Curriculum for General Practice - The Royal New Zealand College ...

P Curriculum Population and for General Public Health Practice
Population and Public Health
A population health approach takes into
account all factors that determine a person’s
health and wellbeing, and it plans how these
factors can be addressed. These factors are
called the determinants of health and include
the environmental factors that affect the health
outcomes of a population. 1
The social determinants of health are the conditions in which
people are born, grow, live, work and age, including the health
system. These circumstances are shaped by the distribution of
money, power and resources at global, national and local levels
and are often responsible for health inequalities in New Zealand.
Primary health care is recognised as being an important
intervention point for improving the health of a population.
In particular, emphasis on promoting health, community
participation, and accurate data collection can help with the
population health approach. An investment in activities that
influence key determinants of health identified at government
level, a commitment to reducing existing inequalities and
focusing on workforce development will also contribute to
improving the health of the population. 2
Many conditions that general practitioners see have a lifestyle
choice or other social determinant underpinning them. Nutrition
is a serious health issue that is having a significant effect on the
health of the New Zealand population. A report released by the
Ministry of Health and The University of Auckland 3 estimates
that nutrition plays a role in about 11,000 deaths a year in
New Zealand (two in every five deaths), of which approximately
8000–9000 reflect diet, and 2000–3000 reflect physical
inactivity. With over 4500 premature deaths in 1997 attributed
to high cholesterol, the report highlights the health impact of
prolonged high intake of saturated fat.
The report also found a substantial health burden due to obesity
partly because of decreasing levels of physical activity, high
blood pressure and lack of fruit and vegetables.
Public health also involves managing the spread of disease
through a population. Managing the spread of communicable
diseases not only involves immunisation and screening
programmes, but also management of communicable disease
that may have an impact on both local and wider populations.
Child health, in particular that of Māori and Pacific children,
requires well-resourced intervention, especially to address
the negative impact of poor socioeconomic conditions
that affect their health, education and lifestyle. Health and
social inequalities can be reduced by initiating cost-effective
approaches in areas such as maternal health, child health
services, early childhood programmes, education, housing
and social development.
GPs have an important role in transforming a variety of
lifestyle activities that impact negatively on people’s health.
Collaboration with other professionals in government, health,
welfare and education is required to address the many issues
facing the New Zealand population at large.
1
World Health Organization. Social Determinants of Health. Geneva: World Health Organization. Available at: http://www.who.int/social_determinants/en/
2
Neuwelt P, Matheson D, Arroll B, Dowell A, Winnard D, Crampton P , Sheridan NF, Cumming J. 2009. Putting population health into practice through primary health care.
NZ Med J. 122(1290):98-104.
3
Ministry of Health and The University of Auckland. 2003. Nutrition and the Burden of Disease: New Zealand 1997-2011. Wellington: Ministry of Health.
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Curriculum for General Practice