position of an individual in the society.
– Discuss how different aspects of the built environment can promote or restrict healthy behaviours
Putting it in the model, it depends on the individual and the choices they make. So this can be shaped by the people around them like family or friends and access to recreational facilities near their homes and things. So what your family or friends eat and their habits will most likely also determine your habits as well. Then the environment is school,job,home.
– Discuss features of urban planning that are health promoting with respect to travel and encourage ‘healthy choices’
Street grid like pattersns are preferred because they are built in a grid structure so everything is accessible and closeby. It increases more active transport chances rather than commuting train bus,car,etc and scooter or bike if running very late. Everything seems nearby because there is more roads/footpaths. Distance is also shortened from starting distance to the destination. You also get more physical activity done as you are actively transporting.
Lecture 17:
Describe Māori health status using key indicators (such as life expectancy, major causes of death, general patterns of morbidity and mortality)
Maori do not get the health intervention they deserve as its influenced by many factors such as not getting the right treatment, denied treatment, treated as less priority. They also face a lower life expectancy than other ethnicies which is an inequality as it should be equal. This gap exists due to inequtieis such as poor housing, less income, reduced job oppurtunties. Its unfair and very avoidable.
Describe the nature and extent of inequities in health status between Māori and non-Māori
Maori children are more likely to get only relievers and not inhales in conjunction compared to non-maori kids. This is inequity because all asthma kids should be treated the same regardless of their ethnicity. Same applies to maori adults and non-maori adults.
Identify an example of an historical process that has influenced current Māori health and wellbeing
Te tiriti o waitangi where maori had their land stolen by the british even tho the treaty was a peace treaty, the maori were continously assaulted, land stolen, could not vote, loss of indigenous flora and fauna, paid less, and faced injustice and unfairness. This past colonisation still lingers in NZ making current Maori in NZ rethink their choices being led by a primarily white driven policies and rules.
Give an example of how social and economic inequities between Māori and non-Māori in Aotearoa/New Zealand have arisen
It has risen due to the structural process like land loss where maori people lost their land from the british so people are not more hesitnat to trust rules made by them and there are some more rules being favoured to others more than maori being created by whites. Indigenous land feom maori was taken overtime and now they have such little land in their own country.
Lecture 18:
Understand what is meant by the term ‘accessibility’
It means if seeing your GP is easy like somewhere nearby instead of travelling far to see your GP. If your GP far you are less likely to see them. Plus in older pacific you are reliant on others to take to GP so hard to see them sometimes or pacific doctors are less and are far.
• 5A’s
Accessibility, Accomdation, Affordability, Acceptability, Availability
• Describe the relationship between accessibility to resources and socio-economic position
Accessibility for ethnic like maori is hard because transport wise if your GP is far it would require more resourcese e.g. fuel and money which can be an issue for people on the low socio-economic position. You may also not have transport so you resort to someone dropping you, public transport,walking etc which are kind of dangerous if your sick without a vehicle or someone with u. You will be less inclined to seek healthcare in the future due to these ressons.
• Demonstrate where access may be 'placed' on the Dahlgren & Whitehead Model
Fits on the social and community area of the model because it shows you are more likely to see doctor of same ethnicity and if your sick your reliant for others for transport.
Lecture 19:
Identify differences between the health system, and the health care that is provided.
Health system is what helps restore and maintain health in community/population which is funded by government and tax payers whereas health care services are places you go too which are determinants of the outcmoe. So docotr or nurse treating your leg is a determinant as it affects your outcome.
Discuss how the health system interacts with the different levels in the Dahlgreen and Whitehead model.
The health system is more of the environment in the D&W model as its what health care services are built from. It’s the system created by many people through government funding and tax payer money. It also is basically how our country treats health in individuals. Like ministry of health or NZ government are the big dawgs.
Discuss how much of the variation in health might be influenced by health care and by the health system.
Healthcare is more better at a population rather than indiciaul, it is better at fixing you when your sick but doesn’t stop you from getting sick in the first place e.g. like cause of the cause. So variation in healthcare may occur whether the health care doctor only helps like 20% of you whereas the other 80 comes from other things. More variation in health as peoples choices, communities, environment influence alongside the doctor medication as the outcome.
Health system is government level where certain rules are passed or made on health like prescriptions free or other things and not training doctors in diverse environments which is a sign of racism as maori group are most likely to be left out, so lower quality of care. So we are seeing why people are getting sick in the first palce whereas healthcare u just help the people that r sick.
Understand how we might look to redesign NZ’s current health system.
Redesign NZ current health system by focusing more on primary care than secondary care even if it means cutting some funding for seconadry caare like specalists care in inefficent things. Because right now priamry care is something you pay for to see gp whereas secondary care is free. People desinign healh systtem know that most people in the lower soceioecnomic field cannot afford primary care due to range of reasons ( AAAAA) so there will be less people coming to secondary care. Another reason is people go to see GP if its very severe and life threathing and by the time they reach hospital (secondary care) the disease is too late which was completely avoidable if primary care was cheaper or not something yoou have to pay for and so the lower soceioencoic group wuld be more inclined to visit primary care.
Lecture 20:
Understand how racism and oppressive systems negatively impact on Pacific Peoples*
Racism is stemmed from history from white people where pacific and maori people wre constantly looked down upon and had faced unfair, unjustness which are inequities as they were disregarde simply because of who they are and nothing biological.
Describe the key components of the Polynesian Panthers Platform
Polynesian panthers fight for rights for maori and pasifika and follow the 3Ps and 3Cs where the 3 p's are stopping racism and maintaing a peaceful relationship with other cultural grups and removing systematic and instituional racism as most are also intertwined in government policies and legalsations, Next is celebrating mana pasifika, so being proud of being an islander and maintiang your ethinic identity when challanged e.g. in a foreign environment. Next is education to liberate so knowing your rights and standing up and fighting for it.
Next is the 3 C.s which is colonisation so how the british coloonised other countries like fiji, niue, tonga, samoa for their own use e,g, fiji for sugarcane farming, trading women and young girls in samoa and tonga and niue from villages. Next is christianity which is what the british white people followa as their main revision and follow the bible by having an hierachy order where whites are the top to justify their treatment towards pacifika. Last is captalism , so exploiting labourers for their own use so pasifika were the lower end people and based on their status they were treated badly.