4.2 Evaluate the application of SDGs 3, 4, 10 and 11 to inform
strategies to improve the health status of a community

1. How have these goals been applied in other communities?

Communities usually apply these goals through coordinated action across prevention, education, targeted support, and place-based change. This is important because health rarely improves through a single service or one-off program. Communities with poorer health outcomes often face several connected barriers at the same time, such as lower access to services, weaker infrastructure, lower health literacy, and fewer safe or supportive spaces for daily life.

1.1 A) Healthy Cities Illawarra

Healthy Cities Illawarra is a community health promotion organisation based in the Illawarra and Shoalhaven. Its role is to improve health and wellbeing by working with local councils, schools, community organisations, and other partners to create healthier communities. Rather than focusing only on treatment, it focuses strongly on prevention and on the wider conditions that shape health, such as physical activity, food access, social connection, and the local environment.

This work includes a range of specific programs and partnerships. These include:

• Active In-Betweens, a free after-school program for children aged 8 to 12
• active transport and safer streets advocacy, including work to support safer walking and cycling routes
• partnerships and networks focused on healthier urban environments
• community action to reduce alcohol and other drug harms

One of the clearest examples is Active In-Betweens. This is a free, place-based, trauma-informed after-school program delivered in local community centres by trained Health Promotion Officers. It is designed to support children, especially those experiencing socioeconomic disadvantage, through:

• structured physical activity
• active games and play
• healthy eating and cooking activities
• friendship, teamwork, and confidence building
• a safe and supportive environment after school

Healthy Cities Illawarra also works on the local environment, not just individual behaviour. Its active transport work supports safer streets and more connected walking and cycling routes, especially around schools. This reflects the idea that health improves not only when people are told to be more active, but also when communities are designed in ways that make active living safer and easier.

This case study is useful because it shows how several SDGs can work together at the same time:

• SDG 3: Good Health and Wellbeing through physical activity, healthy eating, prevention, and stronger wellbeing
• SDG 4: Quality Education through health education, skill development, and improved health literacy
• SDG 10: Reduced Inequalities through free or low-cost programs and support for children and communities experiencing disadvantage
• SDG 11: Sustainable Cities and Communities through safer public spaces, active transport, and healthier local environments

Healthy Cities Illawarra can therefore be judged as a strong model because it does not treat health as only a medical issue. It combines prevention, education, equity, and place-based change in ways that are practical and local. However, like many community health initiatives, its long-term impact still depends on stable funding, strong partnerships, and whether the people most affected are actually reached.

Example: Active In-Betweens shows how one initiative can support several SDGs at once. It improves physical activity and wellbeing (SDG 3), builds healthy habits and social skills (SDG 4), supports children facing disadvantage (SDG 10), and is delivered through trusted local community spaces (SDG 11).

1.2 B) Yuwaya Ngarra-li (Walgett, NSW)

Yuwaya Ngarra-li is a community-led partnership in Walgett, New South Wales between the Dharriwaa Elders Group, an Aboriginal Community Controlled Organisation, and UNSW. Its purpose is to improve the wellbeing, social, built, and physical environment, and the life pathways of Aboriginal people in Walgett through evidence-based initiatives, research, and capacity building. The partnership is guided by five core principles. It is community-led, culturally connected, strengths-focused, holistic, and rights-based.

This case study is useful because it is clearly tied to one specific community and because it shows that improving health status requires more than healthcare alone. Yuwaya Ngarra-li works across local priorities identified by the community itself. These priorities include:

• improving food and water security
• supporting children and young people
• strengthening Aboriginal community leadership, capabilities, and control
• improving the built and physical environment
• reducing Aboriginal children and young people’s contact with the criminal justice system

In practice, this means Yuwaya Ngarra-li is not one single program. It is a long-term community partnership that supports a range of projects shaped by local needs. Official UNSW material describes work focused on:

• food and water for life
• children and young people
• caring for Country
• Aboriginal community leadership, capabilities and control
• research and evaluation that privileges Aboriginal community knowledge and decision-making

A concrete example is the Gali water kiosk in Walgett. This provides free, clean and safe drinking water to community members in response to local water security problems. Before the kiosk opened, many residents were relying on bottled water because the town water supply was poor quality and high in sodium. This shows how Yuwaya Ngarra-li addresses health through practical community action on everyday living conditions, not just through clinical care.

