assignment 6 social health

Teaching Pack Materials (8)

Lesson Plan (4)

Lesson Material (1)

Bibliography (1)

Glossary (1)

Instructor Note (1)

Publication (8)

High-School Teachers (7)

Digital/Media Literacy (1)

Data/Visualization (3)

Critical Thinking (8)

Global Learning (2)

This teaching pack was developed by the Global Health Education and Learning Incubator at Harvard University to introduce high school and undergraduate college students to the “social determinants of health,” which are all of the social factors external to an individual that may not seem directly relevant to health, but that ultimately shape the conditions in which people live, work, and grow in ways that can both promote well-being and confer disease risk. The teaching…

Teaching Pack: Lessons

This teaching pack introduces the social determinants of health through real-world examples in order to understand how broad social factors influence global health challenges. It includes an instructor’s note, a brief guide for educators, lesson plans, an annotated bibliography, and a glossary of terms.

This two-page Instructor’s Note introduces the materials and learning objectives for a teaching pack on …

This two-page Instructor’s Note introduces the materials and learning objectives for a teaching pack on the social determinants of health, developed by the Global Health Education and Learning Incubator at Harvard University. “Social determinants of health” are the social factors external to an individual that may not seem directly relevant to health, but that ultimately shape the conditions in which people live, work, and grow in ways that can both promote well-being and confer disease…

This teaching guide is part of a teaching pack, developed by the Global Health Education …

This teaching guide is part of a teaching pack, developed by the Global Health Education and Learning Incubator at Harvard University, that introduces high school and undergraduate college students to the “social determinants of health,” which are the social factors external to an individual that may not seem directly relevant to health, but that ultimately shape the conditions in which people live, work, and grow in ways that can both promote well-being and confer disease…

This lesson plan is the first of four lessons in a teaching pack on the …

This lesson plan is the first of four lessons in a teaching pack on the social determinants of health developed by the Global Health Education and Learning Incubator at Harvard University. “Social determinants of health” (SDH) are the social factors external to an individual that may not seem directly relevant to health, but that ultimately shape the conditions in which people live, work, and grow in ways that can both promote well-being and confer disease…

This lesson plan is the second of four lessons in a teaching pack on the …

This lesson plan is the second of four lessons in a teaching pack on the social determinants of health developed by the Global Health Education and Learning Incubator at Harvard University. “Social determinants of health” (SDH) are the social factors external to an individual that may not seem directly relevant to health, but that ultimately shape the conditions in which people live, work, and grow in ways that can both promote well-being and confer disease…

This lesson plan is the third of four lessons in a teaching pack on the …

This lesson plan is the third of four lessons in a teaching pack on the social determinants of health developed by the Global Health Education and Learning Incubator at Harvard University. “Social determinants of health” (SDH) are the social factors external to an individual that may not seem directly relevant to health, but that ultimately shape the conditions in which people live, work, and grow in ways that can both promote well-being and confer disease…

This lesson plan is the fourth of four lessons in a teaching pack on the …

This lesson plan is the fourth of four lessons in a teaching pack on the social determinants of health developed by the Global Health Education and Learning Incubator at Harvard University. “Social determinants of health” (SDH) are the social factors external to an individual that may not seem directly relevant to health, but that ultimately shape the conditions in which people live, work, and grow in ways that can both promote well-being and confer disease…

This annotated bibliography, curated by the Global Health Education and Learning Incubator at Harvard University, …

This annotated bibliography, curated by the Global Health Education and Learning Incubator at Harvard University, provides a selective sampling of resources designed to introduce high school and undergraduate students to the basic concepts of the social determinants of health. “Social determinants of health” (SDH) are the social factors external to an individual that may not seem directly relevant to health, but that ultimately shape the conditions in which people live, work, and grow in ways…

This glossary, curated by the Global Health Education and Learning Incubator at Harvard University, provides …

This glossary, curated by the Global Health Education and Learning Incubator at Harvard University, provides a selection of common terms and definitions designed to accompany a teaching pack on the social determinants of health. Social determinants of health” are the social factors external to an individual that may not seem directly relevant to health, but that ultimately shape the conditions in which people live, work, and grow in ways that can both promote well-being and…

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Social Determinants of Health

• Social determinants of health (SDOH) are non-medical factors affecting health, like socioeconomic status, and geographic location.
• Addressing SDOH can enhance health and lead to better outcomes.

