Primary Health Care Review: Determinants and Health Promotion

This report provides a comprehensive review of primary health care in Aotearoa/New Zealand. It begins by examining the socio-political and cultural determinants of health, including education, income, housing, and access to healthcare, and their impact on different ethnic groups, particularly Maori and Pacific populations. The report then delves into the principles of primary health care, such as equity, community participation, intersectoral coordination, appropriate technology, and health promotion, illustrating their application within the New Zealand context. Finally, it analyzes health promotion theories and frameworks, specifically the Ottawa Charter and the socio-ecological model, and their relevance to health promotion programs in Aotearoa/New Zealand. The report highlights the importance of addressing health disparities and promoting community-led initiatives to improve health outcomes.

Primary Health Care Review
University
Assessment 1
Name
Date

Part 1
Socio-political and cultural determinants impacts on health
Health is determined by various key factors such as age, behaviors, genetic, health care
access and external environments such as housing and water. These health factors play a
fundamental role in the overall health overview of an individual. Major social factors
influencing health state to entail education, income, housing, and access to health care.
Education levels affect health status. It offers an avenue for making good decisions, persons
with high education tend to have a healthier life (Mactaggart, et al., 2018). Income levels cut
across individuals to communities. Food purchasing power on quality foods and accessing
clean and healthier services play a fundamental role. Housing is a key social factor that
impacts the health state of the individual to the community level. Access to health care plays
a fundamental role in determining the state of health. Having access to health care indicate,
seeking health care services at all times when faced with health-related challenges. Socio-
political processes such as elections, lobbying, law-making are some of the examples of how
political issues affect health output. Political aspects such as taxation social security and
public services have an impact on the community, individual and even family set up avenues
(Williams, 2017). These factors combined to play a key role in influencing how health care is
attained at individual, family and organization levels.
Socio-political and cultural determinants of health and ethnic groups in New
Zealand
In improving the health of the population there is a need for reducing inequalities and
identifying important factors that promote good health sate. The underlying social-cultural
factors entail income, employment, and education level. Income is one of the key modifiable
determinants of health and overall wellbeing. In New Zealand, there has been a decline of
income per household in the previous decade with Maori and pacific populations being hard
hit. The link and relation between ill health and poverty are still fundamental (Zambas &
Wright, 2016). Employment remains to be a fundamental aspect of determining the adequacy
of the individual in the community. It facilitates social status and improves overall self-
esteem. Unemployment is detrimental to New Zealand. The Maori, Pacific, and young adults
have increased levels of unemployment compared to the general population. Education plays
a fundamental role in determining the social-cultural aspects of a population. Low education
levels are linked to poor health status. The majority of the Maori and Pacifica populations

continue to face low levels of education, while an estimate of 20% of New Zealand’s adults
does not possess any form of education (Ryks, Simmonds & Whitehead, 2019).
The cultural determinants among the indigenous groups of New Zealand entail a mix of
aspects. Among the Maori, they practised frequent visitation to marae/sacred gathering places
which is associated with increased state of physical health linked to quality of life. Further,
mental health issues were linked to aspects of discrimination. This demonstrates that higher
language and cultural association is linked to positive health outcomes (Dyall et al., 2014).
Among the Pacifica region population, existence of traditional beliefs on health care
outcomes affects the overall access to health. They believe health to occur as a result of the
imbalance between the three anchors of the lokahi triangle-mental, physical and spiritual.
They belief healing occurs in all three aspects, further the belief of illness based on historical
trauma s affecting access of health care services (Cavney & Friedman, 2018). Among the
Asian communities they belief illness occurrence as punishment from God, discussion on
aspects such as screening is viewed as a troublesome avenue. Further, they believe that faith
in God is key in disease prevention. Further they are fearful of the health care services as they
view in terms of inflicting pain on them(Zhao, Esposito & Wang, 2010).
Outcomes of health determinants on health outcomes of Aotearoa/New Zeeland
Health determinants among the indigenous communities in New Zealand play a
fundamental role in the overall health state. Findings and reviews have shown that social,
cultural and economic factors continue to be major health determinants among this
population. Current trends of health among these communities play a fundamental role in
health, these underlying socio-cultural factors. Income and social status are linked to better
health outcomes, a greater gap between the rich and poor communities in New Zealand play a
fundamental role in creating the health differences and likely to decrease the overall health
quality state. The non-Maori populations are advantaged more in the context of the school
environment, employment, and income and housing levels. It is estimated that about 27% of
Aotearoa/New Zealand people live in low-income households, a high proportion of the
Pacific and Maori populations are entangled in high economic deprivation areas (Came,
O’Sullivan, & McCreanor, 2020).

