Wider Determinants

Why the wider determinants of health are important

Wider determinants, also known as social determinants, are a diverse range of social, economic and environmental factors that 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 Public Health England’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 of drugs highlighted the huge economic costs of failing to act on the wider determinants of health.

The Wider Determinants of Health

Detailed below are the wider determinants of health for which the local authority currently has data. This will be added to over time with in-depth analysis and more determinants.

Deprivation

Deprivation is an over-arching term that is defined as the damaging lack of material benefits considered to be basic necessities. As such it includes a number of the wider determinants of health and is therefore important in defining the needs of a particular area or community. Throughout this JSNA, data is presented comparing the situation in Bedford Borough with authorities from the same deprivation decile. This helps to identify where deprivation is and is not driving a particular indicator.

To understand how deprivation varies across the country, an Index of Multiple Deprivation (IMD) was created. The IMD identifies levels of deprivation at local authority and ward level and it brings together 39 indicators grouped into the following seven domains of deprivation:

• Income
• Employment
• Education, Skills and Training
• Health and disability
• Crime
• Housing and services
• Living environment

The most recent IMD was published in 2019 and it identified that Bedford Borough ranked 96 out of 151 local authorities measured, putting it in the fourth least deprived decile. This means 60% of local authority areas are more deprived than Bedford Borough. However, this does not tell the full story on deprivation in Bedford Borough as four of its wards – Castle, Cauldwell, Hapur and Castle include areas that are among the country’s 10% most deprived.

Compared to the 2015 IMD, the number of LSOAs in the most deprived 20% nationally has remained at 14, whilst the number in the most deprived 10% has fallen from 5 to 4. Therefore, Bedford Borough can be rated as marginally less deprived in 2019 than in 2015, However, this masks increasing deprivation in some areas.

For a more detail on deprivation in Bedford, download the IMD reports below.