Introduction

Welcome to the Wider Determinants of Health tool. The tool is an ongoing project and will continue to be developed over time. As such, some sections of the tool are currently more developed than others. We would be happy to hear from you to inform this development: you can email us at wider.determinants@phe.gov.uk if you have any feedback.

Further resources

As an addition to the data, the further resources pages provide resources to help you go beyond highlighting variation in the wider determinants and take further action. They contain links to more data, information and ideas that can help you to explore the issues raised in this profile in more detail and inform actions to improve health outcomes.

Click on an image below to access further resources for a specific domain. For resources which are not domain specific, see general resources.

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income_link  crime_link  education_link

This site contains external links. Public Health England is not responsible for the contents or reliability of the linked websites and does not necessarily endorse the content expressed within them.

About

Wider determinants, also known as social determinants, are a diverse range of social, economic and environmental factors which impact on people’s health. Such factors are influenced by the local, national and international distribution of power and resources which shape the conditions of daily life. They determine the extent to which different individuals have the physical, social and personal resources to identify and achieve goals, meet their needs and deal with changes to their circumstances. The Marmot review, published in 2010, raised the profile of wider determinants of health by emphasising the strong and persistent link between social inequalities and disparities in health outcomes. Variation in the experience of wider determinants (i.e. social inequalities) is considered the fundamental cause (the ‘causes of the causes’) of health outcomes, and as such health inequalities are likely to persist through changes in disease patterns and behavioural risks so long as social inequalities persist. Addressing the wider determinants of health has a key role to play in reducing health inequalities, one of PHE’s core functions.

Several studies have attempted to estimate the contribution of the wider determinants to population health, finding that wider determinants have a greater influence on health than health care, behaviours or genetics. It is therefore an important aspect of public health in terms of informing preventative action and reducing inequality. In addition, both the Marmot review and the Dame Carol Black review highlighted the huge economic costs of failing to act on the wider determinants of health.

This tool arose from the need for a resource to support work to reduce the impact of the wider determinants, broadening the existing range of tools which focus on behavioural risk factors and direct measures of health.

Aims

The aim of the profile is to provide the public health system with intelligence regarding the wider determinants of health to help improve population health and reduce health inequalities. This Fingertips profile aims to:

  • provide a set of indicators which describe a range of wider determinants of health and enable a comparison of these factors between areas
  • highlight relationships between wider determinants and other risk factors and health outcomes
  • provide, where possible, links to further resources for tackling wider determinants. This may take the form of best practice, case studies, interventions, guidance, or links to other data tools or analyses.

More information about the profile can be found on the further information page.

Recent updates

Click here (excel file) for a record of changes to the indicator set.

September 2018

Updated indicators:

  • Number of premises licensed to sell alcohol per square kilometre

New materials have been added to the further resources section, including 'Urban visits to Greenspaces' and 'Cold Homes Toolkit'.

August 2018

Updated indicators:

  • First time entrants to the youth justice system
  • First time offenders
  • Pupil absence

New materials have been added to the further resources section, including 'Air pollution: a tool to estimate healthcare costs'.

May 2018

New indicators added:

  • Average weekly earnings
  • Gender pay gap
  • Households with problem debt
  • Income deprivation
  • Job density
  • Domestic abuse-related incidents and crimes
  • 16-17 year olds not in education, employment or training

Updated indicators:

  • Individuals not reaching the Minimum Income Standard
  • Work-related illness
  • Rate of complaints about noise
  • Air pollution: fine particulate matter
  • Economic inactivity rate
  • Children in the youth justice system
  • 19-24 year olds not in education, employment or training

Removed indicators:

  • Domestic abuse: replaced with new measure
  • Children in low income families (all dependents <20yrs)

New materials have been added to the further resources section.

April 2018

New materials have been added to the further resources section.

March 2018

New materials have been added to the further resources section.

February 2018

The following indicators have been updated:

  • Killed and seriously injured (KSI) casualties on the roads
  • Adults in contact with secondary mental health services who live in stable and appropriate accommodation
  • Adults with a learning disability who live in stable and appropriate accommodation
  • Injuries due to falls in people aged 65 and over
  • Gap in the employment rate between those with a learning disability and the overall employment rate
  • Gap in the employment rate between those in contact with secondary mental health services and the overall employment rate
  • Violent crime: Rate of hospital admissions for violence
  • Violent crime: Rate of violent offences
  • Violent crime: Rate of sexual offences
  • School readiness: Good level of development at age 5
  • School readiness: Good level of development at age 5 with free school meal status
  • School readiness: Year 1 pupils achieving the expected level in the phonics screening check
  • School readiness: Year 1 pupils with free school meal status achieving the expected level in the phonics screening check
  • Healthy life expectancy at birth
  • Healthy life expectancy at birth
  • Life expectancy at birth
  • Life expectancy at birth
  • Inequality in life expectancy at birth
  • Inequality in life expectancy at birth
  • People reporting low life satisfaction
  • Health related quality of life for older people

December 2017

User testing results published in the further resources section.

New materials have been added to the further resources section.

November 2017

New indicators added:

  • Employment support allowance claimants
  • Access to healthy assets and hazards index
  • Workplace injury
  • Affordability of home ownership.

Updated indicators:

  • Unemployment
  • Children in the youth justice system
  • Employment rate
  • Fuel poverty
  • Excess winter deaths
  • Gap in the employment rate between those with a long-term health condition and the overall employment rate
  • Sickness absence - % of employees who had at least one day off in the previous week
  • Sickness absence - % of working days lost due to sickness absence
  • Statutory homelessness: Households in temporary accommodation
  • Statutory homelessness: Eligible homeless people not in priority need
  • Social Isolation: adult social care users who have as much social contact as they would like
  • Mortality rate from causes considered preventable
  • Under 75 mortality rate from all cardiovascular diseases
  • Under 75 mortality rate from cancer
  • Under 75 mortality rate from liver disease
  • Under 75 mortality rate from respiratory disease.

New materials have been added to the further resources section.

October 2017

New materials have been added to the further resources section.

August 2017

The following indicators have been updated:

  • Sickness absence - % of employees who had at least one day off in the previous week
  • First time entrants to the youth justice system
  • First time offenders
  • Pupil absence

New materials have been added to the further resources section.

May 2017

New indicators added:

  • Density of fast food outlets
  • Air pollution: fine particulate matter
  • Economic inactivity rates.

New data in the Marmot domain:

  • Individuals not reaching the Minimum Income Standard
  • Inequality in life expectancy at birth
  • 19-24 year olds not in education, employment or training
  • Long-term claimants of Jobseekers Allowance.

New links added in the 'Further resources' section.

New functionality: local authority and regional population pyramids.

March 2017

  • Marmot indicators updated
  • Wider Determinants of Health tool launched