Local authority levers to address wider determinants of health

Background and rationale.

There is substantial evidence of the effects of wider determinants (e.g. employment, environment, housing, education) on individuals' health and wellbeing and on population health inequalities.

Recently, there has been growing awareness of the role that local authorities (LAs) could play in addressing wider determinants of health (WDH); however, there is limited understanding of the specific policy levers that are and could be deployed, particularly at the LA level, and limited evidence of their effectiveness across different contexts and population subgroups.

In this study context, the inner London Boroughs of Islington and Camden (LBI/LBC), there are wide disparities within very small geographic footprints. Research questions.

Overall, this research asks: How can LAs most effectively influence wider determinants to reduce inequalities and improve the health and wellbeing of their residents?

Specifically, this project will investigate three interlinked sets of questions: What wider determinants drive resident wellbeing in urban England? How do different domains of their lives interact with one another and with what effects? How does this vary across different resident profiles? What is the role of the LA and other institutions in influencing these factors?

Which policy levers and institutions can influence one of the key drivers (identified through RQ1 e.g. social isolation, housing)? What are the effects of a specific, large LA programme intended to address this driver? Methods.

Respectively, each component will be addressed through: 1) a longitudinal qualitative study (n=48) of residents who at baseline report low, medium and high perceived wellbeing, matched on 3 demographic or geographic variables (e.g. gender, age/ethnic group, borough); 2) policy and stakeholder analysis; and 3) a process and mixed method outcome evaluation, together drawing on data from in-depth interviews, document and budget review, observation, focus group discussions and surveys.

Dissemination.

This study will produce written, oral and visual outputs, tailored to five key audiences: LBI/LBC decision-makers and practitioners, residents, other LAs, academics, and other external stakeholders in the health and social care system and with jurisdiction over wider determinant domains.

These outputs will include presentations at internal and external meetings and public health conferences, briefing notes, a policy matrix and infographic, an evaluation report and journal articles. Impact.

This research ultimately aims to reduce inequality gaps by contributing a person-centred, place-based investigation of LA policy levers and their effectiveness in addressing WDH.

By filling important gaps in the evidence base, this research will contribute to improved understanding among decision-makers, staff designing, delivering and evaluating WDH, and residents, which in turn will help to improve policies and programmes in order to enhance the environment in which people live, particularly for those most deprived.

This research is explicitly linked to the new Health Determinants Research Collaborations.

The research questions are scalable and would generate further insights through a future multi-site study across LAs working in different contexts.

In that sense, this study is laying the groundwork for an ambitious, new portfolio of empirical, conceptual, methodological and policy relevant research in line with recent NIHR investments.