North Nottinghamshire Public Health Network
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Determinants of Health
Health Indicators


4. Determinants of Health

4.1 Introduction

The 1998 Acheson Report Independent Inquiry into Inequalities in Health report concluded that: "the weight of scientific evidence supports a socio-economic explanation of health inequalities. This traces the roots of ill health to such determinants as income, education and employment as well as material environment and lifestyle".

Dahlgren and Whitehead's model (below) highlights some of the main factors determining the health of our regional and local populations.

Age, sex and genetic make-up undoubtedly influence people's health potential, but are fixed. Other factors in the surrounding layers of the model can potentially be modified to achieve a positive impact on population health:

  • individual lifestyle factors such as smoking habits, diet and physical activity have the potential to promote or damage health;
  • interactions with friends, relatives and mutual support within a community can sustain people's health;
  • wider influences on health include living and working conditions, food supplies, access to essential goods and services, and the overall economic, cultural and environmental conditions prevalent in society as a whole.

Regional and local comparative data are available which relate to some of the determinants of health described above. These data are described in detail in the EMPHO product "Key Health Indicators 2003". The website includes downloadable data for the East Midlands local authorities including the North Notts districts.


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4.2 Indices of Deprivation 2000

Recognition that many of the key determinants of health are interdependent has stimulated the development of indices of multiple deprivation such as the Jarman Underprivileged Area Score, the Townsend Material Deprivation Score and the Indices of Multiple Deprivation 2000 (IMD2000).

IMD2000 is the most widely used current measure of small area deprivation. Further details are available at It replaces indexes based on the 1991 Census such as the Townsend and Jarman score.

Scores in the Indices of Deprivation 2000 (ID 2000) are derived from 33 ward level indicators in the following six 'domains' of deprivation:

  • Income Deprivation
  • Employment Deprivation
  • Health Deprivation and Disability
  • Education, Skills and Training Deprivation
  • Housing Deprivation
  • Geographical Access to Services

The six ward level Domain Indices are combined to make the ward level Index of Multiple Deprivation 2000 (IMD 2000). he IMD 2000 was constructed by combining the six transformed domain scores, using the following weights:

Income (25%)
Employment (25%)
Health Deprivation and Disability (15%)
Education, Skills and Training (15%)
Housing (10%)
Geographical Access to Services (10%)

In contrast to other deprivation indices based on 1991 Census data, most of the indicators used in the IMD2000 can be updated regularly. Multiple data sources are used including:

  • DSS, ONS, DfEE, ES, UCAS, LA, Post Office Counters, Data Consultancy Ltd., NHS, BMA, English House Condition Survey, Residata.

There are 354 local authorities in England and each can be given a score (average ward score) and a rank on the index of multiple deprivation. The lower the rank, the more deprived the district (1 would be most deprived, 354 the least deprived). Scores and ranks for the North Notts Local Authorities are provided below.

Index of Multiple Deprivation scores for PCTs were included in a recent PCT data set produced by Eastern Region PHO on behalf of all PHOs. Values for North Notts PCTs are provided below.

A related indicator is the population within a given local authority area which live in wards that rank among the most deprived 10% of wards in the country. Values for North Notts local authorities are provided below.

Proposals for updating IMD2000 are at

Ward level scores for the six IMD2000 domains of deprivation for the North Notts PCTs are provided below.

Summary measures for local authorities and NHS administrative areas are also available. the District level presentations of the IMD2000 are provided below.

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4.3 Income/Poverty

Within IMD2000 (see above) there is a separate income deprivation index. Scores are derived from counts of people in families in receipt of means tested benefits. Scores for local authorities are counts of individuals experiencing income deprivation, i.e. they give an indication of the absolute rather than the relative level of income deprivation.

Scores for the income deprivation index for North Notts local authorities are provided below.

ID2000 also includes a child poverty index derived from the proportion of children under 16 living in means tested benefit reliant families. Scores are available at ward level. Scores at local authority level are not available, although scores for PCTs were computed as part of the recent PCT data set produced by Eastern Region PHO on behalf of all PHOs. Values for North Notts PCTs are provided below.

Ward level child poverty index scores for the North Notts PCTs are provided below.


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4.4 Data Sources for other determinants indicators

Some key data sources for other health determinants are provided through the links below.

Income and Poverty, Employment and Education, Crime:
1. ONS "Neighbourhood Statistics" website:
2. East Midlands Observatory website:
3. Annual Local Labour Force Surveys website:
4. NOMIS website (official labour market statistics)
5. "Crime in England and Wales" series (combines the reporting of police recorded crime and the British Crime Survey (BCS) results:

As mentioned previously, a more comprehensive presentation of determinants of health is provided at East Midlands Public Health Observatory Determinants of Health


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