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Local Commissions tackle Social Determinants of Health

One of the risks of making something statutory is that times change and what seemed like a good idea becomes at best a distraction and at worst an impediment. I wonder if we are beginning to see this with Joint Strategic Needs Assessments.

I think that we are beginning to see a growing dissonance between on the one hand  Department of Health requirements to produce a Joint Strategic Needs Assessment, a Joint Health and Wellbeing Strategy, the various outcome frameworks and on the other hand approaches developed by local leaders to tackle tricky issues like health inequalities.

Ironically the big driver here is  governments promotion of localism and citizenship.

The problem with many JSNA is that they start from the premise that is possible to build plans upwards from a rational assessment of need. I think that this approach is mistaken – it ties up scarce and precious analytical resources in a sisyphean task – and produces a product that is often still too siloed in health, is too complex for most to connect with and is by its nature too often reduced to a set of rather bland statements that have little impact on commissioning.

The JSNA problem

Unsuprisingly agencies and organisations on the front line in particular find it hard to engage with this technical process of dubious impact.

Tackling the Social Determinants – the Commission Model

Increasingly local authorities are developing new models to drive commissioning that incorporate evidence, intelligence and citizens voice in ways that bring genuine challenge. one of the most promising are “Commissions”.

The approach here is different. The starting point is usually one where local politicians have made a decision to investigate a pressing and wicked issue and have asked for evidence and ideas about how to address this. Commissions recognise that the answers and evidence are just as likely to come from the front line and citizens as from ‘experts’. Indeed successful actions depend on all stakeholders being involved in problem solving.

Characteristics of a good commission approach include:

There are already a number of examples of these and it is not suprising that one of the key players is the Equality Trust – the organisation established following publication of the Spirit Level.

Here are 4 Commissions that I am aware of:

Islington – Fairness Commission

Wakefield – Poverty and Prosperity Commission

York – Fairness Commission

Sheffield – Fairness Commission

Strategic Questions

Here are some examples of the sort of questions that the commissions are asking – the grouping is mine – you may disagree


The commission approach feels the right way round with:

What do you think?

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