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Joint strategic needs assessment - JSNA

A Joint strategic needs assessment (JSNA) is a statutory document summarising the needs of the population. Its purpose is to provide an evidence base for commissioners and to inform strategies, notably the Joint Health and Wellbeing Strategy. 

2020 JSNA

The 2020 JSNA is the result of a collaboration between Barking and Dagenham, Havering and Redbridge (BHR) with the aim of producing a JSNA which is consistent across the developing BHR Integrated Care System. JSNA profiles for the three constituent boroughs can be found here.

An interactive tool has been created to support the use of the data within the JSNA profiles.  Instructions for using the tool can be found within the user guide.

2018 JSNA

The 2018 JSNA is based on three presentations to workshops informing the Joint Health and Wellbeing Strategy that took place in July 2018. As such, it is a themed JSNA, using the same three themes as the Joint Health and Wellbeing Strategy.

JSNA 2018 executive summary (PDF, 476 KB)

JSNA 2018 report (PDF, 2.5 MB)

Previous years

JSNA 2017 executive summary (PDF, 911.35 KB)

JSNA 2017 report (PDF, 1.67 MB)

JSNA 2016 key recommendations (PDF, 243.09 KB)

1. Introduction Toggle accordion

Joint strategic needs assessment 2016

Joint strategic needs assessment (JSNA) is an assessment of the health and wellbeing needs of the local area.

Since 2007, there has been a statutory duty for local authorities and clinical commissioning groups (CCGs) to undertake this assessment and there is also a legal requirement for NHS and local authority commissioners to use the information in the JSNA when commissioning services.

In practice, the JSNA process is led by the director of public health and undertaken on behalf of the Health and Wellbeing Board (HWBB) for the Barking and Dagenham area.

The work is undertaken each year to provide a shared, evidence-based consensus about key local priorities and to support commissioning to improve health and wellbeing outcomes and reduce health inequalities.

Our 2016 approach

This year we provide an update of the key health and wellbeing priorities for the borough.

The edition produced for 2016 has aimed to make and to update the material from previous years, while still maintaining the structure used in previous years.

The main changes are:

  • Section 1 – included 2011 census data and refreshed demographic data references
  • Section 2 – using updated demographic, maternity and early years data
  • Section 3 – using updated demographic, school data and refreshed data on children and young adults
  • Section 5 – revised material on housing and adult social care
  • Section 6 – revised material on environmental factors and community safety
  • Section 7 – revised material on health prevention, promotion, support and treatment needs and services.
  • Section 8 – revised material on safeguarding children

In 2010, the government commissioned an independent review into health inequalities in England, chaired by Professor Sir Michael Marmot on behalf of the Secretary of State for Health.

The Marmot Review Team published the review ‘Fair Society, Healthy Lives’, in February 2010.

This highlighted key policy objectives that need to be addressed in order to tackle health inequalities in England.

The six key priorities are intended to focus policy on addressing inequalities are:

  • give every child the best start in life
  • enable all children, young people and adults to maximise their capabilities and have control over their lives
  • create fair employment and good work for all
  • ensure a healthy standard of living for all
  • create and develop healthy and sustainable places and communities
  • strengthen the role and impact of ill health prevention

We have used these priority areas to examine the health and wellbeing priorities for the borough.

The structure of the JSNA document this year follows this approach and each priority area is a section of the JSNA.

Within these six sections we examine the key aspects of inequalities and the key themes that need addressing for the borough.

We also examine our position on the majority of the new Public Health Outcome Framework indicators Healthy lives, healthy people: Improving outcomes and supporting transparency

This structure allows us to review a wide range of the determinants of health and wellbeing, some of which we have never considered in detail before.


1.1 Looking ahead (PDF, 109.04 KB)

1.2 Growth and changes in population (PDF, 234.27 KB)

1.3 Local population statistics (PDF, 360.31 KB)

1.4 The population impact of migration (PDF, 194.95 KB)

1.5 Deprivation (PDF, 397.30 KB)

1.6 Health inequalities (PDF, 353.56 KB)

1.7 Debt and benefits (PDF, 120.06 KB)

1.8 Barking and Dagenham’s updated health profile (PDF, 303.19 KB)

2. Children: The best start in life Toggle accordion

Giving every child in Barking and Dagenham the best start in life

The foundation of good health is built in early childhood, during pregnancy, and even before a baby is conceived.

Good health does not just depend upon the quality and availability of local health services or on inherited characteristics but on a much broader range of factors: the 'wider determinants'.

