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Working in disadvantaged communities: What additional competencies do we need?

Elizabeth Harris1*, Mark F Harris2, Lynne Madden34, Marilyn Wise5, Peter Sainsbury6, John MacDonald7 and Betty Gill8

Author Affiliations

1 Centre for Health Equity Training, Research and Evaluation, University of New South Wales, Sydney, NSW, Australia

2 Centre for Primary Health Care and Equity, University of New South Wales, Sydney, NSW, Australia

3 Current address: Australasian Faculty of Public Health Medicine, Royal Australasian College of Physicians, Sydney, NSW, Australia

4 Division of Population Health, NSW Department of Health, NSW, Australia

5 Department of Public Health, University of Sydney, Sydney, NSW, Australia

6 Division of Population Health, Sydney South West Area Health Service, Sydney, NSW, Australia

7 Social Justice Social Change Research Centre, University of Western Sydney, Sydney, Australia

8 College of Health and Sciences, University of Western Sydney, Sydney, Australia

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Australia and New Zealand Health Policy 2009, 6:10  doi:10.1186/1743-8462-6-10

Published: 24 April 2009



Residents of socioeconomically disadvantaged locations are more likely to have poor health than residents of socioeconomically advantaged locations and this has been comprehensively mapped in Australian cities. These inequalities present a challenge for the public health workers based in or responsible for improving the health of people living in disadvantaged localities. The purpose of this study was to develop a generic workforce needs assessment tool and to use it to identify the competencies needed by the public health workforce to work effectively in disadvantaged communities.


A two-step mixed method process was used to identify the workforce needs. In step 1 a generic workforce needs assessment tool was developed and applied in three NSW Area Health Services using focus groups, key stakeholder interviews and a staff survey. In step 2 the findings of this needs assessment process were mapped against the existing National Health Training Package (HLT07) competencies, gaps were identified, additional competencies described and modules of training developed to fill identified gaps.


There was a high level of agreement among the AHS staff on the nature of the problems to be addressed but less confidence indentifying the work to be done. Processes for needs assessments, community consultations and adapting mainstream programs to local needs were frequently mentioned as points of intervention. Recruiting and retaining experienced staff to work in these communities and ensuring their safety were major concerns. Workforce skill development needs were seen in two ways: higher order planning/epidemiological skills and more effective working relationships with communities and other sectors. Organisational barriers to effective practice were high levels of annual compulsory training, balancing state and national priorities with local needs and giving equal attention to the population groups that are easy to reach and to those that are difficult to engage. A number of additional competency areas were identified and three training modules developed.


The generic workforce needs assessment tool was easy to use and interpret. It appears that the public health workforce involved in this study has a high level of understanding of the relationship between the social determinants and health. However there is a skill gap in identifying and undertaking effective intervention.