Social determinants of health (SDOH) are non-medical factors that affect health outcomes. They include the conditions in which people are born, grow, work, live, and age. SDOH also include the broader forces and systems that shape everyday life conditions.

These forces and systems encompass economic policies, development agendas, social norms, social policies, racism, climate change, and political structures. CDC adapted this definition from the WHO 2022 definition of SDOH. Healthy People 2030 highlights SDOH in its key health indicators.

How SDOH Impacts Lives

A better understanding of incorporating SDOH into public health work and the 10 Essential Public Health Services strengthens public health capacity. Health equity ensures everyone has a fair chance to achieve optimal health. Along with the powerlessness that can arise from poverty and discrimination, limited access to the following can also occur:

• Quality jobs
• Safe environments

To advance health equity, SDOH factors, such as those above, should be addressed.

The following are a few ways in which the CDC's National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce (Public Health Infrastructure Center) integrates SDOH into its activities.

Pathways to Population Health Equity

Pathways to Population Health Equity (P2PHE) provides tools for public health leaders to enhance population health, well-being, and equity. P2PHE includes a framework, roadmaps, compass, and various tools to help public health practitioners develop more prepared, resilient, and proactive systems. These tools and framework are adaptable to address the most pressing issues in any jurisdiction.

Community health assessment and improvement planning

CDC collaborates with various partners to offer technical support, resources, and training. This helps health departments and community partners in assessment and planning. For instance, the Public Health Infrastructure Center partners with the National Association of County and City Health Officials to promote the Mobilizing for Action through Planning and Partnerships (MAPP) planning framework. This framework integrates health equity in its guidance and practice.

Health department, hospitals, and others use certain tools and requirements to drive planning for community health assessment and health improvement. These tools and requirements emphasize data on health inequities, SDOH, and structural determinants of health in state and community planning efforts.

These collaborative processes involve diverse populations and multi-sector partners across jurisdictions. This results in plans that identify priorities and strategies to tackle health disparities.

Innovative funding strategies to support SDOH efforts

The Public Health Infrastructure Center works with partner organizations to explore health department use of innovative financing strategies . These strategies can be opportunities to address SDOH. Examples from partners include case stories about the following:

• Braiding and layering funds to address housing and food insecurity .
• Use of participatory budgeting to ensure community-driven funding decisions .

COVID-19 health equity grant

The National Initiative to Address COVID-19 Health Disparities Among Populations at High-Risk and Underserved, Including Racial and Ethnic Minority Populations and Rural Communities is a $2.5 billion grant supporting 108 state, territorial, local, and tribal health departments. It aims to reduce COVID-19 health disparities and promote health equity by enhancing capacity and services of the following health departments:

• US territorial
• Freely associated state

One key strategy is to engage partners and collaborators to advance health equity and address SDOH related to COVID-19's effect on higher-risk and underserved groups.

Public health accreditation

The CDC backs the national accreditation program , managed by the Public Health Accreditation Board (PHAB). The national standards, which are central to the accreditation program, emphasize health equity and SDOH across various requirements. This includes community health assessment, health improvement planning, health promotion, policy development, and internal training. Health departments are striving to meet these standards. Evidence from evaluation studies and accredited sites indicates that in doing so, they are enhancing multi-sectoral partnerships and adopting practices like:

• Formulating health equity policies.
• Setting up agency-wide health equity councils.

Public Health Gateway

CDC's National Center for State, Tribal, Local, and Territorial Public Health Infrastructure and Workforce helps drive public health forward and helps HDs deliver services to communities.

Social Determinants of Health

What are social determinants of health.

Social determinants of health (SDOH) are the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a wide range of health, functioning, and quality-of-life outcomes and risks.

SDOH can be grouped into 5 domains:

Suggested citation

Healthy People 2030, U.S. Department of Health and Human Services, Office of Disease Prevention and Health Promotion. Retrieved [date graphic was accessed], from https://health.gov/healthypeople/objectives-and-data/social-determinants-health

Social determinants of health (SDOH) have a major impact on people’s health, well-being, and quality of life. Examples of SDOH include:

• Safe housing, transportation, and neighborhoods
• Racism, discrimination, and violence
• Education, job opportunities, and income
• Access to nutritious foods and physical activity opportunities
• Polluted air and water
• Language and literacy skills

SDOH also contribute to wide health disparities and inequities. For example, people who don't have access to grocery stores with healthy foods are less likely to have good nutrition. That raises their risk of health conditions like heart disease, diabetes, and obesity — and even lowers life expectancy relative to people who do have access to healthy foods.

