A Framework for NHS action on social determinants of health

Policymakers are increasingly emphasising the NHS’s role in addressing social and economic factors that shape health, but guidance on how this should be done in practice is limited.

In this long read, we outline a framework to understand potential approaches for NHS organisations seeking to address social factors that shape health, focusing on the role of local and regional action. We describe four categories of potential approaches, from more narrow interventions focused on improving care for individual patients, to broader partnerships to improve health of populations.

The most concrete policy action to address social needs in the NHS in England is the expansion of social prescribing for individual patients. But wider interventions and partnerships to improve social conditions across communities likely offer greater potential to improve health and reduce health inequalities.

There is limited evidence to guide the choice of health care interventions on social factors shaping health, and there is a risk of unintended consequences, such as medicalising social issues and widening inequities. Rigorous testing and evaluation are needed to learn more about what works, for who, in what context.

Ultimately, social and economic conditions that shape health are influenced by policy choices beyond the NHS’s control, such as government decisions on wider social spending. Health inequalities in England are widening and the current cost of living crisis will put even more pressure on people and public services.

Read the report here.