Urban health

Urban health inequality: then, now, and in the future

4 March 2021
5 min read

International and National Partnerships Manager Rowena Estwick shares what we’ve learned so far about global urban health inequality, and how we’re taking action.

In 2019 we started a two-year project to build on our understanding of urban health. Whilst the London boroughs of Lambeth and Southwark are our home, they’re similar to so many other places so we also looked at similar cities and neighbourhoods to ours across the world.

We started by identifying those comparable cities with a view to understanding what urban health equity (or lack of) looked like globally. Even in different cultural and political contexts, we wanted to know if there were any commonalities between health and the places people live, work, and hang out that would help deepen our understanding of what drives positive health outcomes for all.

Fast forward to 2021 – we’re in the middle of a pandemic; we’ve had global protests calling on the world to value the lives of Black people; and (at the time of writing) we are in the third UK national lockdown. That’s huge change in such a short space of time, but importantly we are now watching a live example of how health inequalities, especially in urban areas, play out in extreme circumstances.

Redesigning our research during COVID-19

When the pandemic took hold in 2020, the cities worst affected tracked closely with the cities we identified for our research. This not only presented challenges for engaging with those places, but also pushed our thinking on the purpose of the research itself. With such a heightened focus on health inequalities, structural inequalities, and systemic racism, simply exploring commonalities of health outcomes between cities, while important, seemed limited.

With this in mind, we continued with our research across those cities, but commissioned two additional pieces. One with Urban Institute, a US urban health think tank, to help us convene experts internationally to consolidate what we are learning as the pandemic unfolds. The other with the London School of Economics, to help us develop future scenarios of what London could look like post COVID-19, and in turn what that could mean for other similar cities.

Importantly, we are now watching a live example of how health inequalities, especially in urban areas, play out in extreme circumstances.

Rowena Estwick International and National Partnerships Manager

Lessons on health inequity

Together, these reports can help governments, businesses, investors, philanthropists, health care providers, and others who work in and with urban neighbourhoods understand three key things:

  • What urban health inequity is, and the key elements needed in any approach to create health equity in cities. Speaking with representatives from Kresge Foundation, Mayor of Paris, Drexel University Urban Health Collaborative, and others, we’ve reviewed a range of existing approaches that address health inequalities in cities. We have brought together key considerations needed for any approach to successfully maximise health in cities. This report demonstrates that regardless of political or historical context, cities face similar challenges around health inequality. However, their ability to evolve over time to their changing and growing populations primes them as catalysts for long term change.
  • What the COVID-19 pandemic has taught us about health inequalities in cities and how we use this time to embed health equity into the core of our recovery. Our work with Urban Institute collects expert insights from Sir Michael Marmot, Professor of Epidemiology and Public Health at University College London; Qiana Thomason, CEO and President at Health Forward Foundation; Karabi Acharya, Senior Program Director at the Robert Wood Johnson Foundation; and Dr. Ana Diez Roux, Dean of the Dornsife School of Public Health and Distinguished Professor of epidemiology at Drexel University. Among several others, they share their experiences of handling the pandemic across their cities as it unfolds in real time.  These discussions are helping us understand why cities are so important in addressing health inequalities, and their role in supporting nations to rebuild a fairer society. We are also identifying the current gaps in knowledge that the pandemic has brought into sharp focus, and what’s needed to fill them.
  • What cities could look like post COVID-19 and how we drive towards a future that is centred on equity. Using London and our boroughs as a focus, our work with LSE takes trends from past recessions and our current understanding of urban health to develop a set of future scenarios of what London may look like in a post-COVID-19 world. These scenarios have been developed in consultation with Lambeth and Southwark Councils, our Community Researchers and Guy’s and St Thomas’ Foundation Trust. They identify policy recommendations to support neighbourhoods and cities like ours across the world, to shape a future where health equity is rooted in recovery and health is considered a key indicator of successful policy.

Shifting the dial for those disproportionally impacted by poor health outcomes starts with acknowledging that these inequalities exist, but that change is possible.

Rowena Estwick International and National Partnerships Manager

What next?

Current world events have heightened the need for the work we and others like us do. The health disparities we find in urban areas around the world are the outcome of wider systemic inequalities, and these inequalities are woven into the fabric of our societies. Shifting the dial for those disproportionally impacted by poor health outcomes starts with acknowledging that these inequalities exist, but that change is possible.

This requires a root and branch approach, centred in collective effort, supported by political will and sustained by leadership – across sectors – taking a long-term view. This pandemic has taught us, more than ever, that we live in a globally connected community; that there is much we can learn and achieve from working together; and that we are only as strong as the most disadvantaged members of our society or the poorest countries in our world.

We will be launching this research and insight at the end of March, and this is just the beginning!  We’re keen to work with decision makers, community leaders, businesses, investors, and others – both here in the UK and internationally – to build on these findings and take practical action towards building health equity as a core output of our place.

You can sign up to receive a copy of the reports when they are published but if, like us, you’re keen to start making change now, contact and let’s see how we can work together.