These wider determinants include socioeconomic status, educational attainment of both parents, parenting and nurturing, housing, and the environment.

For example, children born into households where income is in the top 20% of England are more likely to be read to, and more likely to have regular bedtimes than children in families with the poorest income.

Care of this type leads to improved cognitive ability at a very young age and the differences in cognitive ability between children in the highest and lowest fifths of the population (in terms of socioeconomic status) is already noticeable and growing by the time a child is 3 years old.

There are steps that agencies can take to reduce inequalities, such as promoting early development of physical and emotional health, cognitive, linguistic, and social skills.

This can be delivered through parenting support and education and provision of high quality early years services targeted at those who need it most.


2 Giving every child in Barking and Dagenham the best start in life 2016 (PDF, 335.72 KB)

2.1 Families - circumstances in which they live (PDF, 126.82 KB)

2.2 Maternity need 2016 (PDF, 536.14 KB)

2.3 Health in pregnancy 2016 (PDF, 457.14 KB)

2.4 Outcomes for mothers and babies 2016 (PDF, 735.41 KB)

2.5 Supporting parents and children once they are born 2016 (PDF, 536.25 KB)

2.6 Breastfeeding 2016 (PDF, 267.71 KB)

2.7 Immunisation 2016 (PDF, 442.75 KB)

2.8 Outcomes for infants 2016 (PDF, 532.15 KB)

2.9 Troubled families 2016 (PDF, 285.79 KB)

2.10 Looking forward 2016 (PDF, 386.61 KB)

2.11 CAMHS needs assessment (PDF, 1.83 MB)

3. Enabling children and young people Toggle accordion

Fair Society, Healthy Lives (The Marmot Review, UCL 2010) demonstrates that inequalities in educational outcomes affect physical and mental health, as well as income, employment and quality of life.

To address these inequalities action is needed throughout life, investing in early years development to improve children’s readiness for school, enabling children and young people to develop skills for life as well as achieve qualifications during their school career, and provide learning opportunities throughout life.

For the residents of Barking and Dagenham, strategic partners work together to support children and young people, and their families and carers, to realise their potential through education and lifelong learning opportunities to develop the skills and empowerment to acquire, achieve and aspire to a better future.

“Health inequalities result from social inequalities. Action on health inequalities requires action across all the social determinants of health”. (Marmot)

The social gradient in educational attainment and skills continues throughout school and on into further or higher education. Inequalities in education outcomes impacts on employment opportunities, income and quality of life, as well as adversely affecting physical and mental health.

Those adults with no educational qualifications in 2001 reported long term limiting illness rates over 2 and a half times higher than those with degrees.

If everyone had the mortality rate of those people with a university education then each year it would:

  • prevent 202,000 people aged 30+ dying prematurely (40 % of deaths)
  • result in 2.5 million life years gained.

Not all of the inequality can be attributed to the health behaviours of the different socio-economic groups. But some can, for instance smoking prevalence is significantly higher in routine and manual workers than average, and this will lead to higher prevalence of heart disease, respiratory illness and cancers and therefore premature mortality.


3 Enable all children young people to maximise their capabilities and have control over their lives (PDF, 68.50 KB)

3.1 The school population (PDF, 381.44 KB)

3.2 Children and young people with learning difficulties (PDF, 428.54 KB)

3.3 Children with medical conditions (PDF, 342.65 KB)

3.4 Vulnerable groups (PDF, 182.04 KB)

3.5 Young people not in education employment or training (NEET) (PDF, 115.26 KB)

3.6 Children and adolescent mental health (PDF, 263.08 KB)

4. Fair employment and good work Toggle accordion

Create fair employment and good work for all

Unemployed people have higher rates of long term limiting illnesses, cardiovascular disease and mental health problems. However, while most people agree that being in work is preferable to unemployment, in terms of improved physical and mental health, the quality of the work really matters.

Moving people off benefits and into low paid and insecure work is not a desirable option and it will not see long term improvements in health. Being in work if the working conditions are poor can lead to deterioration in mental health and musculoskeletal disorders.

There is a circular nature to the relationship between unemployment and poor health, as being unemployed can lead to worsening health but poor health also increases the chances that someone will become unemployed.

In order to remain healthy for as long as possible, all those who can work need to be in safe and fulfilling work with remuneration that enables them to meet their basic needs for housing and food. For those unable to work, the benefit system should provide sufficient support to meet basic needs and, wherever possible, help them into interdependence and employment.