Implications of health determinants
This implication in terms of health is linked to increased rates of diseases such as heart
diseases and diabetes which have significantly greater mortality trends for the Pacific
population among the general population. social aspects such as tobacco smoking contribute
significantly to increased to disability and negative outcomes in Aotearoa/New Zealand,
despite, there is poor and no independent institutions which are capable of implementing
policies to curb tobacco, alcohol and unhealthy foods leading to increased occurrence of
diseases and poor health outcomes (LLee et al., 2018).
Part 2
Principles of primary health care concerning Aotearoa/New Zealand
Equity
Globally people experience various social aspects that lead to avoidable health
differences. In New Zealand, Pacific and Maori population, they tend to experience a lower
level of socioeconomic status leading to increasing rates of chronic illness causing higher
mortality, morbidity and inequitable health care outputs. Adequate and reliable health system
plays a fundamental role in ensuring the fair distribution of health care services. Health care
systems play a fundamental role in determining and influencing other social determinants of
health. It plays a fundamental role in promoting equity of health. In pursuit of health, equity
calls for striving for equal opportunities cutting across all social groups with the key focus of
improving the health condition among those groups having fewer opportunities (Te Karu, L.,
Bryant, L., Harwood, M., & Arroll, 2018).
New Zealand health care has undergone a tremendous restructuring process geared
toward primary health care access. Implementation of population health approaches has been
undertaken to reduce the health gap. Chronic illness continues to be the greatest cause of
morbidity and mortality in the New Zealand health care system however despite these
attempts, an increasing heath gap is still being observed between the Maori and non-Maori
populations. The Pacific, Maori and those in lower socioeconomic status continue to
experience high levels of chronic disease and poor health outcomes, signifying poor equity
process (Sheridan et al., 2011).

Community participation
Community participation is a fundamental aspect of primary health aspects.
Participation in health outcomes plays a fundamental role in the provision and utilization of
health care services. It is a key factor in assessing the overall importance of improving health
status. Its absence in health care is a fundamental barrier towards realizing health for all goals
being promoted globally. Entrenching community participation in sustainable development
goals is playing a crucial role in achieving integrated people-centered health care services and
attaining the goals set for participatory avenues (Rifkin, 2014). Further, with the rise of
chronic disease, the key benefits of community participation are essential in outlining
strategies that are community-centric in addressing underlying health determinants (Narain,
2012).
In New Zealand, community practices have continuously shown that community
participation barriers continue to be a fundamental challenge towards the utilization of health
care services and implementing primary care reforms (Hoicka & MacArthur, 2018). There is
continued community development works in Aotearoa New Zealand inspired by practices
such as social capacity building, neighborhood development, social capital, Maori
development prospect and other engagements calling for community participation. The need
for strengthening these avenues is critical in the care process of health care (Furness &
Hunter, 2016).
Intersectoral coordination
The underlying complexities of healthcare and social determinants health have
demonstrated a fundamental aspect in shaping how it should be addressed. Health care
avenues need to collaborate with other relevant sectors to address influential factors in health
care delivery. Globally health care systems are focusing attention on avenues of increasing
and improving coordination and collaboration across various sectors cutting across
professional and administrative units (). This is initiated to respond to challenges being posed
by various population segments and increased morbidity and mortality among various
population settings. In the primary care settings, collaboration across providers and local
communities play a fundamental role in improving the overall health outcomes of the
populations (Lowe, Whitzman & Giles-Corti, 2018).

