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A generic programme logic model
Public Health IntelligenceOccasional bulletin Number 35
Author
John Wren, Senior Advisor, Social Epidemiology, Public Health Intelligence Unit, Ministry of Health, was the author of this guide.
Citation: Ministry of Health. 2006. A Guide to Developing Public Health Programmes: Ageneric programme logic model. Occasional Bulletin No. 35. Wellington: Ministry of Health.
Published in March 2006 by theMinistry of HealthPO Box 5013, Wellington, New Zealand
ISBN 0-478-29914-1 (Book)ISBN 0-478-29917-6 (Internet)HP 4215
This document is available on the Ministry of Healths website:http://www.moh.govt.nz
Acknowledgements
This document draws heavily on material from four sources.
ERGHO. 1996. Choosing a health outcomes measurement instrument: general advice proposed by the European Research Group on Health Outcomes Measures (ERGHO). Quality of Life Newsletter no. 15: 78. URL: http://www.mapi-research.fr/pdf/newsletter/qol15_0.PDF (accessed 3November 2005).
Health Communication Unit. 2001. Logic Models Workbook. Toronto: Health Communication Unit, Centre for Health Promotion, University of Toronto. URL: http://www.thcu.ca/infoandresources/publications/logicmodel.wkbk.v6.1.full.aug27.pdf (accessed 3 November 2005).
Strategic Policy Directorate of the Population and Public Health Branch. 2001. The Population Health Template: Key elements and actions that define a population health approach. Ottawa: Health Canada. URL: http://www.phac-aspc.gc.ca/ph-sp/phdd/pdf/discussion_paper.pdf (accessed 3 November 2005).
WK Kellogg Foundation. 1998. WK Kellogg Foundation Evaluation Handbook. Battle Creek, MI: WK Kellogg Foundation. URL: http://www.wkkf.org/Pubs/Tools/Evaluation/Pub770.pdf (accessed 3November 2005).
Contents
TOC \o "1-2" Acknowledgements iii
Purpose and Background to this Guide PAGEREF _Toc123096702 \h 1
What is a Programme Logic Model? PAGEREF _Toc123096703 \h 3
Logic Model for Developing New Zealand Public Health Programmes PAGEREF _Toc123096704 \h 5
Informative Inputs PAGEREF _Toc123096705 \h 7
Research evidence PAGEREF _Toc123096706 \h 7
Relevant legislation and strategies PAGEREF _Toc123096707 \h 7
Resource and management guides PAGEREF _Toc123096708 \h 9
Summary of activities to implement this stage PAGEREF _Toc123096709 \h 10
Key Components and Associated Activities PAGEREF _Toc123096710 \h 11
Key component 1: Develop pop u l a t i o n h e a l t h f o c u s P A G E R E F _ T o c 1 2 3 0 9 6 7 1 1 \ h 1 1
K e y c o m p o n e n t 2 : A d d r e s s t h e d e t e r m i n a n t s o f h e a l t h P A G E R E F _ T o c 1 2 3 0 9 6 7 1 2 \ h 1 2
K e y c o m p o n e n t 3 : R e d u c e h e a l t h i n e q u a l i t i e s P A G E R E F _ T o c 1 2 3 0 9 6 7 1 3 \ h 1 3
K e y c o m p o n e n t 4 : A d d r e s s M o r i h e a l t h : He Korowai Oranga PAGEREF _Toc123096714 \h 14
Key component 5: Use evidence and examples of best practice PAGEREF _Toc123096715 \h 16
Key component 6: Maximise resources, prioritise and plan PAGEREF _Toc123096716 \h 18
Outputs PAGEREF _Toc123096717 \h 21
Key component 7: Select interventions PAGEREF _Toc123096718 \h 21
Key component 8: Develop project plan PAGEREF _Toc123096719 \h 31
Outcome PAGEREF _Toc123096720 \h 34
Appendices
Appendix A: Examples of Public Health Programme Logic Models PAGEREF _Toc123096721 \h 35
Appendix B: Checklist for Developing a Comprehensive Public Health Programme PAGEREF _Toc123096727 \h 46
Appendix C: Sample Matrix 1: Plotting Interventions PAGEREF _Toc123096728 \h 48
Appendix D: Sample Matrix 2: Plotting Interventions PAGEREF _Toc123096730 \h 49
References PAGEREF _Toc123096731 \h 50
Purpose and Background to this Guide
This guide is to help people design and implement comprehensive, effective and measurable public health programmes that will deliver improved public health outcomes.