4.1 Worklessness (2016) (PDF, 231.33 KB)

4.2 Keeping people in work and maximising in-work incomes (2016) (PDF, 153.00 KB)

4.3 Employment for people with learning disability (2016) (PDF, 128.44 KB)

4.4 Employment support for people with mental health (2016) (PDF, 335.03 KB)

5. How and where people live: Ensure a healthy standard of living for all Toggle accordion

Fair Society, Healthy Lives recommends that taxation should be progressive and that other fiscal policies should be put in place to reduce socio-economic inequalities. In the UK, while income tax is progressive other direct taxes (eg VAT) are not. The current tax system actually disadvantages those people who are already on lower income.

People in the poorest 20% of the population pay 36.6% of their income in taxes, while people in the most affluent 20% pay 35.5% (Tax Research UK). In addition, some of the most affluent people in the country hardly pay any tax on their income at all.

Fair Society, Healthy Lives also recommends that attention is paid to the financial needs of those coming off benefits and into employment as financially they are likely to be worse off for a while before they see their incomes rise.

Lone parents particularly have little incentive to work and earn more, as they risk being subject to withdrawal of tax credits or means-tested benefits. The review also points out that some groups such as adults with disabilities and carers are more likely to be dependent on benefits to live.

One of the greatest impacts on long term health is the type and quality of housing in which people are able to live. People in rented accommodation can experience higher rates of ill health than people who own their own homes. As a group, they can also experience higher rates of unemployment, ill health and disability than the average population.

Poverty is double that of the average population, with fuel poverty highest in the private rented sector. We need to review this position in relation to the changing nature of the renting population in Barking and Dagenham.

However, it is not only the house people live in that impacts on their health. The surrounding environment also has an impact. The fifth of the population with most exposure to green spaces during their lives have lower rates of mortality from circulatory disease than the fifth with least exposure and whilst this is true across all social classes, the difference in rates is most stark in the least well off.

In this section we focus on how and where people live, the extent and impact of poverty on families and how that affects the homes they live in and the how they are able to live – particularly whether they are able to keep their homes warm enough to be n good health. The provision of housing for those with disabilities and other special needs are also considered.

From homelessness to overcrowding to fuel poverty to social housing and special housing needs, people’s health and wellbeing will be improved or made worse by the support that society and communities provide. Finally we consider the importance of access to parks and green space both to create an environment that bring both the pleasure and opportunities for physical activity that improves health.


5.1 Children and adults in poverty (2016) (PDF, 1.30 MB)

5.2 Relationship between benefits and social housing (2016) (PDF, 284.50 KB)

5.3 Homelessness (2016) (PDF, 179.85 KB)

5.4 Housing stock and decent homes (2016) (PDF, 386.84 KB)

5.5 Fuel poverty update (2016) (PDF, 419.05 KB)

5.6 Mental health support, including accommodation (PDF, 287.55 KB)

5.7 Supported living for older people and people with physical disabilities (2016) (PDF, 481.83 KB)

5.8 Adult social care services (2016) (PDF, 610.45 KB)

5.9 Access and utilisation of green space (2016) (PDF, 313.12 KB)

5.10 Access to safe sport and play environments (2016) (PDF, 394.23 KB)

5.11 Levels of air and environmental pollution (2016) (PDF, 564.31 KB)

6. Healthy and safe communities Toggle accordion

Create and develop healthy and sustainable places and communities

Fair Society, Healthy Lives demonstrates the range of inequalities that affect the physical and mental health and wellbeing of citizens. It is clear that lack of community cohesion and social isolation adversely affect health and wellbeing.

This section of the Joint Strategic Needs Assessment (JSNA) explores the context that supports communities to be healthy and sustainable, in particular the extent to which people and communities are able to feel safe and at ease in their home and surrounding area.

The extent to which the home is safe is affected both by the risk of accidents and fire, and the risk of domestic violence as well as a resident’s perception of the level of crime and disorder in an area and their confidence in the authorities to address it. Comfort in the home is affected by neighbourhood noise and the extent of antisocial behaviour in the surrounding area.

Injuries and accident rates are higher in more deprived areas. Children in the 10% most deprived wards in England are four times more likely to be hit by a car than children in the 10% least deprived wards and they are also more likely to die as a result of an unintentional injury at home.

Crime and disorder are particular determinants of the health and wellbeing of people and communities.

Community safety partnerships (CSPs)

In terms of joint working, community safety partnerships (CSPs) are statutory partnerships established in every local authority area to reduce crime and disorder.