In New Zealand, implementation of health strategy has taken shape in focusing on the
government action plan on health; it outlines fundamental aspects of health care outcomes.
The strategy is geared to ensuring health care services are directed and geared to ensuring the
highest population health benefits focusing on health inequalities. To address this,
entrenching collaboration across the different sectors in the health care continuum is vital and
plays a crucial role in processes. The need for focusing on inter-sectorial coordination of care
is vital for the general population in New Zealand with a view of ensuring the marginalized
populations can get primary care services (Hausa, Harrsion & Aspden, 2019).
Appropriate technology
Appropriate technology entails the application of sound, adaptable scientific and
acceptable avenue in applying to people as a means of self-reliance and resources available or
the community. Appropriate technology in health care calls for the application of local
context solutions to solve health-related problems in the care practice (Chauhan et al., 2017).
In New Zealand, the restructuring of the health care system has seen a shift in the manner in
which health care is being facilitated. Interests of the indigenous population have been
incorporated as a means of using locally available resources for self-reliance. In this avenue,
this has seen aspects such as Maori health providers increasing over the years to address the
health needs of the people. Various avenues are being implemented to assess how appropriate
technology can impact positively on the health outcomes of the population at a large
(Tharakan, 2017).
Health promotion
Health promotion continues to play a fundamental role in the primary health care
process. With the increase in lifestyle-related diseases, early identification and prevention
play a fundamental role in the care process (Haber, 2019). The ministry of health in New
Zealand's adoption of the Ne Zealand Health Strategy has shifted focus towards prevention as
an avenue for improving the lives of the population. In this process implementing health
promotion activities is essential.

Part 3
Health and promotion theories and frameworks for Aotearoa/New Zealand
The implication of the Ottawa charter
Ottawa charter addressed five key strategies essential for health improvement; building
healthy public policy, creating supportive environments, strengthening communities,
developing personal skills and reorienting health services. In entrenching this framework, the
PROJECTREPLACE initiated an approach which it was developed from the Maori Health
organization. The project engages the community by targeting specific environments and
practices that align with healthy lifestyles and encouraging participation and engagement
towards health outcomes. The organization's role as part of reorienting health promotion was
tasked with setting their own goals to meet the needs of the general p[population in general.
This was to enable recognition of the needs of the Maori people and their families
(MacManus, 2013).
Underpinning of the theories in the health promotion program
Socio ecological model
Social ecological model is a framework geared at putting in place an understanding of
the different multi faced levels within the society and assessing how individuals and
environment interact with one another in the social system. In this avenue different factors
and determinants coexist at different levels of health, allowing prevention, control and
intervention to be effective when addressed collectively. Designs are formulated so that the
underlying in models overlap, illustrating how the one level is able to influence another level.
According to CDC, in a bid of preventing health related risks factors it is essential to take
action at the different levels of the interplay (CDC, 2018). In approaching community’s
health, actions need to be undertaken at different levels in the model so as to achieve the
desired outcomes.
In addressing and implementing the program, aspects of the ecological model on health
behaviour were applied. This model outlines the role of the various layers of influence in
behaviour change. These layers are individual interpersonal, organizational, community and
public policy. The PROJECT REPLACE was underpinned under the whānaungatanga, highly
rated aspects that view family and relations belonging to the family and obligations to other

members of the community. This was essential; in ensuring community drives towards
behaviour change (Hubley & Copeman, 2018).
Social learning theory
The social learning theory offers an avenue for social support through instilling
expectations, efficacy and utilizing observation learning and other reinforcer to achieve
change. The key components of these theory entail; self efficacy. This is the belief that a
person has control over his behaviour. A person can influence his behaviour in the manner he
or she wants. Behavioural capability aspects relates to the understanding and having kills to
engage in a behaviour process. Expectations engage in determining the outcomes of
behaviour change while expectancies are the assigned values of behaviour outcome change
(Hubley & Copeman, 2018).
Social learning theory was a fundamental aspect of the program, this theory addressed
the socio-cultural determinants of health and outlining the personal determinants . In the
context of the PROJECT REPLACE, the establishment of focused groups and enhancing
personal nutrition behaviour goals was essential in improving health behaviours. Group
sessions such as tai chi, line dancing, and martial arts were employed to suit the program
dimensions. The establishment of a healthy eating policy was fundamental in this program
entrenching social learning aspects determining health (Akers & Jennings, 2016). Social
learning theory incorporates various levels of social ecological model in addressing changes
in behaviour, in this case it is an avenue for health promotion given its emphasis on
individual and environment interplay, thus applicable in the PROJECT REPLACE program.

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