By developing a systematic programme logic for each public health programme, we aim to be able answer questions such as the following.
How do we know the programme delivered better health? Are we measuring the outcomes adequately?
What components are missing from the programme?
Was resourcing adequate for each component of the programme and for the programme as a whole?
Was the intervention mix effective? Was it based on evidence and/or did it generate new evidence? Does it adequately address all five strands of the 1986 Ottawa Charter for Health Promotion?
Do new interventions need to be developed to have a comprehensive range of interventions available for each component of the programme?
Which parts of the programme are working? Which parts of the programme are not working? Do resources need to be refocused?
A comprehensive programme should include a range of interventions consistent with the Ottawa Charters principles of:
promoting healthy public policy
creating supportive environments
strengthening community action
developing personal skills
reorienting health services.
In the New Zealand context, a comprehensive programme should focus on:
a defined populations health
addressing the determinants of health
reducing health inequalities
addressing M o r i h e a l t h b y p r o m o t i n g t h e c o n c e p t o f w h a n u o r a
u s i n g e v i d e n c e - b a s e d i n t e r v e n t i o n s
m a x i m i s i n g t h e r e s o u r c e s a v a i l a b l e
b e i n g o u t c o m e s f o c u s e d .
T h e d e v e l o p m e n t o f s u c h p r o g r a m m e s i s a n a m b i t i o u s t a s k ; t h i s g u i d e i s t o h e l p m a k e i t h a p p e n . T h e g u i d e d e s c ribes a generic programme logic model and checklist that are designed to guide people through the steps of developing a thorough public health programme. At the end of the process, a specific programme logic model and associated implementation plan should be written for every public health programme. While each programme model may differ in how it looks, each should contain the components described in this document.
The guide has been developed as the first of three steps aimed at progressing objective five of Achieving Health for All People: achieving measurable progress on public health outcomes ADDIN EN.CITE Health20031881Ministry of Health2003Achieving Health For All People: A framwork for public health action for the NZ Health StrategyWellingtonMinistry of Health0-478-25807-0(Ministry of Health 2003). The other two steps involve trialling the generic logic model against existing public health programmes and developing and refining the model after the trials as new programmes are developed.
The guide is intended to be a living document that is revised with experience and new developments. It attempts to strike a balance between providing a general overview of the process with clear how to guidance, while refraining from being too prescriptive, and remaining a manageable size. Your comments on the usefulness or otherwise of the guide are welcome, especially suggestions on how it may be improved. These should be directed to John Wren by email: HYPERLINK "mailto:john_wren@moh.govt.nz" john_wren@moh.govt.nz
What is a Programme Logic Model?
The programme logic model has been described as the most recent development to come out of the thinking about measurement and outcomes monitoring. Programme logic reached its most widely recognised form in the late 1990s when United Way of America and the WK Kellogg Foundation adopted and promoted it. Through the efforts of these organisations in the United States, the logic model concept has been adopted by a many governmental and non-governmental organisations that deliver community social services, including health care and support ADDIN EN.CITE Penna20039210Penna, REmerson, J2003Outcome Thinking: Roots and MeaningsStanford University; Rensselaerville Institute18Marchhttp://faculty-gsb.stanford.edu/emerson/(Penna and Emerson 2003).
A programme logic model in its simplest form is a picture of how a programme works a flow chart. The model graphically identifies and links programme outcomes with interventions and processes and the theory and assumptions or principles underlying the programme. The model provides a map for a programme, illustrating how it is expected to work, what activities need to come before others, and how desired outcomes are achieved ADDIN EN.CITE Kellogg Foundation1998981Kellogg Foundation, W.K1998W.K. Kellogg Foundation Evaluation HandbookPetersen, AW.K. Kellogg Foundation110(WK Kellogg Foundation 1998: 35).
Use of the model is a process of implementation evaluation. The objectives of the model are to ADDIN EN.CITE Kellogg Foundation1998981Kellogg Foundation, W.K1998W.K. Kellogg Foundation Evaluation HandbookPetersen, AW.K. Kellogg Foundation110(WK Kellogg Foundation 1998: 27):
improve the effectiveness of current activities by helping initiate or modify initial activities
provide support for maintaining the project over the long term
provide insight into why certain goals are or are not being accomplished
help project leaders make decisions.
In addition, implementation evaluations provide documentation for funders about the progress of a project, and can be used for developing solutions to encountered problems.