Just promoting healthy choices won't eliminate these and other health disparities. Instead, public health organizations and their partners in sectors like education, transportation, and housing need to take action to improve the conditions in people's environments. 

That's why Healthy People 2030 has an increased and overarching focus on SDOH.

How Does Healthy People 2030 Address SDOH?

One of Healthy People 2030’s 5 overarching goals is specifically related to SDOH: “Create social, physical, and economic environments that promote attaining the full potential for health and well-being for all.”

In line with this goal, Healthy People 2030 features many objectives related to SDOH. These objectives highlight the importance of "upstream" factors — usually unrelated to health care delivery — in improving health and reducing health disparities.

More than a dozen workgroups made up of subject matter experts with different backgrounds and areas of expertise developed these objectives. One of these groups, the Social Determinants of Health Workgroup , focuses solely on SDOH.

Explore Research Related to SDOH

Social determinants of health affect nearly everyone in one way or another. Our literature summaries provide a snapshot of the latest research related to specific SDOH.

View SDOH Infographics

Each SDOH infographic represents a single example from each of the 5 domains of the social determinants of health. You can download them, print them, and share them with your networks.

Learn How SDOH Affect Older Adults

SDOH have a big impact on our chances of staying healthy as we age. Healthy People’s actionable scenarios highlight ways professionals can support older adults’ health and well-being.

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• Public Health England

Chapter 6: social determinants of health

Published 13 July 2017

© Crown copyright 2017

This publication is licensed under the terms of the Open Government Licence v3.0 except where otherwise stated. To view this licence, visit nationalarchives.gov.uk/doc/open-government-licence/version/3 or write to the Information Policy Team, The National Archives, Kew, London TW9 4DU, or email: [email protected] .

Where we have identified any third party copyright information you will need to obtain permission from the copyright holders concerned.

This publication is available at https://www.gov.uk/government/publications/health-profile-for-england/chapter-6-social-determinants-of-health

1. Main messages

The broad social and economic circumstances that together influence health throughout the life course are known as the ‘social determinants of health’. There is a social gradient across many of these determinants that contribute to health with poorer individuals experiencing worse health outcomes than people who are better off.

Children growing up in more deprived areas often suffer disadvantages throughout their lives, from educational attainment through to employment prospects, which in turn affect physical and mental wellbeing. Although the percentages of children not ready for school, and young people not in education, employment or training ( NEET ) have both fallen in recent years, inequalities remain.

In the academic year 2015 to 2016, just under a third of those who were not eligible for free school meals were not ready for school at age 5, compared with almost half of children who were eligible and 1 in 20 young people living in deprived areas were NEET compared to 1 in 33 living in the least deprived areas.

Income and work are 2 of the most important determinants of health and wellbeing. Unemployment has been falling in England, down to 5.1% in 2015, but this proportion increases to 8.4% for people living in the most deprived areas, more than double that of people in the least deprived areas (3.4%). The quality of available work can also play a part in health outcomes both physically and mentally.

A healthy standard of living such as adequate income and housing is associated with many positive health outcomes. In the financial year 2014 to 2015, just under a third (30.2%) of individuals lived in households with an income below the minimum income standard and this was higher amongst children (45.7%) and children in lone parent families (74.5%).

2. Introduction

Chapter 5 presents a summary of health inequalities in England and shows that life expectancy is lowest in the most deprived areas, around 9 years shorter for males and 7 years shorter for females compared to those in the least deprived areas. These inequalities in population health are an example of the social gradient in health. The lower an individual’s social position the poorer an individual’s health is likely to be [footnote 1] . A regional divide is also evident with health outcomes generally worse and the social gradient in health steeper in northern regions compared to the south of England [footnote 1] , [footnote 2] .

Chapter 5 also shows that behavioural risk factors, such as smoking and a diet low in fruit and vegetables, are higher in more deprived areas. The drivers of these health and behavioural inequalities are reviewed in this chapter.

Health inequalities are underpinned by the conditions in which people are born, grow, live, work and age. The broad social and economic circumstances which together influence the quality of the health of the population are known as the ‘social determinants of health’ [footnote 1] (figure 1). The mechanisms by which these social determinants impact on both mental and physical health are complex and inter-related, often acting over a long period of time [footnote 1] .

