The Marmot Review showed that poor health does not arise by chance and is not simply attributable to genetic make-up, unhealthy lifestyles and a lack of access to medical care, important as these factors are.

Differences in health reflect the differing social, environmental and economic conditions of local communities.

Source: Barton, H. and Grant, M. (2006) A health map for the local human habitat. The Journal for the Royal Society for the Promotion of Health, 126 (6). pp. 252-253. ISSN 1466-4240 developed from the model by Dahlgren and Whitehead, 1991.Dahlgren G, Whitehead M (1991). “The main determinants of health” model, version accessible in: Dahlgren G, and Whitehead M. (2007) European strategies for tackling social inequities in health: Levelling up Part 2. Copenhagen: WHO Regional Office for Europe.

The influence of these ‘wider determinants’ on health requires preventative policy interventions focused on the root causes of ill health. Tackling these conditions determining people’s health outcomes requires a ‘whole system approach’ and action well beyond the influence of the NHS and health services.

In developing Local Plans for each local authority area, planners take account of social, economic and environmental issues. The important link between how places are planned and developed and the health of the communities who live in them is increasingly recognised by planners. However the links between environment, health and health inequalities are not always explicitly and fully addressed in planning documents.

Public health professionals can assist planners to identify and prioritise which wider determinants of health to address, based on a consideration of local data on health outcomes and health inequalities (e.g. the JSNA and health and social care maps); and evidence of the impacts of different wider determinants on priority health issues. Some key issues and advice on how planners, health and sustainability could collaborate to address them are provided in the Joint working? section. An important example is the work initiated by Medway looking at the potential for creating a built environment that is conducive to preventing and reducing existing levels of obesity (see final report).

In ‘two-tier areas’ like Kent districts (with planning powers as well as economic development, housing and other responsibilities) are key stakeholders in improving the wider determinants of health. The District Councils Network with CIEH and RTPI has recently produced’guidance for how district councils can improve the health of the population‘ they are responsible for. The activity of district councils that will impact on the PHOF is summarised in the following two diagrams taken from this guidance: