Everyone in Wales deserves the opportunity for good health. However, too often people become ill or die too early because they do not have the essential factors needed for good health. These include education and skills, a warm safe home, fair work (where workers are fairly rewarded, heard and represented, secure and able to progress in a healthy, inclusive environment where their rights are respected), money and resources, access to affordable and sustainable transport, and a healthy physical environment. These factors, or ‘determinants of health’, affect us from our earliest experiences and throughout our lifetime.
The Well-being of Future Generations (Wales) Act 2015 allows us to work with others to improve the economic, social, environmental and cultural well-being of Wales. We will bring our public health expertise and evidence, working at many levels to influence these determinants and increase opportunities for a fair chance of good health. This has never been more important. The Covid-19 pandemic has shown how all our efforts to improve and protect health are affected by these determinants. Currently, the cost-of-living crisis is disproportionately affecting the health of our most disadvantaged communities, increasing the effect of poverty on communities in Wales.
The wider determinants, often called ‘the causes of the causes’, affect health outcomes in Wales. Different experiences of these causes lead to differences in health outcomes, or health inequalities, which in turn are responsible for ill health and a large number of the total early deaths. People from the most disadvantaged areas of Wales can expect to lose over a decade of life lived in good health compared with those from the least disadvantaged areas (13 years for men and 17 for women). These unfair differences continue across generations.
We can inform, advocate for, and mobilise action on these determinants, locally, nationally and internationally. As a trusted national public health organisation, we can support a ‘health-in-all policies’ approach, informing and influencing policies and how they are put in place.
We are uniquely placed to bring a public health perspective to areas of Welsh national policy relating to health and well-being, such as housing, education, planning, transport, economic development and government spending. We can connect partners and policies to show how they can contribute to improving health and reducing health inequalities. This joint approach and our expertise can also support the wider system, including health boards and local authorities across Wales. We can work with agencies to influence policies outside of Wales where appropriate, including when considering the commercial factors that affect health.
The Well-being of Future Generations (Wales) Act 2015 says we must work to improve social, economic, environmental and cultural well-being by contributing to all of the act’s seven well-being goals. These goals are similar to the wider determinants of health, as they focus on the factors contributing to good health and well-being now and for future generations. Also, under the Socio-economic Duty 2021, we have to consider inequalities that result from social and economic disadvantage. Taking action on the wider determinants of health also contributes to the UK’s duties under the United Nations’ Sustainable Development Goals.
From the post-industrial heritage of Wales, through austerity, the impact of the Covid-19 pandemic and the cost-of-living crisis, the effects of determinants in Wales will continue into the future, both in ways we can predict and ways we cannot.
The main wider determinants of health include:
Wider determinants relate not only to our living conditions, but also include things that affect these conditions, such as economic and commercial forces, political priorities and the unequal distribution of income, wealth and power. These are also called fundamental causes. The relationship between health and these determinants acts both ways, as health and illness can affect our social, economic and environmental well-being. For example, when we are healthy, we are better able to learn or to take part in fair work.
We will work with our partners, using evidence and expertise to inform, advocate for and mobilise action to reduce health inequalities and improve people’s health and well-being throughout their lives. We will use evidence from many sources to do this, ranging from community experiences to monitoring key determinants, to international research.
We will add to this evidence base through advising on and leading research and evaluation related to the wider determinants.
We will organise action on determinants and develop a shared understanding of how we can affect different sectors and areas of policy which are dependent on each other. Our efforts will depend on the evidence we have of the importance of these determinants for people’s health, as well as our unique ability to influence them.