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 Redcar & Cleveland.

What are the most important messages from each topic?


  • Two thirds of offences are recorded as having been committed under the influence of alcohol and/or drugs.
  • Acquisitive crimes (other theft & burglary); antisocial behaviour and related crime/incidents; drugs and alcohol misuse; reducing offending and re-offending; and violence (domestic, sexual and alcohol-related) have been identified as priority problems which require addressing.


  • Achievement at secondary school is unsatisfactory.  Attainment at age 11 is similar to England, but by age 16 is below England.
  • Too many young people are not in education, employment or training.
  • There is a need to create a population that values education by understanding both the opportunities it can bring and the barriers presented by a lack of qualifications.


  • Unemployment is higher than the England average.  There are six wards with particularly high rates of unemployment: Grangetown, South Bank, Kirkleatham, Coatham, Newcomen and Dormanstown.  There is a need to increase the capacity of organisations working with residents to overcome barriers to employment, especially for these areas.
  • Graduate unemployment is a significant issue in Redcar & Cleveland.
  • Redcar & Cleveland’s economy has traditionally been dominated by a few large employers, especially in shipbuilding and heavy industry.  There is a need to diversify the economy, supporting a culture of enterprise and business creation.


  • There is a need to reduce emissions from industrial and commercial sectors.
  • Rising fuel costs, low household income and homes with poor energy efficiency lead to an increase in households in fuel poverty.


  • It is estimated that 12,400 households (20.9%) in Redcar & Cleveland are in fuel poverty.  On average there are an extra 60 deaths each year in winter months compared to other times of the year.
  • There is a lack of affordable housing and, with an ageing population, additional homes with care and support will be needed.


  • There are between 11,200 and 16,100 people in Redcar & Cleveland who are not claiming benefits that they are entitled to.  If all of these benefits were claimed, this could be worth between £17million and £27million to the people and economy of Redcar & Cleveland.  A systematic approach to maximising rightful benefit uptake would help the most vulnerable and disadvantage people.
  • The educational attainment of disadvantaged children is worse than that of other children, perpetuating a cycle of poverty.


  • The rural geography of some parts of Redcar & Cleveland leads to a risk of isolation among residents of those areas. Public sector cutbacks may lead to decreased bus services in the more rural areas limiting people’s access to employment in the early morning, may isolate some residents from public services and could affect mental health by limiting access to social opportunities in the evening..
  • 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)

  • Improve educational attainment at age 16 and reduce the number of young people who are not in education, employment or training.
  • 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.

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 author

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