Determinants of public healthPublic health focuses on finding evidence-based ways to prevent disease, prolong life and promote the health of all New Zealanders through the organised efforts of society. Public health is about population groups rather than medical treatment of individuals, and looks beyond health care services to the aspects of society, environment, culture, economy and community that shape the health status of populations.
Determinants of health:
1. Addressing the underlying economic and societal determinants of health and disease, including historical and contemporary inequities in income and employment, housing, education, urban development and participatory democracy.
2. Strong public health infrastructure such as legislation, workforce, leadership, funding and service providers.
Socio-economic and commercial determinants of health
The environments where we live, work and play influence our health – for better or for worse. Commercial activities are among the factors we call the socio-economic determinants that can have direct and indirect impact on our health outcomes. Selling processed foods and drinks, alcohol, and tobacco are big businesses and demand is high worldwide. The strategies private companies use to promote these products shape the so-called lifestyles and choices of individual consumers—ultimately determining health outcomes.
By addressing the underlying determinants and promoting healthy environments, public health can demonstrate improvements in people’s health and productivity. Public health also includes a strong focus on achieving health equity across ethnic, socioeconomic and cultural groups.
- 27% (290,000) of Aotearoa/New Zealand children live in households with low incomes.
- 12% of NZ children live in household that go without seven or more things they need for their wellbeing – that’s 135,000 children in Aotearoa/New Zealand.
- Non-Māori are more advantaged than Māori across all socioeconomic indicators presented – this includes school completion, employment rates, income level and quality of housing.
- Higher proportions of Māori and Pacific peoples live in areas of high socio-economic deprivation
- Heart disease and diabetes are significantly greater causes of amenable mortality for Pacific people than for the general population, yet approximately 33% of Pacific adults had experienced an unmet need for primary healthcare in the past 12 months.
<0.5% of the health budget is spent on the prevention of harm from tobacco, alcohol and unhealthy food which cause 32% of the premature death and disability
Public health infrastructure
Public health infrastructure provides the necessary foundation for undertaking the basic responsibilities of public health. This includes supportive legislation, workforce development, leadership, funding and effective public health institutions and organisations. It is the government’s responsibility to ensure that public health infrastructure has the capacity and capability to respond to today’s health needs, anticipate tomorrow’s challenges and has the surge capacity to respond to a public health emergency. The New Zealand Health Strategy notes that an investment approach takes into account the long-term impact of government spending on people’s lives and accounts for full long-term costs and benefits.
- Prevention funding for tobacco, alcohol and unhealthy food is less than half of one percent of the Health Budget, whereas these harmful commodities create about one third of Aotearoa/New Zealand’s premature death and disability
- The 1956 Health Act is ill-equipped to deal with the threats to health from tobacco, alcohol and unhealthy food and needs updating
- Aotearoa/New Zealand has no independent institution that can lead on implementing policies to prevent harm from tobacco, alcohol and unhealthy food
- There is no national database of occupations involved in the delivery of public health services and no strategy for developing the workforce
The Coalition will be hosting an annual prevention week to present and discuss the annual Prevention Aotearoa report with latest evidence on policies and progress on improved health and equity in Aotearoa/New Zealand. This event will be an opportunity to hear national and international speakers on the latest prevention science and policy actions.
Coalition members will have multiple planning meetings during this week to set the year’s priorities. This will concern prevention policies to reduce harm from tobacco, alcohol and unhealthy food, including:
- Comprehensive prevention plans which include setting targets and implementing the effective policies and strategies recommended by WHO and other expert groups
- Pricing strategies (e.g. health levies on sweetened drinks and alcohol)
- Access strategies (e.g. availability of alcohol in communities and unhealthy food in schools, access to e-cigarettes)
- Marketing strategies (e.g. regulations on marketing unhealthy food to children, plain package cigarettes)
- Labelling strategies (e.g. warning signs for alcohol, sugar, salt and saturated fat)
- Reformulation strategies (e.g. reducing sugar and salt in key food groups)
- Monitoring and evaluating the impacts of policies and actions
Aotearoa/New Zealand’s public health infrastructure and socio-economic and commercial determinants of health will also be discussed, and integrated in the action plan and policy priorities of the Coalition.