2.1 Figure 1: the Dahlgren and Whitehead model of health determinants

The broad social and economic circumstances that together determine the quality of the health of the population are known as the ‘social determinants of health’.

Source: Dahlgren and Whitehead (1991)

This shows:

• personal characteristics occupy the core of the model and include sex, age, ethnic group, and hereditary factors
• individual ‘lifestyle’ factors include behaviours such as smoking, alcohol use, and physical activity
• social and community networks include family and wider social circles
• living and working conditions include access and opportunities in relation to jobs, housing, education and welfare services
• general socioeconomic, cultural and environmental conditions include factors such as disposable income, taxation, and availability of work

The Marmot Review ‘Fair Society, Healthy Lives’ [footnote 1] states that action on health inequalities requires action across all of the social determinants of health. This chapter presents indicators of social determinants that influence health across the life course drawn from various (Public Health England) PHE tools. They reflect the priority areas for action identified in the Marmot Review.

3. Child development and educational attainment

Educational attainment is strongly linked with health behaviours and outcomes. More educated individuals are less likely to suffer from long-term diseases and to report themselves in poor health, or suffer from mental disorders such as depression or anxiety [footnote 3] . It is one of the key milestones for wellbeing through the life course and can impact on many outcomes in later life including, quality of work, future earnings, involvement in crime, morbidity, and death [footnote 4] .

Children are assessed for their ‘school-readiness’ upon completion of the Reception Year in school, at around 5 years of age. To achieve a ‘good level of development’ a child should have reached the expected level in early learning goals around communication and language, physical development, and personal, social and emotional development. For example paying attention, listening to stories, using the toilet, dressing themselves, and they should have started to read, write and do simple sums [footnote 5] .

The rate of school readiness has improved in recent years from just under a half of children in the academic year 2012 to 2013 (48.3%) not achieving a good level of development, to just under a third of all children (30.7%) in 2015 to 2016. However, reporting changes may account for the improvements seen between 2012 to 2013 and 2015 to 2016.

The rate of school readiness differs across the social gradient. From 2015 to 2016, 14.0% of children in England were eligible to receive free school meals (a proxy for low household income). Of these children, 45.6% did not reach a good level of development compared with 28.3% of children not eligible for free school meals (figure 2).

3.1 Figure 2: percentage of children who are not achieving a good level of development at the end of Reception Year (age 5) by free school meal status, England, 2012 to 2013 up to 2015 to 2016

Almost half of children eligible to receive free school meals do not achieve a good level of development by age 5 compared to under a third of children not eligible for free school meals.

Source: Public Health Outcomes Framework: Health Equity Report

Note: this is the inverse of the Marmot indicator on school readiness and the population of school children not eligible for free school meals has been calculated for comparison.

• the rate of school readiness has improved in recent years, but around a third (30.7%) of all children did not reach a good level of development in 2015 to 2016
• 14% of children in England were eligible for free school meals (a proxy for low household income); Children eligible for receiving free school meals were significantly less likely to reach a good level of development than children not eligible for free school meals, with an attainment gap of 17 percentage points between the 2 groups. However, this gap has reduced from 19 percentage points in 2012 to 2013

See how your area compares.

Other disadvantaged groups also face challenges in development and educational attainment that can lead to poorer health outcomes in later life. Children with special educational needs, those whose first language is not English and children from the Gypsy, Roma community and travellers of Irish heritage have some of the lowest proportions of children achieving a good level of development [footnote 6] , [footnote 7] .

Further challenges exist for children in care who often have multiple risk factors inhibiting educational attainment. A higher proportion of children in care have special educational needs and poorer emotional and behavioural health [footnote 8] , again impacting on educational attainment, and in turn health outcomes in later life. In addition, pupils in deprived areas are more likely to miss school and therefore have lower levels of educational attainment [footnote 9] .

GCSE examinations assess school children in Year 11. For pupils leaving education, GCSEs will determine the kind of work they will be offered, while for pupils continuing in education, results will determine the courses open to them at the next level.

A total of 14% of children were eligible for free school meals in the academic year 2014 to 2015. Only a third (33.1%) achieved 5 good GCSEs (including maths and English), while nearly twice as many (60.9%) pupils not eligible for free school meals attained this level (figure 3). There has been little change in the size of the attainment gap between these 2 groups of children in recent years.

