Acting on the wider determinants of health will be key to reduced demand

While the quality of health services is important, it makes a much smaller difference to people’s overall health than things like income, employment and housing. Well-established models suggest that clinical care accounts for 20% of health outcomes while social and economic factors and physical environment together make up 50%.

Acting on these wider determinants should be much higher up the agenda if we are serious about improving people’s health and the quality of their lives. But while we might all agree with that, it leads straight into the territory of big, expensive policy changes.

Sorting out the social welfare system so that it provides an effective safety net. Improving the quality and quantity of affordable housing. Ensuring access to education and development from early years through to adulthood.

At Citizens Advice, we’re keen to see those policy shifts because we can see the difference they would make to the people coming to us for help. Because we see so many people, we have a huge amount of data about the problems they need help with and how they interact.

Over half the people who come to us for debt advice are now in negative budgets, with essential outgoings exceeding their income. The underlying causes of that are deep-seated and will need sustained attention across sectors and policy areas.

But as well as seeking to change the system, we also work within the system as it currently is to reduce the number of problems that people face. And the action that we support people to take has a direct impact on people’s health.

Right now, a lot of that is at the level of the essentials of life. Providing a food bank voucher for Katie, a single parent, ensured they had something to give their family to eat in a crisis.

Intervening when Zafar’s family was about to be evicted kept a roof over their heads. Supporting Tomas, a client with a long-term condition, through the process of challenging benefit withdrawal put money in their pocket and meant their food could come from a supermarket rather than a food bank.

It’s pretty obvious that living in cold, damp conditions is bad for people’s health, increasing the risk of heart attacks, strokes, lung illnesses, flu and other diseases. Not eating properly, being homeless or indeed threatened with homelessness also have negative effects on both physical and mental health.

And these are basic needs which, if not met, make it much harder for people to address other issues in their lives. So, the connection of advice to health is obvious. It comes through in our regular client experience survey too, with 48% of our debt clients reporting an improvement in their physical health after they have received advice from Citizens Advice and six in ten saying that they feel less stressed, depressed or anxious.

Much of our advice is provided in the community, acting as early intervention and prevention upstream of any healthcare provision. In many parts of the country, we also work in partnership with the NHS. Making advice available in primary care settings can provide alternative routes to resolving problems, and complement health interventions for people whose medical condition is exacerbated by non-medical issues.

In secondary care, advice can help people address financial anxieties that are inhibiting recovery and put the conditions in place for discharge when it’s clinically appropriate. It’s important that these partnerships represent value for money and we’re involved in a number of academic studies to understand and evaluate the impact of advice alongside healthcare interventions.

As well as helping people directly through advice, our services provide an indirect benefit through a wealth of robust data which tells joined-up stories about client experience as well as offering insights at the population level.

Citizens Advice is a leader in sharing our data and analytics and in doing so we contribute to population health management in strategic planning, decision-making, service design, delivery and evaluation. This supports integrated care systems in making use of real-time linked data to provide cross-sector insight into some of the risks faced by different population groups.

In Nottingham, for example, partners in the ICS and its data specialists have worked to find almost 20,000 people at high-risk of illness due to fuel poverty in ten of the most deprived areas and are offering them local help to stay well.

Having spent several decades in and around the health and care system, I know how difficult it is to translate the rhetoric of shifting towards prevention into the reality of even marginal changes to budgets that could be spent many times over.

But it’s a challenge that needs to be tackled. If a small part of that shift in spending went to support advice which directly addresses wider determinants of health, the effect could be transformative.

For more information about the CABs work on cost of living see the Cost of Living Dashboard or get in contact at

Clare Moriarty

Dame Clare Moriarty, Chief Executive, Citizens Advice.

Clare was appointed Chief Executive of Citizens Advice in April 2021. She leads the national charity and network of local Citizens Advice charities across England & Wales. Through 1:1 advice, online support and advocacy, Citizens Advice gives individuals the knowledge and confidence they need to find their way forward and speaks up on their behalf to bring about wider change.

Clare was previously a civil servant for nearly 35 years, latterly as Permanent Secretary of the Department for Environment, Food and Rural Affairs from 2015 to 2019, and of the Department for Exiting the EU until its closure in January 2020. Her early career was spent mainly in the Department of Health and the NHS, with senior roles in the Ministry of Justice and the Department for Transport.

After leaving the Civil Service, Clare chaired the Health Foundation’s Covid-19 impact inquiry and worked with organisations including Transport for London and the Bank of England. She is a trustee of the History of Parliament Trust and chairs the South Downs Partnership. Clare was made a Dame Commander of the Order of the Bath in the 2020 Birthday Honours.