Yuwaya Ngarra-li also shows how the SDGs can work together in one community:

• SDG 3: Good Health and Wellbeing is reflected in work to improve wellbeing, food and water security, and healthier life pathways.
• SDG 4: Quality Education is reflected in work with children and young people, local learning, capability building, and stronger future pathways.
• SDG 10: Reduced Inequalities is reflected because the partnership is Aboriginal-led and responds directly to long-term disadvantage, exclusion, and unequal outcomes.
• SDG 11: Sustainable Cities and Communities is reflected in work to improve the built environment, local infrastructure, and the conditions of everyday community life.

This makes Yuwaya Ngarra-li a strong example of holistic, community-led action. It does not treat health as only a medical issue. Instead, it links health to safe water, stronger environments, better life pathways, and Aboriginal community leadership. It can therefore be judged as a strong model because it is shaped by local priorities and cultural authority rather than imposed from outside. However, like other long-term place-based initiatives, its effectiveness still depends on sustained support, strong partnerships, and continued community control.

Example: The Gali water kiosk shows how one local strategy can support several SDGs at once. It improves access to safe drinking water and everyday wellbeing (SDG 3), responds to inequality in living conditions (SDG 10), and strengthens the physical conditions of community life in Walgett (SDG 11). When combined with Yuwaya Ngarra-li’s broader work on children, young people, and community capability, it also contributes to stronger future pathways linked to SDG 4.

2. What lessons can be drawn from other communities and applied to their own community context?

These case studies show that communities do not improve health through one simple solution. There are 4 common lessons that can be drawn from other communities and applied to another community’s context.

These lessons should not be copied exactly. They should be adapted to the chosen community. A strategy that works in one place may need to be changed in another because of differences in geography, workforce, cultural context, transport access, funding, or the level of existing services.

To transfer lessons from one community to another, you should ask:

• What are the major health issues in the chosen community?
• Which groups are most affected?
• What barriers reduce access or participation?
• Which organisations or services already exist?
• What kinds of change are realistic, sustainable, and measurable?

Example: A community education program about preventive health may work well in an urban area with many local services, but in a remote community it may need to be paired with transport support, outreach, and culturally safe service delivery to have the same effect.

3. What are the major health issues for a community?

At this point, you need to move beyond the case studies and carry out your own research into a chosen community.

This means collecting and analysing community-specific data rather than making assumptions. You will need to investigate the health profile of that community using relevant sources so that your judgement about strategies is based on actual evidence from that community. This aligns with NESA’s expectation that students research a specific community, analyse the data available, identify the major health issues, and then use that evidence to inform and evaluate strategies.

The major health issues for a community should be identified through a community health profile, not through assumptions. This means using available community data to build a clear picture of the main health problems, the groups most affected, and the factors driving those patterns.

NESA’s support material specifically points students towards sources such as ABS Census data by region and local health district data when researching a chosen community.

A strong community health profile usually considers three linked areas:

1. identifies the main health outcomes, such as:
   • patterns of mortality and morbidity
   • chronic disease burden
   • mental health concerns
   • injury patterns
   • preventable hospitalisations
     
     
2. identifies the main risk factors, such as:
   • smoking
   • poor diet
   • physical inactivity
   • alcohol and other drug harms
   • low screening participation
   • delayed help-seeking
     
     
3. identifies the main determinants of health, such as:
   • education (socioeconomic characteristics)
   • employment and income (socioeconomic characteristics)
   • housing quality and stability (environmental factors / socioeconomic characteristics)
   • transport access (environmental factors)
   • local safety (environmental factors / broad features of society)
   • discrimination or exclusion (broad features of society)
   • access to health services (environmental factors)

This matters because the major issue is often not just the illness itself. In many communities, the deeper problem is that the conditions for good health are weaker. For example, a community may have high chronic disease risk, low screening rates, poor access to bulk-billing GPs, and limited transport. In that case, the issue is not only disease. It is also the barriers that make prevention, early intervention, and care harder to access.

A useful way to organise this analysis is to use the four SDGs as guiding questions:

Example: If a coastal regional community has rising preventable hospital admissions, low screening participation, weaker public transport, and a higher proportion of older residents, its major health issues may include both poor access to care and local conditions that make preventive healthcare harder to use.

4. What strategies are needed to advocate and improve a community’s health status?

Strategies should be selected only after the major health issues in the chosen community have been identified. The strongest responses are usually integrated strategy sets, not one separate strategy for each SDG. In practice, one well-designed strategy may reflect several SDGs at once.

4.1 Start with the issue, not the SDG

A strong strategy begins with the community issue. You should first ask what the data shows, which groups are most affected, and what barriers are driving the problem. The SDGs then help organise the response.

For instance, if a community has low screening participation and high preventable hospital admissions, the response should not be limited to “more health information”. It may also need better access to services, transport support, culturally safe outreach, and stronger local partnerships. This is where the goals become useful as a planning framework rather than a list of definitions.

4.2 Build integrated strategy sets

Most community health issues require a combination of actions. These may include:

• prevention and early support, such as screening programs, health checks, or early mental health support
• education and health literacy, such as practical community education and clearer support to navigate services
• equity-focused support, such as reduced cost barriers, outreach, transport assistance, or culturally safe delivery
• place-based change, such as safer walking routes, better public spaces, improved local facilities, or stronger service access within the community

The value of this approach is that it reflects how people actually experience health. A person may need knowledge, access, affordability, safety, and local support at the same time. A strategy is more likely to work when it responds to that full picture.

Example: If a rural community has poor access to mental health support for young men, a stronger response may combine telehealth access, local outreach, mental health education, partnership with sporting clubs, and transport support for face-to-face care when needed. This is stronger than relying on one awareness campaign alone.

4.3 Advocacy is part of the strategy

Improving health status also requires advocacy. A strategy may be well designed, but it will still be limited if decision-makers do not support it, fund it, or help implement it. Advocacy means using evidence, partnerships, and community voice to argue for action.

This is especially important when a community issue depends on systems beyond health services alone. For example, if poor transport is a major barrier to healthcare access, advocacy may need to involve local government, transport providers, health services, and community organisations. This shows again that the SDGs are best applied as an interconnected framework.

5. How do you know these strategies may be effective?

A strategy may be considered effective when there is a clear match between the community issue, the strategy chosen, and the evidence that would show improvement. This is where the directive verb evaluate becomes important. To evaluate means to make a judgement based on criteria. In this dot point, you are not just identifying strategies. You are judging whether those strategies are likely to improve the health status of the chosen community.

To avoid confusion, it helps to separate this judgement into two stages. First, you judge whether the strategy is well designed before implementation. Second, you judge whether the strategy is actually working after implementation.

5.1 Judging whether the strategy is well designed before implementation

Before a strategy is introduced, it cannot yet be judged by whether health outcomes have improved. At this stage, it should be judged by the quality of its design. This means asking whether the strategy matches the issue, targets the right groups, reduces barriers, is realistic, can continue over time, and includes a clear plan for measuring success.

These criteria help you judge whether a strategy is likely to be effective. A strategy is more likely to succeed when it is based on local data, targets real barriers, and is designed in a way that fits the chosen community.

5.2 Measuring whether the strategy is working after implementation

After the strategy has been introduced, it can then be judged using evidence of implementation and evidence of impact. This is where process measures and outcome measures become important.

This distinction is important. A strategy may have strong process measures but weak outcome measures. For instance, a program may attract high attendance, but still have little long-term effect on health. On the other hand, a strategy with poor participation is unlikely to improve outcomes, even if the idea behind it is strong.

A strategy can therefore be judged as more effective when it is well designed before implementation, and when the evidence after implementation shows that it is both being delivered properly and improving health outcomes.

Example: If a community introduces a mobile screening service for low-income older residents, the strategy could first be judged as well designed if it is targeted to that group, uses accessible locations, reduces transport barriers, and includes a clear plan to track participation and health outcomes. After implementation, it could then be judged as effective if attendance increases, the intended group is actually reached, and preventable illness is identified earlier. It would be judged as less effective if few priority residents use it, if it operates only briefly, or if there is no measurable improvement in access or early detection.