3.2 Figure 3: the proportion of pupils (aged 15 to 16 years) achieving 5 or more GCSEs of grade A* to C or equivalent including English and maths, by free school meal status. England, 2009 to 2010 up to 2014 to 2015

Only a third of children eligible for free school meals do well at gcse compared to almost two-thirds of pupils who are not eligible to receive free school meals.

• 14% of children were eligible for free school meals in 2014 to 2015
• only a third (33.1%) of children eligible for free school meals achieved 5 good GCSEs including maths and English in 2014 to 2015, while nearly twice as many pupils not eligible for free school meals attained this level (60.9%)
• there has been little change in the size of the attainment gap between these 2 groups of children since 2009 to 2010

See the full data source: Department for Education: Revised GCSE and equivalent results in England: 2014 to 2015

4. Employment

Employment is one of the most important determinants of physical and mental health; the long-term unemployed have a lower life expectancy and worse health than those in work [footnote 10] . The effect of unemployment does not just affect individuals. Children growing up in workless households are almost twice as likely to fail at all stages of education compared with children growing up in working families [footnote 11] .

Young people who are NEET are considered to be at greater risk of poor physical and mental health, being unemployed, and having low quality and low wage work in later life [footnote 12] .

Over the past 4 years, there has been a steady decline in the proportion of young people in England who are NEET . This is due in part to legislation introduced in 2013 that required all young people to remain in some form of education or training until the end of the academic year in which they turned 17, a threshold that rose to age 18 in 2015.

Across the whole of England in 2015, 4.2% of 16 to 18-year-olds were NEET , which is down from 6.1% in 2011 before the changes in legislation (figure 4). However, there are still inequalities between different groups of the population, with the proportion of NEETs living in the most deprived areas at 5.1% compared to 3.0% in the least deprived areas and little change in the absolute gap over time (figure 4).

When analysis is focused on the 19 to 24 year age group to account for the age changes in compulsory education, the proportion of young adults who were NEET in 2016 was higher at 13.4%, but the overall trend showed a continuing decline from 2012 (16.4%) [footnote 13] . Deprivation data was unavailable for the 19 to 24 year age group.

4.1 Figure 4: the percentage of 16 to 18-year-olds who are NEET by deprivation decile, England, 2011 to 2015

In the most deprived areas 1 in 20 young people are neet , compared with 1 in 33 young people living in the least deprived areas.

Source: Public Health Outcomes Framework

IMD 2015 deprivation deciles are based on upper tier local authority deciles [footnote 14] .

Missing points for decile level data in 2012 and 2014.

• over the last 4 years there has been a steady decline in the proportion of young people in England who are NEET ; This is due in part to legislation introduced in 2013 that required all young people to remain in some form of education or training until the end of the academic year in which they turned 17, a threshold that rose to age 18 in 2015
• the proportion of young people who were NEET was significantly higher in the most deprived areas. In 2015, 5.1% of young people aged 16 to 18 years in the most deprived local authorities were NEET , compared to just 3.0% in the least deprived local authorities

Unemployment has been falling in England, down to 5.1% in 2015, but this proportion increases to 8.4% for people living in the most deprived areas, more than double that of people in the least deprived areas (3.4%) (figure 5).

4.2 Figure 5: unemployment rate in persons (16+ years) by deprivation decile, England, 2013 to 2015

Unemployment in the most deprived areas is more than double that of the least deprived areas.

Source: Wider Determinants of Health Profile

Note: IMD 2015 deprivation deciles are based on district/unitary authority deciles [footnote 14] .

• there is a clear social gradient in unemployment
• in 2015, unemployment in the most deprived local authorities was more than double that of the least deprived local authorities
• the gap between unemployment in the most and least deprived decile has decreased from 7.5 percentage points in 2013 to 5.1 percentage points in 2015

While being in good quality employment can be good for physical and mental health, certain aspects of jobs or features of work can be detrimental.

The Marmot Review sets out 10 key components of good work that protect and promote good health. Examples of these include: having a safe working environment with good job security; individuals having a degree of control through decision-making on working patterns; appropriately challenging work; promoting a sense of belonging and meaningfulness; having the ability to participate in organisational decision making; and preventing social isolation. Lack of control and lack of reward at work are crucial determinants of several stress-related disorders and these are more prevalent among lower occupational status groups [footnote 1] .

