A dirty determinant of health: What is the role of public health units in reducing the inequitable effects of inadequate income on health and wellbeing?

Public health Public health evaluation Community health Income Pacific Area

This study examines the role regional public health units could play in contributing to reducing the inequitable effects inadequate income has on health and wellbeing. It also recommends appropriate steps for Wellington's Regional Public Health. It uses qualitative methods involving six group interviews with key informants from a range of public health units. From these it also examines current income-related work within public health units including views on: potential income-related interventions; how public health units could engage on these issues; and documentary analysis. These are supplemented by the six in-depth interviews with the senior people from the poverty and public health sectors. Their views and opinions on poverty, income and how public health units could address these issues were gauged and noted. Additionally, a literature review was undertaken to assess the strength of evidence of sub-national, income-related interventions both in New Zealand and internationally. The research found that while the staff from the six public health units had a solid understanding of the importance of income in health, and that this has been captured in strategic planning documents, little action could be identified which addressed the situation. There was a consensus of opinion among the six that, for the most part, the solutions to inadequate income lay outside the health sector, but that health could play an important role in the collection, analysis and dissemination of evidence on income and health. The literature and the results from the interviews suggested that to address income, consideration must be given to the enablers and disablers of income generation. Advocacy, evidence building and intersectoral action arose as key tools for public health units to use in income-related issues. However, significant concerns were raised about the perceived and actual limitations placed on public health unit advocacy. The research concludes that public health units can play an important role in reducing the effects of inadequate income through the use of intersectoral collaboration and advocacy built on a strong evidence base by a highly trained and professional workforce. A series of recommendations around these key conclusions has also been made for Regional Public Health and other public health units.

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