The wider determinants of health and health inequality for individuals, communities and public policy
This element explores how factors such as income, education, environment, and social networks shape health outcomes differently across populations. It examines the ethical and practical implications of health inequalities and the role of community-led interventions in addressing them. Learners will apply this understanding to design or evaluate strategies that improve health and wellbeing at multiple levels.
Assessment criteria
Topic Overview
This topic explores the theoretical foundations and practical applications of supporting behaviour change within professional health and wellbeing practice. It covers key models such as the Transtheoretical Model (Stages of Change), the COM-B system, and motivational interviewing techniques, enabling practitioners to tailor interventions to individual readiness and context. Understanding these frameworks is essential for designing effective, person-centred strategies that promote sustainable health improvements.
Behaviour change is central to public health and wellbeing, as many chronic conditions (e.g., obesity, smoking-related diseases) are linked to modifiable behaviours. This module equips students with evidence-based tools to assess, plan, and evaluate interventions, addressing barriers like ambivalence and relapse. It also emphasises ethical practice, cultural competence, and the importance of building therapeutic rapport to empower clients.
Within the wider RSPH Level 3 Diploma, this topic builds on foundational knowledge of health determinants and communication skills, preparing students for roles in health coaching, community health, or further study. Mastery of behaviour change principles is critical for achieving positive outcomes in diverse settings, from NHS stop-smoking services to workplace wellness programmes.
Key Concepts
Core ideas you must understand for this topic
- →Transtheoretical Model (Stages of Change): Precontemplation, Contemplation, Preparation, Action, Maintenance, and Relapse – each stage requires different intervention strategies.
- →COM-B Model: Capability, Opportunity, Motivation – three essential conditions for behaviour change; interventions must target one or more components.
- →Motivational Interviewing: A client-centred, directive method for enhancing intrinsic motivation by exploring and resolving ambivalence.
- →SMART Goals: Specific, Measurable, Achievable, Relevant, Time-bound – used to structure behaviour change plans and track progress.
- →Relapse Prevention: Identifying high-risk situations and developing coping strategies to maintain long-term change.
Learning Objectives
What you need to know and understand
- Understand the wider determinants of health and the impact these can have at an individual and population levelUnderstand inequalities in health and how these impact on health and wellbeingUnderstand the impact of behaviours on both physical and mental health and wellbeingUnderstand a community development approach to implementing health and wellbeing interventions
Assessment Criteria
Key criteria assessors look for in your portfolio
- Award credit for demonstrating a clear distinction between health inequality and health inequity, with relevant examples from UK population health data.
- Expect evidence of applying the Dahlgren and Whitehead model of wider determinants to explain specific health disparities in a given community or case study.
- Look for a critical analysis of how individual behaviours are influenced by social and structural factors, not presented as isolated lifestyle choices.
- Credit for outlining a community development approach that engages local assets, empowerment principles, and partnership working to tackle a health inequality.
Assessment Guidance
Guidance for achieving higher grades
- 💡For assignments, always link theory to practice by including a concrete example of a community development project, detailing stages from needs assessment to evaluation.
- 💡When discussing the impact of behaviours, use a biopsychosocial model to acknowledge both agency and structural constraints, which demonstrates a sophisticated understanding.
- 💡In assessment responses, explicitly name and apply a recognised model of health determinants (e.g., Rainbow Model) to structure your analysis and show systematic thinking.
- 💡Use current UK public health statistics (e.g., from the Office for Health Improvement and Disparities) to substantiate claims about health inequalities, as currency of data is often a marking criterion.
- 💡When answering questions on models, always link theory to practice. For example, explain how you would apply the COM-B model to a specific scenario (e.g., increasing physical activity in older adults) by identifying capability, opportunity, and motivation barriers.
- 💡Use the acronym OARS (Open questions, Affirmations, Reflections, Summaries) when discussing motivational interviewing – examiners look for specific technique names and their purpose.
- 💡For evaluation questions, critically appraise models: mention strengths (e.g., Transtheoretical Model's stage-matched interventions) and limitations (e.g., oversimplification of complex behaviours).
Common Mistakes
Common errors to avoid in your coursework
- Conflating health inequality (measurable difference) with health inequity (avoidable and unjust difference) – students often use the terms interchangeably without noting justice implications.
- Attributing poor health solely to individual lifestyle choices without considering the wider determinants that constrain or enable those behaviours.
- Overlooking the cumulative effect of multiple disadvantage – treating each determinant (e.g., housing, employment) in isolation rather than as intersecting factors.
- Failing to reference specific policy frameworks or legislation (e.g., Health and Social Care Act 2012, Marmot Review) when discussing public policy responses to inequalities.
- Misconception: 'Motivational interviewing is just being nice to the client.' Correction: It is a structured, evidence-based technique that uses open questions, affirmations, reflections, and summaries (OARS) to elicit change talk, not simply empathy.
- Misconception: 'The Stages of Change model is linear – clients always move forward.' Correction: Relapse is common and part of the cycle; practitioners should normalise setbacks and help clients re-engage at an appropriate stage.
- Misconception: 'Behaviour change is solely the client's responsibility.' Correction: Effective practice recognises the role of environmental, social, and systemic factors (e.g., access to resources, social support) that practitioners must address collaboratively.
Frequently Asked Questions
Common questions students ask about this topic
Pass / Merit / Distinction Evidence Checklist
How your portfolio evidence is graded for ROYAL SOCIETY FOR PUBLIC HEALTH The wider determinants of health and health inequality for individuals, communities and public policy
Every vocational unit is marked against named criteria rather than an exam percentage. Your tutor's brief lists the exact codes for this unit — here is what each band is asking you to do.
Demonstrate baseline knowledge, accurate terminology, and core practical application.
Provide detailed analysis, structured explanations, and clear workplace reasoning.
Deliver thorough evaluation, original problem solving, and fully justified recommendations.
Before You Start
Prior knowledge that will help with this topic
- •Understanding of social determinants of health and health inequalities (e.g., from earlier units on public health).
- •Basic communication skills in health and social care (e.g., active listening, empathy).
- •Familiarity with the concept of person-centred care and ethical principles (autonomy, beneficence, non-maleficence).
Coursework AI Review
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Key Terminology
Essential terms to know
- Understand the wider determinants of health and the impact these can have at an individual and population levelUnderstand inequalities in health and how these impact on health and wellbeingUnderstand the impact of behaviours on both physical and mental health and wellbeingUnderstand a community development approach to implementing health and wellbeing interventions
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