Hertfordshire and West Essex Integrated Care Strategy

Strategic priority 2: support our communities and places to be healthy and sustainable

We will work with our communities to improve our residents’ health and wellbeing by reducing health inequalities and taking action on the wider determinants of health including housing, employment and the environment.

Where we are now

Housing costs and accessibility issues have significantly increased in England and with the current rising cost of living on top of this, the impact will be most felt by lower income households. Poor-quality housing, overcrowded housing, and unaffordable housing harm health. Evidence shows that exposure to poor housing conditions (including damp, cold, mould, noise) is strongly associated with poor health, both physical and mental 1. Children living in cold homes are more than twice as likely to suffer from a variety of respiratory problems as children living in warm homes and mental health is negatively affected by fuel poverty and cold housing for all age groups 2 .

The 2020, UK Climate Change Commission Health Equity Report highlights how direct and indirect impacts of climate change will widen existing health inequalities in the UK. It warns that the most vulnerable will be hit hardest unless health equity is considered alongside future government greenhouse gas targets. Air pollution is the largest environmental risk to the public’s health, contributing to cardiovascular disease, lung cancer and respiratory diseases. Poor air quality contributes to shortening life expectancy and disproportionately impacts the most vulnerable in society.

Access to good quality green space improves physical and mental health, improves community cohesion, and supports actions to mitigate the effects of climate change and protect biodiversity. Green spaces have been shown to improve cognitive and immune functions and to reduce mortality rates and health inequalities3 . Access to and use of green spaces tends to reduce as the level of deprivation increases, which was highlighted during COVID-19 pandemic.

In Hertfordshire and west Essex health outcomes are mostly favourable when compared with the national picture however there are persistent health inequalities, especially in poorer areas and for specific groups such as people of all ages providing care. The COVID-19 pandemic exposed and widened these inequalities and led to many more people experiencing ill-health. For example:

  • Unpaid carers provide critical support for people with health and social care needs. The support provided by carers is often physically and emotionally demanding, with consequences for carers’ own health and wellbeing.
  • Those in the most deprived areas in Hertfordshire and west Essex die three to four years earlier and spend up to 18 years longer in a state of poor health than those in the least deprived areas.
  • On average, rough sleepers die 30 years earlier than the general population4.
  • Health inequalities are most stark in Harlow, Stevenage, Watford, Welwyn Hatfield, and Broxbourne.
  • Harlow at £545 and Stevenage at £476 are both significantly below the East of England average (£602) for median weekly pay for residents and workers (2021).
  • In Hertfordshire and west Essex there are four districts that are below the East of England average (81%) percentage of people that are economically active. These are Stevenage, Welwyn Hatfield, Hertsmere and Harlow.


Outcomes we want to achieve

We want people to be able to say the following:

  • I live in a safe, decent place that I can call home, which is accessible according to my needs, and designed so that I can be as independent as possible.
  • I have access to benefits that I am entitled to, and I can afford access to paid activities.
  • I have people in my life who care about me – family, friends, and people in my community.
  • I know about and can access social groups, leisure, as well as health and care services.
  • I feel welcome and safe in my local community, and I am satisfied with the local place where I live.
  • I have opportunities to learn, volunteer and work, and I can do things that match my interests, skills, and abilities.
  • I live in an environment which supports me to be healthy.


What will change

We will:

  • Step-up our support to and engagement with communities and groups at risk of the worst health outcomes.
  • Support people with disabilities or health conditions to get back to work or remain in work through inclusive employment practices.
  • Increase recruitment from our most deprived communities and work with our supply chains to create local economic opportunities.
  • Work in partnership to support the delivery of more homes, including key worker housing and implement the adoption of decent home standards in all social and private rented sector accommodation.
  • Take shared action to increase the supply of good quality, decent and accessible supported accommodation for people with learning disabilities and autism, and physical disabilities.
  • Increase community participation by embedding Asset Based Community Development principles (citizen-led, relationship-oriented, asset-based, placed-based, inclusion-focused) in our organisations, adopting a joined-up approach to social prescribing and securing social value.
  • Work with partners to put health, equity, wellbeing, and sustainability at the heart of local planning and strategy and actively support health involvement in statutory local development plans.
  • Ensure that consideration is given to reduce pollution and waste as well as to protect our natural areas.
  • Work with partners to create healthy streets and places by promoting green spaces and working with partners to prioritise provision of new green spaces in areas of higher deprivation with better signage and signposting.
  • Use the NHS England ‘Core20PLUS5’ framework to direct our approach with a focus on the five clinical areas prioritised in the NHS Long Term Plan, in other words continuity of maternity care for women in the most deprived areas and those from Black, Asian and minority ethnic groups; annual health checks for those with severe mental illness, chronic obstructive pulmonary disease management (with a focus on COVID-19, flu and pneumonia vaccination uptake), early cancer diagnosis and hypertension case-finding.
  • Tackle unhealthy environments by delivering improved infrastructure for safe walking and cycling and by providing easy access to reliable public transport in local areas and promoting a more efficient transport network.

  1. Michael et al (2020) Health equity in England: The Marmot Review 10 years on. London: Institute of Health Equity
  2. Michael et al (2020) Health equity in England: The Marmot Review 10 years on. London: Institute of Health Equity
  3. Allen J, Balfour R (2014) Natural solutions for tackling health inequalities. Institute of Health Equity
  4. Marmot et al (2020). Build Back Fairer: The Covid-19 Marmot Review