Self-reported work-related illness has been falling gradually in England over the last decade from 4,290 per 100,000 employees in the financial year 2012 to 2013 to 3,990 employees per 100,000 in 2014 to 2015 [footnote 16] .

Around 80% of self-reported work-related conditions in 2015 to 2016 were musculoskeletal and mental health disorders such as stress, depression and anxiety [footnote 17] . As outlined in chapters 3 and 4, these disease groups are major contributors to the total burden of morbidity across England and EU countries.

5. Living standards

There is a strong association between income and health, with many health outcomes improving incrementally as income rises. Income can affect many aspects of health and in turn, have a knock-on effect on other social determinants. For example, a parent’s income may influence a child’s early development and educational opportunities, which in turn can affect a child’s employment opportunities and their income [footnote 18] .

The minimum income standard is defined as a ‘minimum acceptable standard of living’, based on what members of the public think is enough money to live on. The proportion of the population in England not reaching the minimum income standard has risen from 25.7% in the financial year 2008 to 2009 to 30.2% in 2014 to 2015, and the figure rises to 45.7% among children. For children in lone parent families in Britain, the figure is 74.5% [footnote 19] .

Poor housing conditions are associated with a number of health problems, including respiratory infections, asthma and poor mental health [footnote 20] , [footnote 21] . In 2013, a fifth of dwellings (21%, 4.8 million homes) failed to meet the decent homes standard [footnote 22] , which is a reduction of 2.9 million homes since 2006 when around a third of homes (35%, 7.7 million) failed to meet the standard [footnote 23] .

Significant expansion of the private rented sector in the last 20 years (from 10% to 19%), has provided an additional 2.5 million homes. However, this sector had the highest proportion of non-decent homes. The social rented sector had the lowest proportion of non-decent homes (15%) and almost a fifth (19%) of owner-occupied homes failed to meet the standard. Conditions in the private rented sector are still behind, but the situation has been an improving trend, falling from 47% of non-decent homes in 2006 to 28% in 2014. More families with children are using the private sector where homes are less likely to meet the decent homes standard.

With the shortage of housing in the social rented sector, due in part because of a lack of affordable housing [footnote 24] , more low-income families are relying on private sector accommodation, where homes are less likely to be affordable and meet the decent homes standard.

Fuel poverty is the condition of being unable to afford to keep one’s home adequately heated for comfort, and this is one of the factors associated with a reduced quality of health [footnote 25] . In England, 10.6% of households were fuel poor in 2014 (figure 6). However, a social gradient in fuel poverty exists where those on lower household incomes are more likely to be at risk of fuel poverty, contributing to social and health inequalities [footnote 26] .

In 2014, 12.6% of households living in the most deprived local authorities were living in fuel poverty, compared to just 7.6% of households in the least deprived local authorities. Households living on low income are more likely to live at lower temperatures [footnote 27] , which is linked to a range of negative health outcomes [footnote 28] , contributing to excess winter deaths across England and morbidity from cardiovascular and respiratory disease [footnote 25] . More information on excess winter deaths is presented in chapter 7.

5.1 Figure 6: the proportion of households living in fuel poverty by deprivation decile, England, 2014

Just over 1 in 10 households are in fuel poverty in england, equating to almost 2.4 million households.

• in England, 10.6% of households were fuel poor in 2014. This increases to 12.6% of households in the most deprived local authorities and reduces to 7.6% of those in the least deprived local authorities
• the proportion of households experiencing fuel poverty in the most deprived areas was significantly higher than those in the least deprived areas

6. Sustainable communities and places

There is strong evidence to suggest that access to green spaces has a beneficial impact on physical and mental wellbeing through both physical access and use [footnote 29] . Access to green space is unequally distributed across the social gradient, with poorer communities generally having less access [footnote 30] .

In England, the proportion of people who used outdoor space in a given week for health or exercise increased from 14.9% in March 2012 to February 2013 to 17.9% in 2014 to 2015 (figure 7). While it is positive to note an increase, this still means that less than 1 in 5 people regularly use outdoor space for health or exercise. This indicator measures health behaviour, which is not a social determinent, but provides useful information about the use of outdoor space [footnote 31] .