[I]mplementation evaluation allows you to put ... outcome data in the context of what was actually done when carrying out the project.
ADDIN EN.CITE Kellogg Foundation1998981Kellogg Foundation, W.K1998W.K. Kellogg Foundation Evaluation HandbookPetersen, AW.K. Kellogg Foundation110(WK Kellogg Foundation 1998: 27)
Programme logic models come in a wide variety of forms and have been categorised as the:
outcomes or classic flow chart model
activities or results chain model
theory model
spheres of influence model.
All these types of model display the logical, valid and causal relationships between a programmes goals and its objectives ADDIN EN.CITE Kellogg Foundation1998981Kellogg Foundation, W.K1998W.K. Kellogg Foundation Evaluation HandbookPetersen, AW.K. Kellogg Foundation110Canada.11116Treasury Board of Canada.Module 2 - Profile and Logic ModelTreasury Board of Canada Secretariat200420 Aprilwww.tbs-sct.gc.ca/eval/tools_outils/RBM_GAR_cour/Enh/module_02(Treasury Board of Canada Secretariat 1993; WK Kellogg Foundation 1998).
Outcomes models show how short-term objectives help to achieve long-term goals. They are useful for showing efforts aimed at achieving longer term or hard-to-measure outcomes.
Activities models display the order in which interventions should be implemented to ensure the programmes success. They are helpful for planning complex initiatives involving many partnerships and institutional arrangements.
Theory models reveal the underlying assumptions informing the programme. They are appropriate for complex initiatives involving many organisations, communities and target populations.
Spheres of influence models highlight the areas of control or influence available to the organisation and programme. In these models, usually only indirect influence can achieve the stated outcomes.
Commonly, a projects programme logic model will combine two or more types of model into a hybrid logic model. There is no one logic model for public health programmes. Each programme model will look different, reflecting the goals, circumstances and contributors to the programme.
The logic model in this guide simply outlines the components that should be included in any comprehensive New Zealand public health programme and outlines a process for developing a specific logic model appropriate to the task under consideration.
Examples of public health programme logic models are in Appendix A.
Logic Model for Developing New Zealand Public Health Programmes
The logic model in Figure 1 depicts the components of a comprehensive New Zealand public health programme.
The model identifies that the first stage in the development of a public health programme is the collection of informative inputs. Informative inputs are the key documents and information needed to inform any public health programme in New Zealand.
The next stage is for a planner to work through the key components that collectively create a framework through which the collected informative inputs can be analysed.
These components fall into two groups. In the f i r s t g r o u p a r e t h e e s s e n t i a l f u n c t i o n s a n y c o m p r e h e n s i v e N e w Z e a l a n d p u b l i c h e a l t h p r o g r a m m e s h o u l d d e l i v e r ( i e , h a v i n g a f o c u s o n a d e f i n e d p o p u l a t i o n s h e a l t h , a d d r e s s i n g t h e d e t e r m i n a n t s o f h e a l t h , r e d u c i n g h e a l t h i n e q u a l i t i e s a n d a d d r e s s i n g M o r i h e a l t h b y p r o m o t i n g w h a n u o r a ) . I n t h e s e c o n d g r o u p a r e t h e c o n s i d e r a t i o n s t h a t s h o u l d b e t a k e n i n t o a c c o u n t w h e n p l a n n i n g a n d m o n i t o r i n g a p u b l i c h e a l t h p r o g r a m m e . T h e s e c o n s i d e r a t i o n s c o n s i s t o f e n s u r i n g i n t e r v e n t i o n s w i l l b e e v i d e n c e b a s e d a n d t h a t r e s o urce use will be maximised and prioritised.
To shape the parameters of the analysis, the programme logic model identifies the key activities to be undertaken for each component.
Identifying and collecting the information and analysing it in accordance with the key components, will create a framework within which the public health programme can be built.
The third stage identifies the outputs to be extracted from the analysis. They will give shape to the programme and identify how it is to be created.
When planning a public health programme, use Figure 1 to ensure you have included all the components of a comprehensive public health programme in your development process. To help you to do this, the models elements have also been converted into a checklist in Appendix B.
Figure 1: Logic model for developing New Zealand public health programmes
Informative Inputs
The informative inputs provide the basis for your analysis of the key components associated with the development of a public health programme.
While the expected result of this first stage of planning is a body of information, it also identifies information gaps. It may reveal, for instance, that an insufficient amount of research has been undertaken but that the public health need has been identified within national or international strategies or as part of legislation. Such a result will lead to the identification of the research needed for the analysis to proceed in the key components stage.
