Exploring how Health and Wellbeing Boards are tackling health inequalities with particular reference to the role of environmental health

  • Surindar Dhesi

    Student thesis: Unknown


    Abstract Institution: The University of ManchesterCandidate name: Surindar Kishen DhesiDegree title: Doctor of PhilosophyThesis title: Exploring how Health and Wellbeing Boards are tackling health inequalities, with a focus on the role of environmental healthDate: 2014 Health and Wellbeing Boards (HWBs) are new local government (LG) sub-committees tasked with assessing local health and social care needs, and developing strategies for promoting integration and tackling health inequalities; yet they have no statutory authority to compel action. This research explored how they approached tackling health inequalities, focussing on the role of environmental health (EH), the LG public health occupation, in the pre-shadow and shadow stages and as they went live in April 2013. Four case study sites (based around individual HWBs) were purposively sampled to ensure that a variety of HWBs were included, including unitary and two-tier authorities and urban, suburban and rural areas. Data collection at each case study site included semi-structured interviews, observation of HWB meetings, and documentary analysis and extended for 18 months from early 2012. In addition, EH practitioners and managers were interviewed from each of the English regions to provide a wider context. The data was analysed thematically both inductively and deductively using Atlas.ti. and conclusions drawn. HWBs were varied in their structures, practices and intentions and some changed considerably during the research, as would be expected at a time of new policy development and implementation. There was evident commitment and enthusiasm from HWB members to improve the health of local populations. However it is unclear what 'success' will be or how it will be measured and attributed to the work of the HWB, and there were some tensions between the various parties involved. There was an espoused commitment to the principles of Marmot, in particular to children, however much of the focus during HWB meetings was on integrating health and social care. Taking action on many of the social determinants of health is outside the core sphere of HWB control, however they did not generally appear to be utilising some of the readily available tools, such as EH work to improve local living and working conditions. EH was found to be largely 'invisible' within its own public health community and does not have a tradition of evidence based practice needed to secure funding in the new system. This, along with the decline of the regulatory role, has led to a period of reflection and adaptation. The research findings are linked by the policy approaches of 'doodle' and localism, including the shrinking of the state, and in particular the retreat of statutory and regulatory roles and the introduction of overt political values in policy making; shifting the focus to relationships, partnership-building, integration and the impact of individuals. The contexts in which the research has taken place, both at local and national levels, including financial austerity, major health restructuring, and high national and local expectations are all significant factors which have shaped the findings.
    Date of Award31 Dec 2014
    Original languageEnglish
    Awarding Institution
    • The University of Manchester
    SupervisorAnna Coleman (Supervisor), Stephen Harrison (Supervisor) & Katherine Checkland (Supervisor)


    • Health and Wellbeing Boards
    • Health Inequalities
    • Environmental Health
    • Public health policy

    Cite this