The Barking and Dagenham Community Safety Partnership brings together all those who work together to tackle crime, anti-social behaviour and substance misuse in Barking and Dagenham and who want to make the borough a safer place where people treat each other fairly and respectfully.

The partners include:

  • the council
  • the police
  • probation
  • NHS
  • The London Fire Brigade
  • representatives of the voluntary and community sector

All partners have a key role to play in reducing and preventing crime and in building community confidence in public agencies with regard to this agenda.

Victimisation plays a major part in how people feel about their neighbourhood. At a neighbourhood level reductions in resources and the risk of increasing crime and disorder levels will lead to and reinforce feelings of isolation, these will need neighbourhood level solutions and we will need to have regard to this in terms of commissioning of resources to empower local communities to, themselves, be part of the solution.


6.1 People affected by environmental and neighbour related antisocial behaviour 2016 (PDF, 429.97 KB)

6.2 Risk of death and serious injury on the roads in Barking and Dagenham 2016 (PDF, 1.00 MB)

6.3 Incidents of domestic abuse and violence 2016 (PDF, 574.25 KB)

6.4 Perceptions of community safety 2016 (PDF, 533.33 KB)

6.5 First time entrants into the youth justice system 2016 (PDF, 333.71 KB)

6.6 Rates of violent crime including sexual violence 2016 (PDF, 425.75 KB)

6.7 Crime and violent crime victimisation 2016 (PDF, 257.32 KB)

6.8 Reducing re-offending 2016 (PDF, 479.97 KB)

6.9 Health of young offenders 2016 (PDF, 359.13 KB)

7. Reducing ill health Toggle accordion

Strengthen the role and impact of ill health prevention

Enabling adults to maximise their capacity and have control over their lives

The NHS Five Year Forward View sets out the importance of enabling adults to maximise their capacity and to have control over their lives through self-care and self-management.

This builds on the November 2010 public health white paper, Healthy lives, healthy people: our strategy for public health in England, which sets out what is described as a new approach that ‘empowers individuals to make healthy choices and gives communities the tools to address their own particular needs’.

Health conditions such as cancer and cardiovascular disease are most closely associated with health inequalities. This is described in the Fair Society, Healthy Lives report, which highlights the relationship between health and lifestyle behaviours.

These contribute to the development of the chronic diseases that follow the social gradient, such as smoking, alcohol, obesity, lack of physical activity and poor diet.

People’s personal decisions about how they live their lives are made in the context of local and national decisions about education, the workplace, housing and the environment and other key determinants of health, as well as their access to support, guidance and treatment provided by the NHS.

For further reading see the download below (7 Strengthen the role and impact of ill health prevention).


7.1 Understanding and supporting the needs of carers (2016) (PDF, 324.62 KB)

7.2 Adults with learning disability and the health Issues (2016) (PDF, 577.44 KB)

7.3 Support for adults with autism (2016) (PDF, 102.54 KB)

7.4 Active ageing (2016) (PDF, 334.00 KB)

7.5 Sensory disability - eye health and low vision (2016) (PDF, 276.89 KB)

7.6 Communicable diseases and health protection (2016) (PDF, 329.20 KB)

7.7 Excess seasonal mortality (2016) (PDF, 410.37 KB)

7.8 Obesity and healthy weight (2016) (PDF, 1.21 MB)

7.9 Smoking (2016) (PDF, 266.21 KB)

7.10 Alcohol 2016 (PDF, 678.01 KB)

7.11 Substance misuse (2016) (PDF, 491.61 KB)

7.12 Participation in physical activity - V1.0 (PDF, 513.42 KB)

7.13 Sexual health (2016) (PDF, 390.87 KB)

7.14 Dental health (2016) (PDF, 648.94 KB)

7.15 Bone health falls and fractured hips (2016) (PDF, 143.49 KB)

7.16 Musculoskeletal services (2016) (PDF, 646.84 KB)

7.17 Cardiovascular disease - case finding and treatment (2016) (PDF, 757.14 KB)

7.18 Cardiovascular disease screening - NHS Health Check (PDF, 60.48 KB)

7.19 Stroke (2016) (PDF, 495.83 KB)

7.20 Diabetes (2016) (PDF, 1.02 MB)

7.21 Diabetic retinal screening and diabetic eye disease (2016) (PDF, 458.42 KB)

7.22 Cancer (2016) (PDF, 953.66 KB)

7.23 Chronic obstructive pulmonary disease (2016) (PDF, 808.81 KB)

7.24 Adult mental health and wellbeing (2016) (PDF, 474.73 KB)

7.25 Suicides and self-harm (2016) (PDF, 312.03 KB)

7.26 Dementia (2016) (PDF, 321.81 KB)

7.27 Unplanned hospital use (2016) (PDF, 283.78 KB)

7.28 Sickle cell disease (2016) (PDF, 275.14 KB)

7.29 End of life care (2016) (PDF, 331.80 KB

8. Safeguarding Toggle accordion

Ensuring that children and vulnerable adults are protected from harm are shared responsibilities of everybody involved in the planning and delivery of local public services.