It is also possible the situation may be reversed: a body of evidence may exist that identifies an emerging public health programme, but strategies have not been developed to guide action. In this situation, analysis as part of the key components stage will reveal the important need for policy development.
Research evidence
The importance of developing evidence-based interventions means a literature search is an important first step in the programmes planning. If this evidence exists, some studies will focus on the public health issue, other studies will consider the best interventions to address the issue. For emerging public health issues where reliable studies have not been developed, quantitative or qualitative data may at least raise the discussion about why it appears the issue is emerging.
A population health approach draws on the full range of data types both qualitative and quantitative as well as data from other sectors. Data types include environmental data, lifestyle data, vital statistics data, social and economic data, epidemiological data, health systems data, consumer information and demographic data.
Use the evidence gathered to understand the causes of the problem and health inequalities and to identify what is currently known about the most effective and efficient interventions.
Relevant legislation and strategies
Every public health programme in New Zealand should be informed by the core pieces of information that form the philosophical, legislative, evidence and resource base for public health action. Collectively, the documents identified in the logic model define and set the boundaries for public health programmes in New Zealand.
The legislative frameworks and national strategies provide the authorisation and operational framework for public health actions in New Zealand. International strategies and conventions may also have a significant role in defining the nature of New Zealands obligations.
Public health programmes must comply with relevant legislation and standards. Knowledge of the legal framework is particularly important when the programme is closely related to a regulatory function, for example tobacco control and water safety standards. Programmes, such as those aimed at injury prevention, while not having a regulatory function, should also be informed about the legal setting for the programmes activities. This is important to ensure any information or advice given or activities undertaken are consistent with legislation and policy statements. For example, it would be inadvisable for a public health programme promoting playground safety to suggest the height of playground equipment should be higher than the height recommended in the relevant New Zealand standard.
The key national strategies and policy documents are:
the New Zealand Health Strategy (Minister of Health 2000)
He Korowai Oranga: M o r i H e a l t h S t r a t e g y ( M i n i s t e r o f H e a l t h a n d A s s o c i a t e M i n i s t e r o f H e a l t h 2 0 0 2 )
R e d u c i n g I n e q u a l i t i e s i n H e a l t h ( M i n i s t r y o f H e a l t h 2 0 0 2 b ) ( i n t e r v e n t i o n f r a m e w o r k ) a n d H e a l t h E q u i t y A s s e s s m e n t T o o l ( H E A T o r t h e e q u i t y l e n s )
t h e N e w Z e a l a n d D i s a b i l i t y S t r a t egy (Minister for Disability Issues 2001)
the Health of Older People Strategy (Associate Minister of Health and Minister for Disability Issues 2002)
the Public Health Service Handbook.
The purpose of each of these documents is briefly described below.
The New Zealand Health Strategy forms the basis for the Governments action on health. The strategy outlines the principles for action, highlights key goals and objectives, and identifies 13 priority population health objectives for the Ministry of Health an d D i s t r i c t H e a l t h B o a r d s ( D H B s ) t o f o c u s o n i n t h e s h o r t a n d m e d i u m t e r m .
H e K o r o w a i O r a n g a : M o r i H e a l t h S t r a t e g y s e t s o u t t h e G o v e r n m e n t s a p p r o a c h t o i m p r o v i n g M o r i h e a l t h . T h e s t r a t e g y s a i m i s w h n a u o r a : M o r i f a m i l i e s s u p p o r t e d t o a c h i e v e t h e i r maximum health and wellbeing (Minister of Health and Associate Minister of Health 2002: 1). The strategy asks the health and disability sectors to recognise the interdependence of people, that health and wellbeing are influenced and affected by the collective as well as the individual, and the importance of working with people in their social contexts, not just with their physical symptoms (Minister of Health and Associate Minister of Health 2002: 1).
Reducing Inequalities in Health sets out the Ministry of Healths response to the Governments focus on reducing health inequalities, which is a New Zealand Health Strategy priority. The Health Equity Assessment Tool supplies a set of questions to help you to consider how particular inequalities in health have come about and where the effective intervention points are to address them.
The New Zealand Disability Strategy presents a long-term plan for changing New Zealand from a disabling to an inclusive society The strategy sits alongside the New Zealand Health Strategy and is intended to ensure government departments and other government agencies consider the needs of people with disabilities before making decisions.
