Multiple long-term conditions

Multiple long-term conditions programme strands

Slowing progression to multiple long-term conditions by addressing the social determinants of health

In our multiple long-term conditions programme, we support projects and activity through two strands of preventative work: addressing social determinants of health and improving healthcare. We believe that people’s progression from one-to-many long-term conditions is influenced by a complex mix of factors including their personal finances, housing and employment.

Social factors like meaningful work, financial health and housing can profoundly affect people’s health. Interventions that improve these wider determinants can practically improve people’s health.


Why we focus on the social determinants of health

Social factors like meaningful work, financial health and housing are key to our strategy for two reasons: we believe they can profoundly affect people’s health and that they are not set in stone but are amenable to change.



Where you live matters for your health. A healthy home is safe, stable and in good condition. There is growing evidence that secure, affordable homes that are in good condition can protect our health and wellbeing, and unsuitable, unstable homes can have a serious effect on people’s physical and mental health.

In our work on housing as a social determinant of health we focus on:

  • Reducing the fear and incidence of evictions for those at risk of developing long-term health conditions.
  • Supporting renters in moving out of the precarious private sector.
  • Testing creative interventions that shift power and allow tenants to have a greater voice.



Good work – which is fairly rewarded, allows for work-life balance and gives employees a choice to shape their working lives – is physically and mentally healthy. Some jobs, however are precarious, low-paid, physically demanding or dangerous and are in unsupportive workplaces where people face discrimination, and have an adverse effect on mental and physical health.

In the work strand we focus on:

  • Building employers’ understanding that investing in health pays off for business and their staff, especially for and with people in lower income roles.
  • Giving employers the tools to talk about health with their workers and opening up positive dialogue about health and wellbeing.
  • Investigating how good work and genuine opportunities to advance professionally can offer paths out of precarious employment for people at risk of developing multiple long-term conditions.
Women receiving advice and wellbeing check-ins at High Trees Community Trust (before the pandemic).


There are clear links between our physical, mental and financial health. For many people living on low-incomes, health issues and problems with money influence each other. People with long-term health conditions often have less, or a more precarious, income – due to being too ill to work or work regular hours – and more expenses on medication, transport, a special diet, physical exercise to manage pain and ways to keep emotionally well.

In our work on finances and income as a social determinant of health we focus on:

  • Engaging with local and national health, welfare and finance organisations to develop policies that deal with people’s finances and health together, rather than separately.
  • Working with employers, landlords and creditors to make sure their decision-making accounts for health.


The stark differences in the length and quality of people’s lives in urban areas are not inevitable and so can be improved. We believe there is an opportunity to better support people through intervening early and championing secondary prevention, following the first diagnosis for people living with one health condition.

Through our healthcare strand, we are:

  • Exploring how improvements to NHS services can help slow people’s progression from one to many long-term conditions.
  • Focussing on early and timely interventions for those at most risk of progression.



In urban places, areas of affluence and poverty often exist side by side and health inequities between neighbouring communities are stark.

Neighbourhoods can offer secure housing, good local employment opportunities and a sense of tight knit community and security – all of which are good for our health. Neighbourhoods with insecure housing, noise, fear of crime, transient population and social isolation can however be bad for our health.

In the neighbourhoods strand our work focusses on:

  • Collaborating with people and organisations to build on local knowledge to ensure the unique characteristics of local people’s health guide our decision-making.
  • Through our neighbourhood schemes, providing spaces where people can meet, build healthy relationships and form a community, as well as offering residents physical, digital and social access to the wider economy.
  • Supporting community organising and empowerment, enabling residents to shape their neighbourhoods.