Statutory and national guidance outlines these responsibilities in relation to both adults safeguarding and the safeguarding of children and young people, which are overseen in Barking and Dagenham through the adult safeguarding board and the local safeguarding children’s board.


8.1 Safeguarding children and young people (2016) (PDF, 961.31 KB)

8.2 Safeguarding adults and older people (2016) (PDF, 448.12 KB)

8.3 Carer-reported quality of life survey 2014-15 (2016) (PDF, 667.53 KB)


9. Equality impact assessment Toggle accordion

Equality impact assessment of the Joint Strategic Needs Assessment (JSNA) public consultation and plans for the future.

Equality impact assessment 2011-12 (PDF, 74.50 KB)

Equality impact assessment report 2012-13 (PDF, 155.12 KB)

Equality impact assessment JSNA 2015 (DOCX, 25.79 KB)

JSNA resources Toggle accordion

This section contains a range of resources and links to other sources of information to help understand and improve the health of the community

Current Barking and Dagenham profiles

Publicly available reports compiled by Public Health England and other organisations relating to health and social care in Barking and Dagenham

The Public Health Outcomes Framework was launched in 2012 and aims to provide a full set of indicators that will help us to understand how well public health is being improved and protected. The latest profile was issued in August 2013

Public Health Outcomes Framework Aug 2013 (PDF, 954.02 KB)

The health profile is produced by Public Health England using a wide range of public data sources – It is designed to help local government and health services understand their community’s needs. The latest profile was issued in September 2018.

Barking and Dagenham health profile 2013 (PDF, 545.96 KB)

Profiles and reports covering inequality and spend and outcomes

Barking and Dagenham Marmot indicators for local authorities 2012 (PDF, 381.61 KB)

Slope index of inequality (PDF, 176.46 KB)

Spend and outcome factsheet and tool 2011-12 (PDF, 350.96 KB)

Child health profiles

Child health profile 2012 (PDF, 172.18 KB)

Health promotion and community health profiles

Tobacco control profile 2013 (PDF, 270.73 KB)

Alcohol profile 2013 (PDF, 102.30 KB)

Disease profiles

Barking and Dagenham cancer profile 2011/12

Barking and Dagenham stroke profile 2010 (PDF, 255.04 KB)

Barking and Dagenham diabetes profile 2013 (PDF, 767.64 KB)

Diabetes footcare profile 2011-12 (PDF, 552.92 KB)

Diabetes inpatient mortality profile 2012 (PDF, 293.37 KB)

Barking and Dagenham cardiovascular profile 2013

Barking and Dagenham COPD profile 2011 (PDF, 298.14 KB)

Barking and Dagenham kidney disease profile 2012 (PDF, 910.27 KB)

Mental health, community health and care profiles

Community mental health profile 2013 (PDF, 2.92 MB)

End of life care profile 2012 (PDF, 265.50 KB)

Profiles and reports about living and working in the borough

Barking and Dagenham residents survey 2011 (PDF, 3.06 MB)

Barking and Dagenham Clinical Commissioning Group

Archive of previous health profile editions

Previous editions of the Barking and Dagenham health profile

BD Health profile 2012 (PDF, 595.63 KB)

BD Health profile 2011 (PDF, 522.16 KB)

Previous editions of the Barking and Dagenham child health profile

BD Child health profile 2011 (PDF, 413.44 KB)

BD Child health profile 2010 (PDF, 735.92 KB)

Previous editions of the Barking and Dagenham spend and outcome factsheet

Spend and outcome factsheet and tool 2010-11 (PDF, 350.96 KB)

Spend and outcome factsheet and tool 2009-10 (PDF, 331.43 KB)

Spend and outcome factsheet and tool 2008-09 (PDF, 293.15 KB)

Additional tools and information services


Contact us if you have any comments or queries regarding the contents of the JSNA or the process for future refreshes.