The wider determinants also known as the social determinants of health have been described as 'the causes of the causes'. They are the social, economic and environmental conditions that influence the health of individuals and populations. They include the conditions of daily life and the structural influences upon them. They determine the extent to which a person has the right physical, social and personal resources to achieve their goals, meet needs and deal with changes to their circumstances. These factors and their interaction are represented in the diagram below.
The control of these key factors that effect people health status are mainly located outside of the NHS. In order for the NHS to influence the causes of ill health public health seeks to work collaboratively with Tower Hamlets council and also other key members of the Tower Hamlets Partnership. Historically, one of the factors behind the formation of local government was the drive to improve the health of the local population. Disciplines such as town planning and environmental health were borne out of the realisation that to make a difference to peoples health action on people’s basic needs were required such as access to clean water and food, sanitary housing and safer workplaces. While many of the sanitary challenges of the 19th and early 20th centuries how now been met, health inequalities persist driven by the socio-economic inequalities in society.
Profile of wider determinants of health in Tower Hamlets
Tower Hamlets is the third most deprived local authority in England and the health impacts of this cannot be underestimated. Income, employment, education, housing quality, overcrowding and crime are powerfully associated with both physical and mental health. The socio-economic characteristics of Tower Hamlets are major factors explaining poorer health in the borough.
Tower Hamlets has among the highest rates of child poverty and unemployment in the country. Although children achieve results in line with national figures at Key stage 2, results lag behind the rest of the country by Key stage 3.
Tower Hamlets has the highest rates of overcrowding in London and 41.5% of the population live in socially-rented housing.
Crime rates are generally higher than the rest of the country and there are a particularly high number of domestic offences and drug-related arrests.
Our aims
-
Tackle health inequalities and inequalities in the social determinants of health.
-
Help to create healthy sustainable communities in Tower Hamlets.
-
To promote changes in society that will enable people to live healthy lives.
-
To promote wellbeing as opposed to a narrow definition of health.
-
Reduce substantially the mortality rates from major killers.
-
To make a significant contribution to ensuring delivery of the Tower Hamlets Partnership Local Area Agreement targets.
Our work areas
While the main levers for influencing lie outside of NHS Tower Hamlets, public health works with partners to promote better health for all. Current work activities include:
-
ensuring health and health inequalities is considered in a strategic documents such as the Housing Strategy and Local Development Framework,
-
undertaking the Healthy Spatial Planning project as part of the Healthy Borough Programme,
-
food security – working to ensure there is a access to healthy food across the borough and working with partners to address issues such as the proliferation of fast food outlets,
-
mental wellbeing – promote a better understanding of the relationship between poor mental wellbeing and the adoption of unhealthy behaviours, and
-
crime and social exclusion – promoting a better understanding of the role of rehabilitation of offenders and ex-offenders, along with addressing their underlying health needs, in reducing social exclusion.
