As the health and wellbeing boards get under way, The MJ has teamed up with researchers Local Futures to produce a comprehensive guide to how each English local authority is performing in tackling ill-health.

In the first of three articles, John Fisher looks at the determinants of ill health – economic, social, environmental – and assesses the different challenges faced in different parts of the country.

The latest figures show for the first time how all 324 local authorities are performing when it comes to tackling health inequalities in their areas.

Most health data focuses on health conditions, such as mortality rates and other factors that affect health outcomes.

But this new analysis looks also at the determinants of ill health, such as deprivation and housing conditions, assessing the scale of economic, social and environmental determinants within an area.

By comparing performance on the two measures, the research helps identify the extent to which local authority areas are performing, in outcome terms, above (or below) what would be expected, based on their determinants score.

An important context is the recommendations of the Marmot Review, which proposed an evidence-based strategy to reduce health inequalities that would address the wider social and economic determinants of poor health.

The Global Burden of Disease report also reaffirmed the important role of social determinants and recommended that a better understanding of determinants should be a priority for public health.

In this first MJ/Local Futures focus we examine some of the main determinants of ill-health at a local authority district level, with the summary findings presented here.

A large proportion of England’s high performing local authority areas on our overall Determinants Index are located within London’s wider hinterland.

Rural parts of the Midlands also perform well.

There are far fewer highly performing areas in the North of England, with only the main commuter belts of Leeds, Manchester and Preston recording high scores.

Lower performance is more prevalent in the North of England and especially within some of the major towns and cities, such as Nottingham, Stoke and Leicester.

Local authority areas across the M62 corridor perform poorly, as do parts of Tyneside and Teesside.

Some of England’s most peripheral areas – Cornwall, Lincolnshire, Norfolk and Durham also perform poorly on the Determinants Index.

This focus examines the determinants of ill health by breaking down the overall score into the three main types of determinants – economic, social and environmental.

Each of these is made up of a composite score consisting of five indicators that have been summed using an equal weighting and indexed to the national average.

Ranking the composite scores can then assess the performance of local authorities.

A higher ranking indicates better performance.

In terms of economic determinants, the Home Counties perform particularly well, along with parts of Hampshire, Oxfordshire, Warwickshire and Cambridgeshire.

With the exception of Kingston-upon-Thames, the entire top 10 is located in this area. There are a few clusters of high scoring areas further north, usually covering the commuter belts of major cities.

Parts of Norfolk perform poorly, with Great Yarmouth recording the lowest score in England.

However, overall it is the northern local authority areas that tend to perform least well.

The metropolitan belt between Liverpool and the Humber, including Knowsley and Hull in the bottom 10 list, scores poorly, as do Durham and Lincolnshire.

The ranked table for the social determinants shows the strength of the South of England.

High scores in the South East shires extend north and west, into Cambridgeshire, Hertfordshire, Oxfordshire and Dorset, to name four examples.

All of the top 10 ranked local authority areas are located in this area.

Hotspots of high scoring places are also evident in the areas surrounding the Midlands cities and in rural North Yorkshire.

Urban areas tend to score less well on our overall measure of social determinants. London performs poorly, with both Barking & Dagenham and Tower Hamlets featuring in the bottom ten list.

The Birmingham and Liverpool-Manchester metropolitan areas also do badly, along with other cities, such as Nottingham, Blackpool and Leicester.

In terms of environmental determinants the picture is more mixed.

Urban areas tend to score less well, as might be expected.

London performs very badly, with all ten of the bottom local authority areas coming from the capital.

Outside of London there are clusters of poor performance in and around Birmingham, Liverpool-Manchester, Newcastle-Sunderland and Sheffield-Leeds metropolitan areas.

High performance is evident in parts of Gloucestershire, Oxfordshire, Hampshire, Cambridgeshire and parts of East Anglia also do well.

Maldon and South Norfolk, for example, are in the top ten list.

Other areas of strong performance can be found further north in Cumbria and North Yorkshire, as well as large parts of rural East Midlands such as North Kesteven and Rushcliffe.

John Fisher is director of the Local Futures Group