A Department of Health programme is uniting local organisations to address key determinants of health, write Lucy Reynolds, Russell Collins and Sam Shah

Healthy Places, Healthy Lives is a Department of Health funded programme to develop a joint approach between public services that will address the social determinants of health. 

Each of the 30 sites has a marked gradient in certain health inequalities and each will focus on a local priority, such as alcohol related harm, infant mortality or teenage pregnancy.

The NHS Institute for Innovation and Improvement, Local Government Improvement and Development (formerly IDeA), and the Health Inequalities National Support Team support the programme, while external consultants offer hands-on support to each site.

External relationship managers provide a 12 month support package to enable sites to make significant progress in previously intractable areas. 

Initial support begins with an event to get local stakeholders to identify what major challenges they face and what the social determinants approach means for them.

The next step is to model the primary and secondary drivers of their chosen priority target using the NHS Institute’s driver diagram tool. On the ground interventions are then mapped to identify total commissioned activity against these drivers, gaps in service provision and areas of duplication. 

The six policy objectives identified by Sir Michael Marmot in his review of health inequalities (see box) are also applied as a framework to challenge local partnerships to consider the wider determinants of health inequality. 

Driver diagrams enable each site to identify the “causes of the cause” and to prioritise societal programmes that will impact on health outcomes.

A whole area approach is fundamental to reducing health inequalities, so sites are being supported to engage stakeholders from across local strategic partnerships, by identifying the social and economic benefits of reducing health inequalities. 

Outcome metrics are set nationally for each area, but these may take years to identify, so it is also important for sites to define output and process indicators, such as stronger partnership working or improved service data. For some sites, this process is a basis for developing local performance monitoring tools.

Healthy Places, Healthy Lives is the beginning of a new journey for commissioners across local authorities and the health service, as they work together to focus on social determinants. 

This has brought people in some organisations together for the first time. It provides a powerful tool for engaging cross-sector stakeholders and a way of assessing shared economic and social impacts.

Lucy Reynolds, Russell Collins and Sam Shah are consultants at Finnamore.

Marmot’s mission

The six policy objectives identified by Sir Michael Marmot’s review of inequalities

  • Give every child the best start in life
  • Enable all children, young people and adults to maximise their capabilities and have control over their lives
  • Create fair employment and good work for all
  • Ensure a healthy standard of living for all
  • Create and develop healthy and sustainable places and communities
  • Strengthen the role and impact of ill health prevention

Case studies

Kirklees identified primary and secondary drivers of infant mortality, including congenital abnormalities, risky personal behaviours and demographic risk factors. Opportunities for minimising these have been identified and cross-referenced against existing programmes to ensure activity is focused.

Thanet used the opportunity to address social determinants to reduce teenage pregnancy. The local authority and primary care trust are working to improve education, employment, access to health services, environment and housing. Implementing minimum social housing standards aims to provide better living conditions and lead to benefits such as a reduction in teenage pregnancy.

In Luton, the driver analysis helped engage partners from across the local strategic partnership. Together with the deputy director of public health, external consultants have attended partnership board events to introduce Healthy Places, Healthy Lives and the Marmot review and highlight the role that each of the partnership boards can play in reducing childhood obesity

Brighton is combining multiple, alcohol relevant action plans into one jointly owned, outcomes-focused delivery plan, to be managed by the alcohol strategic management board. Work is under way to identify performance measures and a platform for monitoring work carried out under the action plan. Both processes will be used to guide intelligent commissioning.