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 Hartlepool.

What are the most important messages from each topic?


  • Crimes committed for financial gain including burglary, robbery and all theft offences continue to be prominent in Hartlepool.
  • Nationally, alcohol consumption is linked to 44% of violent offences, creates problems at weekends and in particular locations, and is associated with antisocial behaviour.
  • There is an association between levels of crime and deprivation.  Crime rates in the most affluent wards are less than half of those in the most deprived wards.


  • Educational attainment rates at Key Stage 1 (aged 7 years) and at GCSE level are below England.
  • Not enough schools are judged by OFSTED to be ‘Good’ or ‘Outstanding’.


  • There is a high rate of worklessness in Hartlepool, fewer than average jobs per working-age resident and higher than average number of unemployed people per vacancy.
  • Unemployment varies between wards, with the highest rates occurring in Manor House and Victoria wards.


  • Hartlepool’s environment needs to be improved in terms of tackling derelict land and buildings; making streets safer, cleaner and greener; and developing, maintaining and improving green spaces.
  • Tackle climate change and maintain sea defences.
  • Hartlepool has 6,900 dwellings (21.2%) which contain households in fuel poverty.


  • There will be a 50% rise in the proportion of residents aged 75 by 2028, with increased demand for suitable housing.
  • About one-third of homes in Hartlepool is classed as non-decent.
  • There are estimated to be 6,900 (21.2%) households in fuel poverty within Hartlepool.


  • There are between 7,500 and 10,500 people in Hartlepool 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 Hartlepool.  A systematic approach to maximising rightful benefit uptake would help the most vulnerable and disadvantage people.
  • Over 6,000 children in Hartlepool are growing up in poverty and there are many areas where more children are in poverty than not.  Children eligible for free school meals have worse educational outcomes than their peers.


  • 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) in the relatively compact town of Hartlepool need to be maximised to help both physical and mental health.
  • Availability of public transport limits some people’s access to employment in the early morning and may isolate some residents from public services and could affect mental health by limiting access to social opportunities in the evening.

What should be the highest priorities for commissioners?

Short-term (1 to 2 years)

  • Tackle 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)

  • Ensure school readiness of children and parents.
  • Improve 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 Hartlepool.

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

Carole Johnson
Head of Health Improvement
Hartlepool Borough Council

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