This section contains further details about the contents of the Public Health Outcomes Framework tool and links to other useful information. It is split into the following sections:
Indicator selection
Interpreting values
Updates, revisions and corrections
Sources of data
Inequalities
Information about areas
Colour shading
Recent trend markers
Box plots
At a glance documents
Slope index of inequality in life expectancy
Obesity and excess weight
The Public Health Outcomes Framework Healthy lives, healthy people: Improving outcomes and supporting transparency sets out a vision for public health, desired outcomes and the indicators that will help us understand how well public health is being improved and protected.
The framework concentrates on two high-level outcomes (healthy life expectancy and differences in life expectancy and healthy life expectancy between communities) to be achieved across the public health system, and groups further indicators into four ‘domains’ that cover the full spectrum of public health. The outcomes reflect a focus not only on how long people live, but on how well they live at all stages of life.
The Public Health Outcomes Framework is refreshed every three years, most recently in 2019, following user consultation. Details of the previous frameworks can be found on the pages for 2013 to 2016 and 2016 to 2019. Data from the previous frameworks can be obtained by contacting us.
The Public Health Outcomes Framework is not a performance management tool for local authorities. PHOF data will enable local authorities to benchmark and compare their own outcomes with other local authorities.
You can use and reuse the data and charts from the Public Health Outcomes Framework data tool (not including logos) free of charge in any format or medium under the terms of the Open Government Licence. To view this licence in an offline capacity write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or e-mail: psi@nationalarchives.gov.uk.
Please cite any use of this website as follows specifying the date of access:
'Public Health England. Public Health Outcomes Framework. [Date accessed] https://fingertips.phe.org.uk/profile/public-health-outcomes-framework © Crown copyright [Year]'
Updates to the Public Health Outcomes Framework data tool are published as official statistics. They are produced in accordance with best practice set out in the Code of Practice for Official Statistics to ensure that they are fit for purpose, methodologically sound, politically independent and produced in a transparent way.
The phrase ‘Pre release Access’ refers to the practice whereby Official Statistics in their final form and any written commentary are made available to an eligible person in advance of their publication. The rules and principles which govern pre-release access are featured within the Pre-release Access to Official Statistics Order 2008. Post holders who are given pre-release access 24 hours prior to release can be found in the quarterly release pages in the Public Health Outcomes Framework Collection.
We carry out regular user engagement activities to make sure the way we present PHOF indicators continues to meet the changing needs of stakeholders. This latest survey of PHOF users was in 2016, and the results led to actions summarised in a report.
Detailed criteria were used to select indicators for inclusion in PHOF. These are set out in the table below.
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Essential [required for all indicators] |
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Clarity |
it is clear what it measures, outcomes or activities |
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Rationale |
it addresses a specific policy issue or draws attention to a particular outcome |
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Relevance |
it relevant to the policy and action available to improve |
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Attributable |
it measures progress attributable to the interventions/activities |
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Interpretation |
it is meaningful to the intended audience(s) |
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Validity |
it has an unambiguous definition, is methodologically and technically sound from a reliable data source which is available at an appropriate level (for example LA or CCG) to make it meaningful and sustainable |
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Construction |
the methods used support the stated purpose of the indicator and there is transparency about how they have been tested and justified |
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Risks |
any limitations, risks or perverse incentives are identified and stated with any mitigating actions |
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Availability |
it is collected at sufficient level of geographical or organisational split |
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Affordability and value for money |
it benefits without disproportionate costs and where new burdens are created these will be estimated and sustainable funding identified |
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Desirable [wherever possible] |
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Timeliness |
it is possible to update with sufficient frequency (ideally can be reported quarterly) and data time lag (ideally less than one year but may vary for surveys) |
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Comparable |
suitable UK or international metrics are available for making meaningful direct or proxy comparisons |
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Disaggregates |
there is potential to break down by equalities / inequalities characteristics to measure impacts on different groups |
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Supports alignment |
it is used across the health and care system via the other outcome frameworks. |
They were developed with expert input from stakeholders to provide a comprehensive means of assessing the suitability of each candidate indicator. These were used to assess the final set of indicators, including those suggested in response to the initial consultation. Indicators that passed a sift, based on the criteria, went on to form the first publication of the Public Health Outcomes Framework.
When the PHOF was first published in 2012 there was a commitment not to make any changes for three years to allow it to become established during the transfer of public health responsibilities from the NHS to local authorities.
It is planned to update the framework every 3 years so a further process will begin in 2021 to 2022. If you are working on indicators for future inclusion, they will need to meet the criteria by then. Please discuss this with us during indicator development by contacting us.
All indicators require context in order to understand them. In general, the indicator values are somewhat abstract, and don’t mean much to anyone unless they are presented in comparison to other values of the same indicator. The Fingertips platform that is used to present PHOF indicators does this in several ways:
PHE has produced a range of technical guidance to aid the interpretation of indicators and comparators.
Data are published as part of a quarterly update cycle in August, November, February and May. Exact dates will be announced on the statistical release calendar and this website.
Updates and additions will be announced on the homepage. Full details of the indicators updated can be found here.
A list of indicators updated, for the most recent and previous releases, can be found in the Public Health Outcomes Framework Collection.
Public Health Outcomes Framework data will be revised and corrected in accordance with Public Health England's Official Statistics Revisions and corrections policy and the Code of Practice for Official Statistics. A revisions and corrections document listing all changes to the indicators within the PHOF from September 2017 can be found here.
Indicators in the Public Health Outcomes Framework have been based on existing data sources wherever possible. The data source for each indicator is set out in the definitions tab.
Indicators are only shown in the tool where there are data available for them. All indicator data that is contained in the webtool is available to download from the download tab and metadata for the data download can be found here.
The fingertipsR package allows you to download public health data using R and the Fingertips API (Chrome only) allows public health data to be retrieved in either JSON or CSV formats.
The Public Health Outcomes Framework focuses on achieving positive health outcomes for the population and reducing inequalities in health. The majority of indicators in this framework have the potential to impact on inequalities and we aspire to make it possible for all indicators to be disaggregated by equalities characteristics and by socioeconomic analysis wherever possible. This is intended to support work locally to reduce in-area health inequalities where these persist. A list of inequalities data available within the tool is available here.
In July 2017 PHE published a health equity report which presents analysis and commentary on inequalities for 18 indicators from the PHOF. This report supports understanding of inequalities in health for different populations in England, with a particular focus on inequalities between ethnic groups. The report was accompanied by a blogpost on ‘Understanding health inequalities in England’.
In general, indicators in PHOF are presented at Upper Tier Local Authority, region and England level. Where possible, we also present data for Lower Tier Local Authorities, Combined Authorities, PHE Centres, ONS area classification groups and subgroups, and local authority based deprivation deciles.
In the data tool, it is possible to compare your local authority with others in the same region, Public Health England Centre or deprivation decile in the Overview tab. It is also possible to compare your local authority with its CIPFA nearest neighbours (for details of these, see here). For Lower Tier Local Authorities, the ability to compare to others within the same ONS classification group is also available. Combined Authority groupings have now been added to the tool. Other comparators may be added in future. Please contact us if you have any specific requirements.
Following the restructure of local authorities in some parts of England on 1 April 2019, two generations of lower and upper tier local authorities are available now in the PHOF. For the new areas, data points were calculated where it was absolutely safe to do so (proportions and crude rates where all contributing old areas have valid values and the calculation can be done simply using the numerator and denominator).
Where it has not been possible to automatically recalculate the data for new areas, we are taking a step wise approach to updating in a similar way to the gradual release of revised back series data following revisions to mid year population estimates released by ONS in 2018. At the time when an indicator is scheduled to get fully updated we will, where possible, produce data for the new geographies and calculate a back series.
In July 2015, Public Health England reorganised its Centres (the parts of the organisation that provide local advice and support to the public health system), moving from 15 Centres to 9. The new Centre areas are largely co terminous with the former Government Office Regions, the only difference is Milton Keynes local authority being located in the East of England PHE centre (whereas it is located in the former South East Government Office Region).
Values for City of London and Isles of Scilly local authorities are not included when calculating the highest and lowest values for England that are used in the spine charts in the Area Profiles view. The reason for this is that for many indicators, these values can artificially skew the distribution of values in England. They are therefore excluded to give a more representative range of values.
The England best and worst values are not displayed (and the spine chart is absent) in the Area Profiles view if more than 25% of local indicator values are not presented.
For many indicators, the way that the colour is assigned is based on statistically significant differences from the England value. This is determined within the PHOF tool by using the England or region value depending on the benchmark selected and seeing whether this lies within the confidence interval of the Local Authority in question. For some indicators, there is a set goal (for example, 90% for many of the immunisation indicators). If a local authority meets this goal or not determines their colour.
Indicators that are shaded blue rather than Red or Amber or Green are presented in this way because it is not straightforward to determine for these indicators whether a high value is good or bad. Indicators that are shaded white are presented in this way because they do not have confidence intervals with which to compare against the benchmark value, and therefore it is not possible to determine whether the local value is statistically significantly higher or lower than the benchmark.
