Domain 2: Population health and wellbeing, inequalities and the JSNA

Does the board drive its work from a rigorous, actively used understanding of its population's health and wellbeing needs?"

Score 1: Not evident

The board publishes a joint strategic needs assessment on schedule and a joint local health and wellbeing strategy that references it - but in practice neither document visibly shapes the board's agenda, its conversations about priorities, or the commissioning decisions of its partner organisations. 
Health inequalities appear in the strategy as a stated concern, but the board does not regularly interrogate whether its work is reaching the populations experiencing the worst outcomes, or whether any of its priorities are widening rather than narrowing the gap between those at the top and bottom of the health distribution.

Population data is presented to the board periodically but treated as context rather than as a challenge. The board's intelligence base is predominantly health service data and does not systematically cover the housing, employment, education, environment and social conditions that determine the majority of health outcomes. The board measures its performance in terms of activity and process rather than population outcomes, and has no agreed set of indicators against which it tracks whether health inequalities are changing.
The board's agenda reflects the priorities of its NHS partners disproportionately and gives limited sustained attention to children and young people, even where population intelligence shows significant unmet need in younger age groups.

Score 3: Growing

The board regularly connects population health and wellbeing intelligence to its priority discussions and health inequalities are named as a driver rather than a qualifier in how priorities are framed. 
The evidence base is beginning to extend beyond health service data to the wider determinants. However, the board is not yet consistently testing whether its priorities are narrowing the health inequality gap, and its attention to children and young people alongside adult services is uneven.

Score 5: Embedded

The board's priorities are demonstrably shaped by a rigorous, maintained and actively used JSNA that covers the full range of social, economic and environmental conditions that determine health, not only health service data and clinical outcomes.

Members engage with population health and wellbeing intelligence as a matter of course, not only when it is formally presented, and are comfortable using it to challenge their own and each other's assumptions.

The board tests its priorities not against whether average population health and wellbeing indicators are improving, but against whether the gap between those experiencing the best and worst health outcomes is narrowing. This is the primary test applied to every significant programme and priority: "narrowing the gap" rather than "chasing the population average," recognising that those furthest from the average have the most to gain from genuine progress on inequalities.

The board's intelligence base and priority discussions give visible attention to the whole life course.

Children and young people's health and wellbeing are consistently present alongside adult priorities, and the JSNA draws on evidence about the conditions in which people are born, grow, live, work and age, not only the conditions in which they become ill. The board has agreed on a small set of population outcome measures, linked to the JSNA, that it tracks consistently over time. These are the same measures it uses to assess its strategic progress (see domain 3), so that accountability for the strategy and accountability for population health and wellbeing are inseparable.

Population health and wellbeing intelligence is embedded in how the board is supported and serviced: officers and advisers treat the maintenance and communication of this evidence base as a core function, not a background task.