Tackling the root causes of health inequalities


The Department of Health commissioned the NHS Institute to oversee support for local partnerships, to help them accelerate their progress in addressing health inequalities.

The programme was intended to tackle not only the ‘wicked problems’ – entrenched health issues affecting communities – but also the wider social determinants of ill health – the ‘causes of the causes’.

Each HPHL partnership selected its own wicked problem to address, and HPHL provided external expert support to each of the partnerships. Partnerships were supported by webinars, learning events, peer exchanges, a community web forum and access to Institute resources.

The Institute wanted to understand what works well in tackling health inequalities at a local level. Because of our extensive experience in conducting complex evaluations in the healthcare sector, it commissioned OPM to discover the success factors, challenges and impacts of projects and the HPHL programme as a whole.

What we did

We used a range of evaluation methods, including literature reviews, an online survey (covering local authority, PCT and other stakeholders from the partnerships), site visits, developing case studies and information mapping. We wanted to hear from stakeholders and learn from different approaches.

HPHL partnerships experienced success in different ways; for some, the project added a new, but complementary, health inequality strand to their work. These partnerships were characterised by strong senior leadership and day-to-day project management, and had existing governance arrangements and previous experience of addressing health inequalities. Others needed support to overcome the barriers to achieving the HPHL objectives.


The evaluation highlighted that different approaches are needed to really have an impact, with a shift from tackling symptoms to fully understanding what lies behind health inequalities. The programme acted as a catalyst, sharpening partners’ focus on the wicked problems and adding momentum by bringing partners together and providing support.

Through the collaborative, formative approach we adopted, the Institute and partnerships were able to incorporate learning as it emerged. The Institute has used the evaluation findings to help shape the second round of HPHL, for example, refining the support for partnerships, and continuing to enhance the webinars with a range of expert speakers, which the evaluation identified as useful to the partnerships. Several partnerships are sustaining their programmes, particularly where they were able to integrate HPHL activities with other workstreams.

This learning is informing the council’s future approach to community leadership and member development, and the programme is now being rolled out into other parts of the county.