The Health of Older People Strategy is a key health action in the New Zealand Positive Ageing Strategy Action Plan ADDIN EN.CITE Health.20021171Ministry of Social Policy2001New Zealand Positive Ageing Strategy Action Plan for 2001/02WellingtonMinistry of Social Policy(Ministry of Social Policy 2001). Its development has been guided by the aims and principles of the New Zealand Health Strategy, the New Zealand Disability Strategy and He Korowai Oranga: M o r i H e a l t h S t r a t e g y . T h e H e a l t h o f O l d e r P e o p l e S t r a t e g y f o c u s e s o n i m p r o v i n g o l d e r p e o p l e s h e a l t h s t a t u s , p r o m o t i n g q u a l i t y o f l i f e w h e r e h e a l t h c a n n o t b e r e s t o r e d , r e d u c i n g i n e q u a l i t i e s a n d p r o m o t i n g p a r t i c i p a t i o n i n s o c i a l l i f e a n d i n d e c i s i o n s a b o u t h e a l t h c a r e a n d d i s a b i l i t y s u p p o r t p r o v i s i o n .
T h e N e w Z e a l a n d H e a l t h S t r a t e g y a n d N e w Z e a l a n d D i s a b i l i t y S t r a t e g y a r e t h e G o v e r n m e n t s p l a t f o r m f o r a c t i o n o n h e a l t h a n d d i s a b i l i t y , i n c l u d i n g M o r i h e a l t h . T h e s t r a t e g i e s p r i n c i p l e s , g o a l s , o b j e c t i v e s a n d a c t i o n a n d s e r v i c e p r i o r i t i e s f o r i m p r o v i n g t h e h e a l t h a n d d i s a b i l i t y o f N e w Z e a l a n d e r s a r e a l l r e l e v a n t t o i m p r o v i n g M o r i h e a l t h . H e K o r o w a i O r a n g a e x p a n d s t h e p r i n c i p l e s a n d o b j e c t i v e s f o r M o r i i n b o t h s t r a t e g i e s , b y p r o v i d i n g m o r e d e t a i l o n h o w M o r i h e a l t h o b j e c t i v e s c a n b e a c h i e v e d . A t t h e s a m e t i m e , H e K o r o w a i O r a n g a e x i s t s i n i t s o w n r i g h t . I t s e t s t h e d i r e c t i o n f o r M o r i h e a l t h i n o t h e r s e r v i c e o r p o p u l a t i o n - g r o u p s t r a t e g i e s , i n c l u d i n g t h e P r i m a r y H e a l t h C a r e S t r a t e g y ( M i n i s t e r o f H e a l t h 2 0 0 1 ), the Health of Older People Strategy (Associate Minister of Health and Minister for Disability Issues 2003) and the Public Health Strategy.
Issue-specific strategies are national strategies particular to a specific issue, for example, tobacco control, cancer control and youth suicide prevention. When planning a programme related to a national issue, refer to any existing strategy for the area.
Resource and management guides
The final key pieces of information that should be obtained are documents that outline the availability of the financial, workforce and infrastructure resources for the programme. In addition, take into account government guidelines issued by The Treasury on contracting and purchasing and internal guidelines applicable to the organisation that will run the programme.
The New Zealand Public Health Service Handbook describes the principles and practices used in the purchasing process and the service specifications for all services Public Health funds.
Summary of activities to implement this stage
To implement this stage, review:
the literature on the public health issue
the relevant legislation and standards
core international, national and issue-specific strategies
resource and management guides.
Key Components and Associated Activities
The following key components provide a framework within which the information inputs can be analysed. The analysis associated with each component will result in a body of information that records the essential factors about the public health issues being addressed and which must be taken into account when the interventions are designed.
Key component 1: Develop population health focus
A critical component of planning any programme is clarifying what the problem is and identifying the population (or populations) of interest.
Define population health problem
Public health has been defined as the science and art of preventing disease, prolonging life and promoting health through the organised efforts of society (Acheson 1988). A public health approach is about promoting wellbeing and preventing ill health.
A population focus involves taking into account all the factors that determine health and planning how these factors can be addressed. In the context of the Ottawa Charter for Health Promotion public health action may:
take place at many levels throughout the health sector and beyond
be planned and implemented collaboratively with other sectors
advise other sectors on the health impact of their activities and, where necessary, regulate these
support other parts of the health sector to take a population health approach to service planning and delivery
aim to influence entire population groups (eg, policy makers, communities, organisations, families and groups of individuals)
create or advocate for healthy social, physical and cultural environments
obtain immediate objectives, but a long timeframe may be required before the goal is achieved and it may be invisible to the public ADDIN EN.CITE Health.20021181Ministry of Health.2002Health For All People: An overview of Public HealthWellingtonMinistry of Health0-478-27036-4(Ministry of Health 2002a).
