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Bedford Central Beds Milton Keynes
Central Bedfordshire JSNA
living & working well

Why the wider determinants of health are important

Wider determinants, also known as social determinants, are a diverse range of social, economic and environmental factors that impact on people’s health. Such factors are influenced by the local, national and international distribution of power and resources which shape the conditions of daily life. They determine the extent to which different individuals have the physical, social and personal resources to identify and achieve goals, meet their needs and deal with changes to their circumstances.

The Marmot review, published in 2010, raised the profile of wider determinants of health by emphasising the strong and persistent link between social inequalities and disparities in health outcomes. Variation in the experience of wider determinants (i.e. social inequalities) is considered the fundamental cause (the ‘causes of the causes’) of health outcomes, and as such health inequalities are likely to persist through changes in disease patterns and behavioural risks so long as social inequalities persist. Addressing the wider determinants of health has a key role to play in reducing health inequalities, one of PHE’s core functions.

Several studies have attempted to estimate the contribution of the wider determinants to population health, finding that wider determinants have a greater influence on health than health care, behaviours or genetics. It is therefore an important aspect of public health in terms of informing preventative action and reducing inequality. In addition, both the Marmot review and the Dame Carol Black review of drugs highlighted the huge economic costs of failing to act on the wider determinants of health.

Deprivation

Deprivation is an over-arching term that is defined as the damaging lack of material benefits considered to be basic necessities. As such it includes a number of the wider determinants of health and is therefore important in defining the needs of a particular area or community. Throughout this JSNA, data is presented comparing the situation in Central Bedfordshire with authorities from the same deprivation decile. This helps to identify where deprivation is and is not driving a particular indicator.

To understand how deprivation varies across the country, an Index of Multiple Deprivation (IMD) was created. The IMD identifies levels of deprivation at local authority and ward level and it brings together 39 indicators grouped into the following seven domains of deprivation:

  • Income

  • Employment

  • Education, Skills and Training

  • Health and disability

  • Crime

  • Housing and services

  • Living environment

See the latest information on deprivation in Central Bedfordshire in the IoD Dashboard

The most recent IMD was published in 2025 as part of the indices of Deprivation (IoD). A detailed analysis of the relative position of Milton Keynes City across each of the seven Index of Multiple Deprivation (IMD) Domains of Deprivation, as well as for the IMD overall, Income Deprivation Affecting Children (IDACI) and Income Deprivation Affecting Older People (IDAOPI) can be found in the IoD Dashboard.

The analysis includes: change from previous IMD report (2015 and 2019), neighbour comparisons (CIPFA, CSSNBT, Deprivation Decile and Region), smaller geographies including weighted ward averages and LSOAs, and a postcode lookup.