Wider Determinants

Wider Determinant


In his review of health inequalities, one of Sir Michael Marmot’s key messages is that “Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health.”  The review identified six policy objectives which require action to reduce health inequalities.  These are:

  • 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 healthy standard of living for all;
  • Create and develop healthy and sustainable places and communities; and
  • Strengthen the role and impact of ill-health prevention.

The topics within this theme are important contributors to the social determinants of health.  This summary attempts to identify the most important issues contained within each topic and, from these, highlight those which are the most important for action in addressing health needs and inequalities in Stockton-on-Tees.

What are the most important messages from each topic?



  • Crime levels have reduced significantly in recent years.
  • Alcohol consumption is linked to violent offences, creates problems at weekends and in particular locations, and is associated with antisocial behaviour.
  • There is link between antisocial behaviour, crime and deprivation. There are 18 areas in Stockton-on-Tees that have been identified as particularly vulnerable.



  • Attainment at age 11 is similar to England, but by age 16 tends to be below England.
  • Secondary school absence is higher than England.
  • There are gaps in attainment for pupils from certain groups – particularly children with special needs; those eligible for free school meals; and boys.



  • Unemployment in Stockton-on-Tees is higher than England.  There are fewer than average jobs per working-age resident and higher than average number of unemployed people per vacancy.



  • Flooding remains a risk for 3,300 homes in Stockton-on-Tees.
  • There are over 70 additional deaths in the winter months in Stockton-on-Tees compared to the non-winter period.  Fuel poverty affects more that 20% of households and despite long-term energy efficiency improvements, a substantial number of properties still require improvement.



  • There are too many non-decent properties and Category 1 hazards that have a serious detrimental effect on the occupiers’ health and wellbeing.  Too many people live in fuel poverty.  This contributes towards seasonal excess deaths.
  • There is a risk of a lack of appropriate accommodation, including the supply of affordable homes, homes with disability adaptations and properties suitable for older people and people with learning disabilities to live independently.



  • There are between 15,000 and 22,000 people in Stockton-on-Tees who are not claiming benefits that they are entitled to.  Claiming a fraction of these benefits could be worth millions of pounds to the people and economy of Stockton-on-Tees.  A systematic approach to maximising rightful benefit uptake would help the most vulnerable and disadvantage people.
  • Over 9,000 children in Stockton-on-Tees are growing up in poverty and there are some areas where more children are in poverty than not.  The educational attainment of disadvantaged children is worse than that of other children, perpetuating a cycle of poverty.



  • Too many people are injured in road traffic collisions.  Children in the 10% most deprived areas in England are three times more likely to be pedestrian casualties than those in the least deprived areas.
  • Opportunities for physically active transport (walking and cycling) need to be maximised to help both physical and mental health.


What should be the highest priorities for commissioners? 

Short-term (1 to 2 years)

  • Tackling alcohol-related crime.  This would help relieve weekend pressures on A&E services, reduce domestic violence, and tackle location-based hotspots.
  • Develop a systematic approach to maximising benefits claimants, improving the lives of disadvantaged people and boosting the local economy.

Medium-term (3-5 years)

  • Ensuring school readiness of children and parents.
  • Improving the quality of housing in the private rented sector, including thermal efficiency.
  • Optimise opportunities for job creation for all, but with a focus on young people in Stockton-on-Tees.

Long-term (over 5 years)

  • Develop transport infrastructure to maximise physically active travel and minimise injury and death.
  • Create an environment which supports health and wellbeing.


Summary authors

Sarah Bowman
Consultant in Public Health
Stockton-on-Tees Borough Council

Leon Green
Public Health Intelligence Specialist
Tees Valley Public Health Shared Service


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