Factors that influence the health of individuals, whānau and communities
Levels and determinants
This domain asks you to explain why health outcomes differ, not just describe differences. Use a socio-ecological lens: individual (knowledge, skills, genes), whānau/interpersonal (support, caregiving), community (schools, housing, transport, safety), and societal (income, policy, racism, education, health system). Social determinants of health are the conditions in which people are born, grow, live, work and age. They include income, housing quality, education, employment, food security, racism, and access to services. Risk factors increase the likelihood of poor health; protective factors buffer it.
Equity, not just equality
Health inequities are unfair, avoidable differences between groups-for example, Māori and Pacific peoples experiencing higher rates of many preventable conditions. Explain these through structural determinants such as colonisation, discrimination, income inequality and unequal access, not through personal failure. Upstream action targets policies and environments; downstream action targets treatment and individual behaviour.
Worked example
A family lives in a damp rental and a child has repeated asthma attacks. Individual: the child’s medication routine. Whānau: parents work shifts and lack time for appointments. Community: rental housing shortages and poor transport. Societal: housing policy, low wage levels, and discrimination in the rental market. A strong answer links these levels, identifies protective factors (GP access, school support), and proposes both upstream and downstream responses.
Traps that cost marks
- Confusing risk factors with causes; correlation is not causation.
- Victim-blaming-e.g., “they just make poor choices”-without analysing constraints.
- Ignoring culture, racism and colonisation as health determinants.
- Listing factors without explaining how they interact or which level they sit at.