Defining what shapes our health
Updating the definition of “general health determinants” in Section 43 of the English Devolution and Community Empowerment Bill
The Issue and the opportunity
Section 43 of the English Devolution and Community Empowerment Bill introduces a duty on combined authorities to reduce health inequalities.
To achieve this, the definition of “general health determinants” needs to include all factors known to affect health and life expectancy.
In its current form, the definition fails to recognise the full range of influences, missing out key determinants such as: clean energy, healthy food, clean air, access to nature, active lifestyles, community participation and resilience to extreme weather.
We are therefore proposing an amendment to the definition (see ‘Recommendation’).
We believe that this update will give combined authorities the right tools to act on the conditions that truly shape population health, in alignment with government priorities, international standards, and modern evidence.
Recommendations
To better reflect the conditions shaping health at local and regional levels, we propose expanding the definition of “general health determinants” in Section 43, subsection 5 to include:
- the availability and affordability of clean energy and healthy food
- opportunities for healthy, active lives including access to green space and nature, active travel, and sports and recreation
- exposure to air and water pollution, and resilience to storms, flooding and heatwaves
- the ability of individuals and communities to meaningfully participate in shaping local decisions that impact their health and wellbeing.
Context
In Yorkshire and the Humber, healthy life expectancy for men has fallen to 58.8 years, five years lower than in London and the South East. Within the region, the gap in women’s healthy life expectancy between North East Lincolnshire and North Yorkshire is more than 10 years.
These inequalities reflect unequal access to the wider determinants of health: the social, economic and environmental conditions that shape wellbeing.
The definition of general health determinants in the English Devolution and Community Empowerment Bill does not reflect the evidence. Nor does it align with the statutory duties and strategies that position prevention and place-based delivery as essential to reducing inequalities, such as:
- the NHS 10 Year Health Plan for England (2025), which prioritises prevention and place-based action on the wider determinants of health
- the Environment Act 2021, which creates a legally binding duty for the government to establish targets for nature’s recovery, air quality, water and climate resilience
- the Fuel Poverty Strategy for England (2021), which recognises affordable energy as essential to protecting health and reducing inequalities
- the UK Government Resilience Framework (2023), which identifies extreme weather as a chronic health risk and highlights the importance of locally led adaptation
- World Health Organization guidance, which recognises air quality, green space and active travel as core health determinants.
Benefit of proposed amendment
Our proposed amendment would strengthen the Bill without altering its intent.
If supported, it will:
- align the Bill with the latest evidence on the structural and spatial drivers of health inequalities
- ensure consistency with current national and international legislative and policy frameworks
- provide combined authorities with the clarity they need to deliver on their new health duty, recognising the scale of the challenges and links between them
- enable credible, place-based solutions that narrow health gaps between and within regions
- strengthen accountability by making key determinants explicit.
If the duty is about reducing inequalities, it follows that we must ensure it appropriately describes the determinants that drive them.
This proposed amendment ensures the duty reflects today’s evidence and gives local leaders the tools to build fairer, healthier communities.
A detailed evidence base for the proposed amendment has been submitted to the Public Bill Committee for consideration and will be made publicly available.
