Social Determinants of Health in the UK: Understanding Context, Impact, and Intervention (2025)
Abstract
The health of individuals and communities is profoundly shaped by the social, economic, and environmental conditions in which people live — collectively termed the social determinants of health (SDOH). In 2025, amidst deepening health inequalities and persistent regional disparities, the UK is increasingly acknowledging that medicine alone cannot fix the health crisis. From life expectancy gaps of over a decade between affluent and deprived communities, to rising demand for non-clinical interventions via social prescribing, the social fabric of Britain is being recognised as central to population health. This article critically explores the major social determinants in the UK — income, education, housing, employment, social cohesion — and their intersection with health outcomes. Through the lens of innovative models such as the Bromley by Bow Centre and the Glasgow Centre for Population Health, it further examines the potential of place-based, integrated strategies to reduce inequalities and foster wellbeing.
Introduction
In recent decades, research and public health policy have increasingly converged on a central truth: good health does not start in the hospital or GP surgery but in homes, schools, workplaces, and communities. Social determinants of health — the non-medical factors that influence health outcomes — account for between 30% and 55% of health variation according to the World Health Organization (WHO, 2023). These determinants are shaped by the distribution of money, power, and resources, and they are responsible for many avoidable health disparities observed across and within UK regions.
In the United Kingdom, structural inequalities continue to define health trajectories. Life expectancy in Blackpool, for instance, is 74.1 years, compared to 86.7 years in Westminster — a 12.6-year gap (ONS, 2024). Even within a single city, such as Glasgow, adjacent neighbourhoods like Bearsden and Shettleston can differ by over 10 years in male life expectancy. These statistics are not the result of genetic variation or lifestyle choice alone, but of enduring deprivation, insecure employment, poor housing, and lack of community capital.
Understanding the influence of these determinants is no longer optional — it is essential for the transformation of UK health strategy. The current policy emphasis on ‘levelling up’, NHS transformation, and preventative care all hinges on engaging more deeply with the social landscape of health.
Income and Economic Inequality
Income remains one of the most powerful predictors of health in the UK. According to the Marmot Review Update (Institute of Health Equity, 2023), people living in the most deprived areas are twice as likely to die prematurely compared to those in the least deprived areas. The causal pathways are clear: low income limits access to nutritious food, safe housing, transport, and digital resources. It also increases stress, which in turn raises the risk of cardiovascular disease, diabetes, and mental health conditions.
In 2023–2024, the Joseph Rowntree Foundation reported that 14.4 million people in the UK were living in poverty, including 4.3 million children. These statistics are not only morally alarming but place enormous pressure on health and care systems. Emergency admissions, for instance, are disproportionately higher in low-income postcodes, and data from NHS England shows that the rate of hospital admissions for ambulatory care sensitive conditions — which should be manageable in primary care — is 40% higher in the lowest income quintile.
Furthermore, economic insecurity has spillover effects on mental health. During the cost-of-living crisis, NHS Digital reported a 30% rise in anxiety and depression diagnoses in areas with the highest unemployment and housing stress, with primary care services overwhelmed by social conditions they cannot directly treat.
Education, Health Literacy, and Life Trajectories
Education affects health through multiple mechanisms — shaping employment prospects, income, health behaviours, and access to information. In the UK, educational attainment continues to track with both physical and mental health outcomes. Adults with no qualifications are more than twice as likely to report poor health as those with degrees (PHE, 2020).
Poor educational environments also contribute to adverse childhood experiences (ACEs), which are strongly linked to future chronic illness, addiction, and premature mortality. In many deprived areas, school readiness remains low. In Middlesbrough, for example, only 57% of five-year-olds achieved the expected level in communication, language, and literacy development in 2024, compared to 80% in Surrey.
Furthermore, health literacy — the ability to access, understand, and use health information — remains inadequate in low-education communities, limiting self-management of conditions and exacerbating inequalities in access to services. The rise of digital health tools, while promising, risks widening the gap for those without sufficient literacy or internet access.
Housing, Neighbourhood, and Environment
Housing is not simply a shelter but a key determinant of health. Overcrowding, damp, cold, and insecurity of tenure all contribute to respiratory illness, mental distress, and physical injury. The English Housing Survey (2024) estimated that 1 in 5 homes in the private rented sector failed to meet the Decent Homes Standard.
Moreover, neighbourhood deprivation magnifies poor housing outcomes. In cities such as Bradford and Liverpool, residents in deprived estates are more likely to experience limited access to green space, higher exposure to air pollution, and reduced access to supermarkets with affordable, fresh food. This ‘place-based deprivation’ leads to what public health experts now call “health toxic environments.”
In response, Integrated Care Systems (ICSs) have begun mapping housing data against health outcomes. South Yorkshire ICS, for example, linked respiratory admissions to cold housing and now commissions insulation improvements via public health grants. However, the integration of housing with health remains patchy and underfunded.
Community Networks, Social Capital and Loneliness
Social cohesion — the strength of social relationships, civic engagement, and trust in communities — is increasingly recognised as a protective health factor. The UK has experienced growing concern about loneliness, with the Campaign to End Loneliness noting that chronic loneliness increases risk of stroke and coronary heart disease by 30%, and is as harmful as smoking 15 cigarettes per day (Holt-Lunstad, 2022).
Social prescribing has emerged as a structured response to this issue. NHS England estimates that 2.5 million people were referred to link workers in 2023–24. While early evaluations are promising — particularly in reducing GP attendances — the scalability and consistent funding of these models remain uncertain.
