The Wider Determinants of Health tool aims to provide the public health system with intelligence regarding the wider determinants of health to help improve population health and reduce health inequalities. The tool contains seven domains: the natural and built environment, work and the labour market, vulnerability, income, crime, education and the set of Marmot indicators. The Marmot indicators were developed by UCL’s Institute of Health Equity, in collaboration with Public Health England, several of which have been updated for this release. In addition, there is a health outcomes domain enabling a cursory look at how the wider determinants relate to health outcomes.
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.