The Public Health Outcomes Framework

The Public Health Outcomes Framework (PHOF) sets the context for local areas to decide what public health interventions they will make. It sets out two overarching outcomes:

  • increased healthy life expectancy; and
  • reduced differences in life expectancy within and between communities.

The framework has four domains with supporting indicators as shown below:

The influence of planning cuts across all four domains, as shown in the table below. Thus there is a clear need for public health to engage and collaborate with planning to share knowledge and expertise.

Public Health Outcomes Framework domains/indicators influenced by planning

Domain Indicators influenced by planning
Improving the wider determinants of health
  • Killed or seriously injured casualties on England’s roads
  • Utilisation of green space for exercise/health reasons
  • Fuel poverty
  • Older people’s perception of community safety
  • Social isolation (community cohesion can be affected both negatively with bypasses severing communities and positively with well planned communities)
  • Percentage of the population affected by noise
  • Employment related indicators
Health improvement
  • Excess weight in 4-5 and 10-11 year olds
  • Excess weight in adults
  • Recorded diabetes (through planning’s influence on excess weight)
  • Proportion of physically active and inactive adults
  • Self-reported wellbeing
Health protection
  • Air pollution
  • Public sector organisations with board-approved sustainable development management plan
Healthcare public health and preventing premature mortality
  • Mortality from respiratory diseases*
  • Mortality from all cardiovascular diseases (including heart disease and stroke)*
  • Mortality from causes considered preventable (active travel, air pollution)
  • Excess winter deaths (related to the quality of housing stock)

* The Public Health Outcomes Framework shares indicators with the NHS Outcomes Framework that planning can potentially influence such as under 75 mortality rate from cardiovascular disease; and under 75 mortality rate from respiratory disease.
Source: Based on Reuniting health with planning (TCPA, 2012; p.13)

The way in which planning can influence these domains and indicators is explored further in the How and Joint Working sections.

The PHOF was specifically designed so it would reflect the wider determinants of health such as poverty, education, housing, employment, crime and pollution. All planners would recognise these issues as being under the influence of planning. By working with planners health professionals can have a much greater influence on these wider determinants.

The importance of these wider determinants is reflected in a recent report by Public Health England that covers just one element of one of the determinants listed above. The report estimates that 5.6% of the deaths in Kent can be attributable to concentrations of anthropogenic particulate matter.

The Social Care Outcomes Framework

Planning also has an influence on social care domains and outcomes as highlighted in the table below; a key opportunity is likely to be in delaying/reducing the need for social care services by increasing physical/social activity in the elderly.

Social Care Outcomes Framework domains/outcomes influenced by planning

Domain Outcomes influenced by planning
Enhancing quality of life for people with care and support needs
  • People are able to find employment when they want, maintain a family and social life and contribute to community life, and avoid loneliness or isolation.
Delaying and reducing the need for care and support
  • When people develop care needs, the support they receive takes place in the most appropriate setting, and enables them to regain their independence.
  • Everyone enjoys physical safety and feels secure
Safeguarding adults whose circumstances make them vulnerable and protecting from avoidable harm
  • People are protected as far as possible from avoidable harm, disease and injuries.
  • People are supported to plan ahead and have the freedom to manage risks the way that they wish.
Source: Sustainable needs assessment chapter of Kent JSNA.