Case Study: The Bromley by Bow Centre
Located in one of the most deprived wards in Tower Hamlets, East London, the Bromley by Bow Centre has become a national exemplar of integrated, socially-informed healthcare. Combining a general practice with employment advice, financial counselling, adult education, and creative activities, the centre offers a radically different model of care — one that treats patients as whole people within their lived context.
Evaluation data from 2022 showed that 89% of patients referred to social prescribing services at the Centre reported improved wellbeing, while 73% reduced their reliance on GP appointments within six months. These outcomes reflect a systemic shift: from managing illness to building health.
The centre also works closely with local housing associations and employment services, making it a community anchor rather than an isolated clinic. Its ethos has informed models across the UK and was cited in the NHS Long Term Plan as a case study in integrated neighbourhood care.
Case Study: Glasgow Centre for Population Health (GCPH)
The Glasgow Centre for Population Health operates at the interface of research, policy, and community action. It was founded to explore and explain the “Glasgow Effect” — the city’s persistently poor health outcomes that exceed what deprivation alone would predict.
Through longitudinal studies, GCPH has shown that early life adversity, population displacement due to urban planning, and loss of community identity all contribute to excess mortality in Glasgow. Their work highlights the intergenerational impact of social determinants — showing that inequalities today are rooted in decades-old structural decisions.
Beyond research, GCPH actively supports place-based interventions. Their “Thriving Places” initiative in areas like Govanhill combines community budgeting, local leadership, and cross-sectoral working. A 2024 evaluation showed a 24% reduction in emergency hospital admissions in pilot areas and improved mental wellbeing indicators across age groups.
Implications for UK Health Policy
The NHS cannot solve health inequalities on its own. Social determinants must be addressed across government departments — housing, education, welfare, transport — underpinned by coordinated local implementation. Current developments, such as the rollout of Integrated Neighbourhood Teams and the embedding of public health into ICS structures, are steps in the right direction. However, without sufficient funding, political will, and community co-production, their potential will remain unmet.
To meet the ambitions of “levelling up health,” the UK must go beyond tokenistic health in all policies rhetoric and fund cross-sector, place-based models that are proven to work. Both Bromley by Bow and GCPH offer blueprints — but they need systemic replication, not just admiration.
Conclusion
In 2025, the relationship between social conditions and health outcomes is clearer than ever. Poverty, education gaps, housing precarity, and social fragmentation drive illness more powerfully than most clinical risk factors. While promising models exist across the UK, national commitment to social determinants must go deeper. This means not only integrating care and social support but also recognising that health equity requires tackling the root causes of injustice.
Without this focus, the NHS will remain overwhelmed, and the promise of a fairer, healthier society will remain out of reach.
References
Bromley by Bow Centre. (2018). Unleashing Healthy Communities: Researching the Bromley by Bow Centre. [online] Available at: https://www.bbbc.org.uk [Accessed 16 May 2025].
Campaign to End Loneliness. (2024). Loneliness and Health: Summary of Evidence. [online] Available at: https://www.campaigntoendloneliness.org [Accessed 16 May 2025].
Glasgow Centre for Population Health. (2023). Exploring the Glasgow Effect: Intergenerational Poverty and Population Health. [online] Available at: https://www.gcph.co.uk [Accessed 16 May 2025].
Holt-Lunstad, J. (2022). Social Relationships and Mortality Risk: A Meta-analytic Review. PLOS Medicine, 7(7), pp.1–10. https://doi.org/10.1371/journal.pmed.1000316
Institute of Health Equity. (2023). Health Equity in England: The Marmot Review 10 Years On – Update for Post-COVID Recovery. London: University College London.
Joseph Rowntree Foundation. (2024). UK Poverty 2023/24. [online] Available at: https://www.jrf.org.uk [Accessed 16 May 2025].
Mind. (2023). Evaluation of “Get Set to Go”: Sport and Mental Health. [online] Available at: https://www.mind.org.uk [Accessed 16 May 2025].
NHS Digital. (2024). Mental Health Services Monthly Statistics: England, February 2024 Provisional Statistics. [online] Available at: https://digital.nhs.uk [Accessed 16 May 2025].
NHS England. (2023). Social Prescribing Summary Report. [online] Available at: https://www.england.nhs.uk/personalisedcare/social-prescribing [Accessed 16 May 2025].
Office for National Statistics. (2024). Health state life expectancy by Index of Multiple Deprivation (IMD) decile, England: 2019 to 2021. [online] Available at: https://www.ons.gov.uk [Accessed 16 May 2025].
Office for National Statistics. (2024). Inequality in Healthy Life Expectancy. [online] Available at: https://www.ons.gov.uk [Accessed 16 May 2025].
Public Health England. (2020). Health Matters: Education and Health. [online] Available at: https://www.gov.uk/government/publications/health-matters-health-inequalities [Accessed 16 May 2025].
Public Health England. (2020). Health Profile for England: 2020. [online] Available at: https://www.gov.uk/government/publications/health-profile-for-england-2020 [Accessed 16 May 2025].
Scottish Government. (2024). Adverse Childhood Experiences (ACEs) and Population Health. [online] Available at: https://www.gov.scot/publications [Accessed 16 May 2025].
Sheffield Hallam University. (2022). Social Return on Investment for Sport and Physical Activity in England. [online] Available at: https://www.shu.ac.uk/research/cresr [Accessed 16 May 2025].
The King’s Fund. (2023). Housing and Health: Opportunities for System-Level Impact. [online] Available at: https://www.kingsfund.org.uk/publications/housing-and-health [Accessed 16 May 2025].
World Health Organization. (2023). Social Determinants of Health. [online] Available at: https://www.who.int/health-topics/social-determinants-of-health [Accessed 16 May 2025].