Many of the services and actions that national bodies, local councils, the NHS, charities and other organisations deliver have an important bearing on the conditions that shape our health. This includes the local environment and economy, housing, transport and education. We call these conditions, the social determinants of health.
However, in many areas, there is a complicated mix of local and national actions for health and health equality. In each area, the mix of organisations and groups, including groups of community activists operating at neighbourhood level, working to improve health equality also differs. There are also different connections between and across them. We call this mix of organisations/groups and connections the public health system. We want to know if some mixes and connections are more likely to be successful in improving health equality that others.
In the first phase of this study, we looked at 15 council areas in England. We asked what they were doing to try to reduce health inequalities, and who paid for it. We have a good overview of the sorts of actions local councils take, and who they work with.
We now want to see how these actions work to address health inequalities. We will do this by first looking in detail at two public health systems, one in the south west of England and one in the north west. We will take a County Council in each region as the starting point of describing the system. This is because County Councils provide many services important for health, such as planning immunisations, checking food safety, providing sexual health services, and education. But they do not provide everything. They also have to work with district and city councils as they provide services such as waste and recycling collections and planning. In many areas they also have to work with nearby councils, as people’s work and transport does not happen within council boundaries. All councils also have to work with many other organisations to address inequalities. These include the NHS, police, schools, businesses and charities. We will look at how they do this – how this ‘system’ connects. We will also talk to residents involved in community action to improve health and reduce health inequalities about their encounters with the organisations and professionals in these public health systems.
We will identify important features of the wider public health system in each of our two detailed studies. This includes how complex it is, what connections there are, and what its history is. We will make a list of these features and identify which seem to be related to how well the system deals with inequality. We will also look at how different forms of knowledge including that of local residents and practitioners, findings from research studies and other sorts of information, is or is not used to shape decisions about local action on health inequalities. The next step is to see if this is the same in other areas, with other kinds of council. We will compare what we found to what happens in 10 - 12 other systems, including ones in London, the Midlands and north east England. The final step is to design a study that will test our ideas about what kinds of system work best by looking at whether they do reduce inequalities or not.