Public Health Liverpool

Wider determinants of health

Wider determinants, also known as social determinants, are a diverse range of social, economic and environmental factors which impact on people’s health.  Variation in the experience of wider determinants (i.e. social inequalities) is considered the fundamental cause (the ‘causes of the causes’) of health outcomes, and as such health inequalities are likely to persist through changes in disease patterns and behavioural risks so long as social inequalities persist.

Key facts

  • Liverpool has the  9th highest rate of violent crime in England, with around 348 emergency hospital admissions for violence each year.
  • Liverpool's rate of first-time offenders of 240 per 100,000 is significantly higher than England (166 per 100,000) and the 2nd highest in the Core Cities.
  • High unemployment can worsen both mental and physical health and risky behaviours like smoking and drinking. Around 17,400 (7%) of residents are unemployed which is the 2nd highest in England.
  • Long-term unemployment in 2023 was twice the national rate (1.9 per 1,000 compared to 0.9 per 1,000)
  • In 2022/23 the average ‘Attainment 8’ score for pupils in Liverpool was 40.7% compared to 46.2% in England and the 5th lowest in the country. Attainment 8 measures pupils’ results in 8 GCSE-level qualifications.
  • Economic inactivity is significantly above the national average (27.2% compared to 21.2%).
  • 29.3% of our economically inactive population are long-term sick (Oct23-Sep24) which was higher than England (27.3%).
  • Almost 1 in 5 (18.6%) households are workless compared to 13.5% nationally.
  • Average weekly earnings are significantly lower than nationally (£536.7 versus £565.7).
  • Three in every five (53.2%) residents live in areas (LSOAs) which score in the poorest performing 20% on the healthy neighbourhoods (AHAH) index, the highest in the North West.
  • The ratio of median house price to median gross annual earnings in 2023 was 4.9 compared to 8.3 in England meaning that on average, it is more affordable for people to buy a house in the city.
  • The rate of mortgage repossessions in Liverpool of 400.0 per 100,000 dwellings is 2nd highest in the North West and significantly higher than England (231.7).
  • Landlord home repossessions are also significantly worse than England (1,242 per 100,000 dwellings versus 1,036) and the highest out of the core cities.
  • Density of fast food outlets in the city is significantly above the national average (175.1 per 100,000 population compared to 115.9).
  • Over half (55.3%) of the Liverpool population live in areas at highest risk of food insecurity. Lack of access to enough affordable, nutritious food to live a healthy, active life is associated with a number of negative physical, mental and social health outcomes in adults and children.
  • 17.2% of households in Liverpool were estimated to be in fuel poverty in 2022, the 3rd highest in the North West.
  • Winter mortality is not solely a reflection of temperature, but of other factors as well, these include respiratory diseases and pressure on services. Between Aug 2021 - Jul 2022, there were 160 more deaths in Liverpool that occurred in the winter period (December to March) compared with the non-winter periods (August to November and April to July). Liverpool’s winter mortality index was in line with England (10% compared to 8.1%).
  • The mortality rate from accidental falls is the 4th highest in England (25.9 per 100,000 compared to 13.7).
  • 77.3% of adults with a learning disability were in stable and appropriate accommodation in 2023/24, which was significantly lower than England (81.6%).
  • Around 293 residents were killed or seriously injured in road traffic accidents in 2023. Liverpool’s rate of 217.6 per 1 billion vehicle miles was more than twice the national rate (91.9).

View 'Wider Determinants of Health Profile', Public Health England