What is public health, and why do health inequalities persist between groups?
Public health and health inequalities: the definition and key functions of public health, health surveillance and the measurement of population health, the patterns of health and the social determinants that produce health inequalities.
A CCEA A2 4 answer on public health and health inequalities: the definition and key functions of public health, health surveillance and how population health is measured, and the patterns and social determinants that produce inequalities in health between groups.
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What this dot point is asking
CCEA wants you to explain what public health is: its definition and key functions, how population health is measured through surveillance, and the patterns of health and the social determinants that produce health inequalities between groups.
What public health is
Public health differs from clinical medicine: a doctor treats the patient in front of them, while public health asks why a population is getting ill and acts on the causes across the whole community. It works through government, agencies and society, and it relies on evidence about how healthy a population is and what is making it ill.
The key functions of public health
Surveillance is the evidence base: by measuring patterns of disease, life expectancy and risk factors, public health identifies needs and tracks whether interventions work. Protection guards the population from threats, the clearest example being immunisation and screening programmes. Improvement and planning then use that evidence to act, which is where health promotion (the next dot points) comes in.
Health inequalities and the social determinants
Inequalities are produced by the social determinants of health: income and poverty (limiting access to good food, housing and leisure), employment and working conditions, housing and environment (damp, overcrowding, pollution, lack of green space), education (which shapes knowledge, income and choices), and access to services (often poorer in deprived areas). Lifestyle factors such as higher smoking rates also cluster with deprivation. These determinants interact and accumulate over a lifetime, which is why inequalities are so persistent and why reducing them needs action on the wider causes, not just on individual behaviour. This connects directly to the AS 3 idea of factors that a person cannot control.
Examples in context
Example 1. Immunisation as health protection. Childhood immunisation programmes (for example against measles, mumps and rubella) protect the whole population by building herd immunity, so that even those who cannot be vaccinated are protected. High uptake reduces outbreaks, showing public health acting on a population rather than treating individual cases.
Example 2. The social gradient in life expectancy. Across the UK, people living in the most deprived areas tend to have lower life expectancy and more years of ill health than those in the least deprived areas. This social gradient is a clear illustration of health inequality driven by the social determinants, and it is the kind of pattern that public health surveillance identifies and health promotion seeks to narrow.
Try this
Q1. Define public health. [2 marks]
- Cue. The science and practice of protecting and improving the health of whole populations, focusing on prevention and the wider determinants.
Q2. Name two key functions of public health. [2 marks]
- Cue. Health surveillance, health protection, health improvement and promotion, and planning and evaluating services (any two).
Q3. Explain one social determinant that causes health inequalities. [2 marks]
- Cue. Income or poverty, which limits access to good food, housing and leisure and is linked to worse health.
Exam-style practice questions
Practice questions written in the style of CCEA exam questions on this dot point, with worked answer explainers. The year tag is the paper they imitate, not the source.
CCEA A2 4 20196 marksExplain the key functions of public health.Show worked answer →
A 6-mark answer needs several distinct functions, each explained.
Health surveillance: monitoring the health of the population, tracking patterns of disease, and collecting data on births, deaths and illness, so that needs and trends are identified.
Health protection: protecting the population from threats such as infectious disease, environmental hazards and contamination, for example through immunisation, screening and food and water safety.
Health improvement and promotion: improving health and reducing inequalities by promoting healthier lifestyles and tackling the wider determinants of health.
Planning and evaluating services: using evidence to plan, commission and evaluate services so they meet population needs effectively.
Markers reward several distinct functions, each clearly explained rather than just named.
CCEA A2 4 20218 marksExplain why health inequalities exist between different groups in the population.Show worked answer →
An 8-mark answer needs the idea of inequalities plus the social determinants that cause them.
Health inequalities are avoidable, unfair differences in health between groups, for example by income, social class, area, ethnicity or sex. They show as differences in life expectancy and rates of disease.
Causes (social determinants): income and poverty (limiting access to good food, housing and leisure); employment and working conditions; housing and environment (damp, overcrowding, pollution, access to green space); education (which affects knowledge, income and choices); access to services (which can be poorer in deprived areas); and lifestyle factors that cluster with deprivation, such as higher smoking rates.
These determinants interact and accumulate over a lifetime, which is why inequalities are persistent and why tackling them needs action on the wider causes, not just on individual behaviour.
Markers reward the definition of health inequalities and a range of interacting social determinants that explain them.
Related dot points
- Approaches to health promotion: the medical or preventative, behaviour change, educational, empowerment and social change approaches, what each aims to do and its strengths and limitations.
A CCEA A2 4 answer on the approaches to health promotion: the medical or preventative, behaviour change, educational, empowerment and social change approaches, what each aims to achieve, examples of each, and their strengths and limitations.
- Planning and evaluating health promotion: the models of health promotion (Tannahill and Ewles and Simnett), how a health promotion campaign is planned and delivered, and how its effectiveness is evaluated.
A CCEA A2 4 answer on planning and evaluating health promotion: the Tannahill and Ewles and Simnett models, how a health promotion campaign is planned (aims, target group, methods, resources) and delivered, and how its effectiveness is evaluated against its aims.
- Agencies and settings for health promotion: the roles of government, statutory, voluntary and other agencies, the settings in which health promotion takes place, and the role of national campaigns and legislation.
A CCEA A2 4 answer on the agencies and settings for health promotion: the roles of government, statutory, voluntary and other agencies, the settings in which health promotion takes place (schools, workplaces, the community and health settings), and the role of national campaigns and legislation.
- The factors affecting health and wellbeing: physical, social and emotional, economic, environmental and lifestyle factors, the difference between factors a person can and cannot control, and how factors interact to influence health.
A CCEA AS 3 answer on the factors affecting health and wellbeing: physical, social and emotional, economic, environmental and lifestyle factors, the distinction between controllable and uncontrollable factors, and how these interact to determine a person's health.
- The effects of health and ill health on individuals and on those around them, the indicators and measures used to assess physical health, and how needs are identified across the physical, intellectual, emotional and social dimensions.
A CCEA AS 3 answer on the effects of health and ill health on individuals and their families, and the indicators and measurements (such as blood pressure, body mass index, pulse and peak flow) used to assess physical health and identify needs across the dimensions of wellbeing.
Sources & how we know this
- CCEA GCE Health and Social Care specification — CCEA (2016)