At this stage we have only implemented a simple chi squared test for trend. In order for this to be a valid test for a statistically significant trend in an indicator:
Only the indicators which meet those three criteria have a “recent trend” marker showing.
When there are at least five consecutive non overlapping data points available for a proportion or crude rate indicator, a chi squared statistical test for trend* is carried out on the most recent five points. If a statistically significant trend is present, a red or green arrow is shown next to the indicator. If there is no significant trend in the most recent five points, the test is redone, including an additional (sixth) point, and so on, going further back until the full series has been tested. Please see the Trend markers - technical specification for users.
Markers of significant trends were first added in August 2016, for selected indicator types. In October 2016, we amended the method for the trend icon calculation, by adjusting the significance level from 95% significance to 99.8% significance, as this was felt to be a more appropriate level to test for trends.
This functionality is in development, if you would like to feed back any comments, please contact us.
* Armitage P, Berry G. Statistical Methods in Medical Research (3rd edition). Oxford: Blackwell 1994.
The box plot is a standardised way of displaying the distribution of data. In the Fingertips suite of profiles we have displayed the 95th percentile, 75th percentile, median, 25th percentile, and 5th percentile in chart format, as well as the minimum and maximum values in table format, for each indicator.
Documents showing all indicators for a particular area can be found in the Reports section.
For general viewing it is best to ensure the browser is up to date (particularly Internet Explorer). For printing, users might need to enable background images if the colours are not showing up, depending on their browser settings. To do this
It is advised to reduce the scaling percentage from Print Preview to fit more content onto each page.
If you have any feedback or enquiries on these documents, please contact us.
Life expectancy at birth and Healthy life expectancy at birth for each deprivation decile in England is now available in the data download.
Also available is a guide to the slope index of inequality method for PHOF overarching indicators and a link to the ONS data and briefing for A02c (local level healthy life expectancy slope index of inequality).
Slope index of inequality data for 2016 to 2018 onwards have been calculated using the Index of Multiple Deprivation 2019. A summary report and set of charts have been produced to assess the impact of using the Index of Multiple Deprivation 2019 rather than the Index of Multiple Deprivation 2015 for this time period:
Summary: impact of the change to IMD on slope index of inequality (HTML)
Charts: impact of the change to IMD on slope index of inequality (pdf)
Supporting indicators for the excess weight in adults (aged 18 and over) data in the PHOF are available. Breakdowns of local authority prevalence data by BMI category (underweight, healthy weight, overweight, obese, severe obesity and excess weight) are presented in an Excel spreadsheet: .
Trend data is available for small areas and health geographies on the prevalence of excess weight (overweight including obesity) in children from 2010 to 2011 to 2017 to 2018 and obesity from 2008 to 2009 to 2017 to 2018. Data from the National Child Measurement Programme (NCMP) is presented for Middle Super Output Areas, Electoral Wards, and Clinical Commissioning Groups (CCG).
The following links may be helpful for further information about the health of the population in your local area:
Public Health England data and analysis tools
This page provides links to all PHE data and analysis tools, including specific tools around child and maternal health, alcohol, tobacco, sexual and reproductive health, child obesity and end of life care.
Public Health Dashboard
The purpose of the dashboard is to support local decision making by bringing existing comparative data into one place and making it accessible and meaningful to a wide audience.
Local authority health profiles
The Local Authority Health Profiles provide an overview of health for each local authority in England. They pull together existing information in one place and contain data on a range of indicators for local populations, highlighting issues that can affect health in each locality.
Local Health
Local Health provides quality assured health information at small area level.
National General Practice Profiles
These profiles are designed to support GPs, clinical commissioning groups (CCGs) and local authorities to ensure that they are providing and commissioning effective and appropriate healthcare services for their local population.
Marmot indicators for Local Authorities in England
Fair Society, Healthy Lives: The Marmot Review report was published in February 2010, presenting the recommendations of the Strategic Review of Health Inequalities in England post 2010. The Marmot Indicators for local authorities were released, providing information to support monitoring of the overall strategic direction in reducing health inequalities.
NICE guidance summary for public health outcome domain
A summary of NICE guidance on nursing and midwifery, to underpin practice that will improve population health and wellbeing.
NHS Digital Indicator Portal
NHS Digital has responsibility for standardising, collecting and publishing data and information from across the health and social care system in England.
Ministry of Housing, Communities and Local Government Open Data
Linked Open Data from MHCLG
The LGBT Public Health Outcomes Framework Companion Document
The Lesbian, Gay, Bisexual and Trans Public Health Outcomes Framework Companion Document is a resource for all those commissioning and delivering healthcare services in order to support the delivery of an equitable public health system.