6.1 Figure 7: the proportion of people (aged 16+ years) using outdoor space for exercise/health reasons, England, 2011 to 2012 up to 2015 to 2016

18% of people use outdoor space for health or exercise.

• the proportion of people in England using outdoor space for exercise and health reasons has significantly increased from 14% in 2011 to 2012 to almost 18% in 2015 to 2016

7. Further information

PHE has a statutory duty to have due regard to reducing health inequalities within England (Health and Social Care Act 2012), and like other public sector organisations, to promote equality (Equality Act 2010).

PHE ’s Health Equity Board has selected 18 indicators to help monitor how these duties are met, and this forms the PHE Health Equity Dashboard. The indicators are all drawn from the Public Health Outcomes Framework and are divided into 3 groups:

• core, overarching health outcomes
• PHE priority areas
• social determinants of health

More information can be found in the report ‘Public Health Outcomes Framework: Health Equity Report. Focus on Ethnicity’ [footnote 7] .

Download data

8. References

The Marmot Review Team. (2010) The Marmot Review: Fair Society, Healthy Lives.   ↩   ↩ 2   ↩ 3   ↩ 4   ↩ 5   ↩ 6

Ellis A, Fry R, Office for National Statistics. (2010) Regional health inequalities in England. Regional Trends 42: 60. Accessed 14 June 2017.  ↩

Cutler DM, Lleras-Muney A. (2006) Education and health: evaluating theories and evidence. National Bureau of Economic Research: Cambridge, MA. Working paper 12352.   ↩

PHE . (2015) Public Health Matters: Ensuring all children have the best start in life. Accessed 14 June 2017.  ↩

Department for Education. (2017) Statutory framework for the early years foundation stage. Setting the standards for learning, development and care for children from birth to five. Accessed 14 June 2017.  ↩

Department for Education. (2016) Early years foundation stage profile results: 2015 to 2016. Accessed 14 June 2017.  ↩

Public Health Outcomes Framework: Health Equity Report. Focus on Ethnicity .  ↩   ↩ 2

Department for Education. (2013) Outcomes for Children Looked after by Local Authorities in England, as at 31 March 2013. Accessed 14 June 2017.  ↩

Department for Education. (2011) New data highlights true picture of school absence. Accessed 14 June 2017.  ↩

Bartley M, Ferrie J, Montgomery SM. (2005) Chapter 5: Health and labour market disadvantage: unemployment, non-employment and job insecurity. Social Determinants of Health 2nd Edition. Oxford University Press: Oxford.  ↩

Department for Work and Pensions. (2017) Improving Lives, Helping Workless Families. Accessed 14 June 2017.  ↩

Public Health England and the Institute of Health Equity. (2014) Reducing the number of young people not in employment, education or training. Accessed 14 June 2017.  ↩

PHE . (2017) Wider Determinants of Health in 19 to 24-year-olds not in education, employment or training. Accessed 14 June 2017.  ↩

The IMD is a measure of relative deprivation for small areas. Deciles are calculated by ranking local authorities’ IMD scores from most deprived to least deprived and dividing into 10 equal groups. These deciles range from most deprived 10% to the least deprived 10% of areas nationally.  ↩   ↩ 2   ↩ 3

PHE . (2017) Wider Determinants of Health: Work-related illness. Accessed 14 June 2017.  ↩

Health and Safety Executive. (2017) Work-related ill health and occupational disease. Accessed 14 June 2017.  ↩

Joseph Rowntree Foundation. (2014) How Does Money Influence Health? Accessed 14 June 2017.  ↩

Joseph Rowntree Foundation. (2017) Just about managing: Four million more people living on inadequate incomes in modern Britain. Accessed 14 June 2017. The Joseph Roundtree Foundation report provides data for Britain rather than England. The estimates reported for the proportion of the population not reaching the MIS for all people and for children are for England and were supplied to PHE by the JRF. The figure for children in lone-parent families is from the published report and is for Britain rather than England.  ↩

PHE . (2015) Understanding the cost of poor housing to health: BRE briefing papers. . Accessed 14 June 2017.  ↩

Krieger J, Higgins DL. (2002) Housing and Health: Time Again for Public Health Action. American Journal of Public Health 92(5): 758-768. Accessed 14 June 2017.  ↩

The decent homes standard is based on four criteria, of which one is the need to meet the minimum standard for housing. Estimates of whether this standard is met are based on 15 hazards in order to maintain consistency with survey estimates since 2006.  ↩