Define target population or populations
The collected research evidence and information on core strategies will assist you to define the health problem clearly. This information will also enable programme planners to identify the population groups to be targeted by the interventions.
Target populations are the groups served by a programme. For each intervention or action under the programme, you may have different target populations, such as:
clients or consumers of services (eg, parents aged under 20 or low-income, sole support mothers)
key stakeholders and decision makers (eg, community agency representatives, organisational leaders or politicians)
secondary populations of interest (eg, the parents of parents aged under 20 or informal community leaders).
Summary of activities to implement key component 1
To implement key component 1 define the:
population health problem
target population (or populations).
Key component 2: Address the determinants of health
Identify determinants of health
The objective of key component 2, address the determinants of health, is to identify the determinants of health that are related to the target populations that are the focus of the public health problem.
The determining causes of ill health are complex and interrelated and include:
age, sex and hereditary factors
individual lifestyle factors
social and community influences
living and working conditions
gender and culture
socioeconomic and environmental conditions (NACHD 1998).
Establish links between determinants, health problem and target population
Age, sex and hereditary factors are non-modifiable determinants of health. On the other hand, socioeconomic and environmental conditions are potentially highly modifiable. Evidence clearly suggests that of these determinants of health, income is the single most important. Low income and poor health are persistently correlated world wide. With few exceptions, the financially worst off experience the highest rates of illness and death (NACHD 1998).
The main factor determining adequate income is participation in paid employment. As such, employment is an important determinant of health. In addition to providing income, employment enhances social status and improves self-esteem, provides social contact and a way of participating in community life, and enhances opportunities for regular activity, all of which help to enhance individual health and wellbeing (NACHD 1998).
Along with income and employment status, education is critical in determining peoples social and economic position and health. Good evidence exists that a low level of education is associated with poor health status. Educational attainment is strongly related to subsequent occupation and income level, and poor social circumstances in early life are associated with significant chances of low educational achievement (NACHD 1998).
Poor housing is another source of poor health. Overcrowding, dampness and the cold have direct detrimental effects on a persons physical and mental health (NACHD 1998).
Cultural factors can have positive and negative influences on health. People with strong family, cultural and community ties have better health than people who are socially isolated (NACHD 1998).
Environmental factors, such as access to clear water, sewerage reticulation and electrical power are also essential to maintaining good health. The funding and provision of these basic utilities has changed in the past decade in New Zealand and issues of maintenance, infrastructure development and user charges have implications for health. Ongoing access to some of these services should not be taken for granted, particularly for people on low incomes (NACHD 1998).
Summary of activities to implement key component 2
To implement key component 2:
identify the determinants of health for the target population
establish links between the determinants, the health problem and the target population.
Key component 3: Reduce health inequalities
Identify inequalities, including where they exist, who they affect and interventions to reduce them
It is essential to take into account how any interventions chosen to deal with a public health problem (and the target populations particularly affected by the problem) will also deal with and reduce existing health inequalities. This component, therefore, requires you to analyse the collected information inputs to identify the inequalities existing within those populations to be targeted for the defined public health problem. It also requires you to consider the types of intervention that could address and reduce those inequalities.
In addition to collected research material, use the Reducing Inequalities in Health framework ADDIN EN.CITE Health20031141Ministry of Health2002Reducing Inequalities in HealthWellingtonMinistry of Health0-478-27087-9(Ministry of Health 2002b) and HEAT (the equity lens) to help your decision-making for this component.
Good health is not enjoyed equally across different population groups in New Zealand. Poorer people have worse health than wealthier people, but it is not just a matter of people in poverty experiencing poorer health. Across the socioeconomic gradient (whether measured by education, occupation, income or deprivation and across the whole population), the less well off experience worse health than those who are a little better off. Action to reduce inequalities therefore has the potential to improve the health of all New Zealanders ADDIN EN.CITE Ajwani20031191Ajwani, SBlakely, TRobson, BTobias, MBonne, M2003Disparity: Ethnic mortality trends in New Zealand 1980-1999WellingtonMinistry of Health and University of Otago0-478-25660-4