Department for Communities and Local Government. (2014) English Housing Survey: Headline Report 2013-14. Accessed 14 June 2017.  ↩

Shelter. (2017) Why we need more social housing. Accessed 16 June 2017.  ↩

Hills J. (2012) Getting the measure of fuel poverty. Final report of the fuel poverty review: CASE Report 72. LSE: London. Accessed 14 June 2017.  ↩   ↩ 2

PHE and the Institute of Health Equity. (2014) Local action on health inequalities: Fuel poverty and cold-related health problems. Accessed 14 June 2017.  ↩

Wilkinson P, Armstrong B, London M. (2001) Cold comfort: The social and environmental determinants of excess winter deaths in England, 1986-1996. Joseph Roundtree Foundation: London. Accessed 14 June 2017.  ↩

Marmot Review Team. (2011) The Health Impacts of Cold Homes and Fuel Poverty. Accessed 14 June 2017.  ↩

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HHS Awards $11.6 Million to Address Disparities in Healthy People 2030 Leading Health Indicators

Washington, D.C. — Today, the U.S. Department of Health and Human Services (HHS) Office of Minority Health (OMH) announced $11.6 million in grant awards to 20 organizations for its Community Level Innovations for Improving Health Outcomes Initiative. The awards will support a four-year initiative to identify community level innovations that increase the use of preventive health services with a goal of reducing health disparities – differences in health status among people in certain racial, ethnic, and Tribal communities. Health disparities are often related to social determinants of health (SDOH) .

The Initiative is focused on making progress toward Leading Health Indicator (LHI) targets. The 23 LHIs impact major causes of death and disease in the United States, and LHIs are a subset of high priority Healthy People 2030 (HP2030) objectives selected to drive action toward improving health and well-being.

“Factors such as poverty, limited access to health care, and lack of education or health literacy are examples of SDOH that individually and collectively have negative impacts on health outcomes for racial and ethnic minority and Tribal populations,” said Rear Admiral Felicia Collins, M.D., HHS Deputy Assistant Secretary for Minority Health and OMH Director. “By implementing community interventions that address multiple SDOH, awardees will advance our knowledge of how to increase preventive health service utilization and improve health outcomes related to LHIs.”

The project period for each grant is September 1, 2024 - August 31, 2028.

The recipients are:

The Office of Minority Health (OMH) is dedicated to improving the health of racial and ethnic minority and American Indian and Alaska Native populations through the development of health policies and programs that will help eliminate health disparities. Through its demonstration projects, OMH supports the identification of effective approaches for improving health outcomes and promotes the dissemination and sustainability of these approaches.

Georgia school shooting: Differentiating troubled youth from those posing a serious threat

by GEOFF HARRIS | The National Desk

WASHINGTON (TND) — How do you differentiate troubled youth from those that pose a serious threat? It is a question many are asking after the deadly shooting at a Georgia high school that killed four people and sent another nine to the hospital.

Experts say it's difficult but observation is key, noting that parents or guardians should be on the lookout for any erratic behavior, out-of-control mood swings or big changes to their appearance.

David Thomas, a professor at Florida Gulf Coast University and retired law enforcement said aside from behavior, class assignments are another good thing to pay attention to.

"They have a journal or they have to write reports and what you'll find oftentimes is they'll fantasize in those and that's a window into what's actually going on," Thomas said.

When it comes to the suspected 14-year-old gunman Colt Gray at Apalachee High School, there was a sign online.

Over a year ago, Gray made online posts threatening a school shooting. But investigators didn't have enough evidence to make an arrest. Thomas said that in the state of Georgia, there is no "Red Flag Law" allowing someone to intervene and take the firearms.

"If there are weapons in the house and they feel that those weapons, the person has access to those weapons and they're a threat, they cannot remove the weapons," Thomas said.

In his experience, Thomas said parents are also reluctant to intervene.

"The stigma was there. They thought their kids wouldn't be normal. They wouldn't be accepted," said Thomas.

Dr. Leigh Richardson, a licensed counselor said any time a child makes a threatening post like Gray, there needs to be an evaluation.

A neuropsychological assessment must be conducted," Richardson said.

She believes if one was done, it's possible the results would have shown anxiety, depression or some aggressiveness.

"Something that could have made us stop and think do we need to look at this a little more seriously?" said Richardson.