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Urban health

Mayor’s draft health inequalities strategy response

10 November 2017
9 min read

Our response to the Mayor of London's office


Note: Impact on Urban Health is part of Guy’s and St Thomas’ Charity.


Our consultation response refers to the following sections:

  • Healthy Children
  • Healthy Places
  • Healthy Communities


Is there more that the Mayor should do?

The Mayor should be congratulated on a comprehensive and determined approach to tackling London’s pressing health inequalities. We would particularly support the ambition to spread best practice across boroughs; and to build energetic partnerships between communities, business and the statutory sector.

There are areas the strategy could go further across children, place and communities.

Healthy Children

Emphasise should be placed on the fact that childhood obesity is primarily not a problem of individual knowledge, motivation or self-discipline. Rather, childhood obesity is often ‘a normal response to an abnormal environment’.

The spaces in which many of London’s children and young people spend their time have more barriers to healthy eating and activity than they do opportunities. This is especially true for those living in disadvantaged circumstances. Unless we start from this assumption, we are unlikely to make significant impact, and risk exacerbating existing inequalities.

Our works supports the proposed approach to tackle children’s health in the three environments where children spend most of their time: with their parents/carers (home), education settings (schools/nursery) and play/community settings (streets). We would go further and say that they should not be viewed in isolation as a behaviour or formed habit, but should be integrated with other initiatives that support promoting healthy children.

In addition to this we feel the strategy should:

  • Drive work that makes every home, school, high street and green space an area that encourages a nutritious diet and everyday activity. This should build on existing evidence, reward those who lead the way, and hold others accountable to follow
  • Start from the assumption that the issue of childhood obesity is complex, but that taking action can be relatively simple. What matters is tipping the balance so that the health-promoting features of London’s more deprived environments cumulate to outweigh those that are health-destroying
  • Provide a consistently bright spotlight on work to tackle childhood obesity. Tackling this issue takes time, and sustaining a collective effort will be hard without strong political leadership

Healthy Places

We support the Mayor’s ambitions to make a concerted effort to look at the disparities between and within differing populations in London. Health inequalities within London are strongly linked to wider socio-economic, environmental and cultural inequalities.
Such work would be supported by:
  • Actively promoting the development of integrated health and social care datasets
  • Advancing work to better understand the effect of the built-environment on health
  • Continuing efforts to promote local economic growth. For example, with secure long term employment comes strong social networks, sense of purpose and financial stability–all of which has a has a positive impact on mental and physical health

Healthy Communities

Further work is needed to understand the cumulative effect of urban environment, deprivation and high levels of diversity on people’s health. The Mayor could put London at the forefront of this work.


How can we, Guys & St Thomas’ Charity, help?

As one of the UK’s largest place-based funders, we partner with London local authorities, central government and the Greater London Authority to jointly act, develop knowledge and share learning. Currently we are focusing on children’s health and food, early intervention on multiple Long – Term Conditions and understand the driving factors of Urban Health disparities and solutions.

Healthy Children

Childhood obesity is a global problem, with 70 million young people predicted to be obese by 2025.  We know that the impact of place is as important as individual choice. Both affect the strongest drivers of obesity – eating behaviour and physical activity. For us, the combined lens of urban living and deprivation is critical. These are key ingredients of ‘obesogenic environments’ – those that encourage people to eat unhealthily and not to do enough exercise. We believe that improving these environments is crucial if we want to create a long-term
sustainable impact.

We plan to tackle childhood obesity by taking a whole system, cross sector approach that focuses on creating environments that support and encourage nutritious eating and physical activity in places that children of all ages spend their time: Home, School and Neighbourhoods.

Over the next 10 years, we plan to:

  • Focus on particular neighbourhoods so we can better understand the drivers and context in which effective action needs to take place
  • Layer up initiatives to create a concentration of actives around the children and families who live there
  • Enable great ideas and replicate successful initiative to grow impact
  • Join forces with others, across London, nationally and internationally to share and build evidence  and expertise. See here for further information on our children’s health and food programme model.

Healthy Places

In our work, we are particularly interested in how urban environment, high levels of diversity and deprivation affects people’s health. We know that a person’s socio-economic status and ethnicity links to the known drivers of multiple long term conditions. Research has shown that people from deprived areas are more likely to develop multiple long-term conditions earlier than those from wealthier ones. There is also emerging evidence of an association between ethnicity and multiple long-term conditions. A person’s social context, their education and ability to cope with life events such as bereavement, influences the likelihood and severity of long-term conditions

We plan to improve the lives of people with multiple long-term conditions in urban, diverse and deprived areas. This will involve working both with the formal statutory sector, and with many other actors –businesses, academics, civic organisations, community groups and residents themselves. Over the next 10 years, we plan to:

  • Identify people at risk of developing multiple long-term conditions
  • Intervene early: focusing on early intervention following first onset of a long-term condition to slow down progression and help people live more healthy years
  • Support our local partners: improving the lives of those with multiple long term condition by supporting new ways to care for complex patients that are sustainable and centred around people and their needs. See more about our Multiple Long Term Conditions Programme Model

Healthy Communities

Our programmatic focus helps us to understand and develop our learning of the drivers and contributors of Urban Health, that often see the most vulnerable of our society have the worse health outcomes. We aim to share the insights we gain into urban health from our programmes in Lambeth and Southwark across London and further afield with comparable cities that face the same urban health challenges. Our focus is on the intersections of the urban environment, diversity and deprivation:

  • The urban environment has both protective and risk factors for health. On the one hand there is proximity to services and social networks. On the other, there is competition for resources and the transitory nature of cities means that services have to respond to changing needs
  • Diversity (multi-ethnic, age, sexuality, faith) means that services need to tailor their services to different needs, and some cultures have different perceptions of health
  • Deprivation means that people have limited financial resources or social capital which impacts on their ability to manage their own well-being and health We aim to understand more about the urban environment, diversity and deprivation. Work to date suggests that while there is substantial evidence about how these characteristics individually impact on health and some evidence on the cumulative impact on two factors, there is very little evidence looking at how all three impacts on health

As an independent foundation, we can take risks on new approaches, co-produce with a range of partners and use our assets to leverage further resources. We are open to partnering with anyone who shares our aims of improving the health of urban diverse and deprived communities, to develop solutions, gain insights and share knowledge that can be used to effect change in our boroughs and urban communities like ours.


What should be our measures of success and level of ambition?

The Mayor should make clear, throughout, that a whole system and cross sector approach is needed to tackle health inequalities in London. The Mayor should aim to ensure that reducing health inequalities is an integral factor in all polices and directives which the Mayor has influence over.

Healthy Children

We support the Mayor’s ambitions to give children in London the best start in life. We recommend that the strategy:

  • Sets SMART targets on all ambitions with tangible and measurable outputs
  • Breaks the link between childhood obesity and deprivation over the next decade. In practice this would mean that the childhood obesity rates in the most deprived areas of London come down to the current rates in the least deprived areas of London. This would bring London’s total rates down to some of the lowest in the country
  • Develops a collective agreement around the specific actions required to get there. We know that childhood obesity requires a ‘joined-up, whole-systems approach’. The crucial next step is defining who needs to join up, around what actions, and increasing the pace at which these are taken. We think local authorities, schools and businesses are key players that need to co-ordinate, and that families themselves need to be at the centre of design and delivery of any activity
  • Prioritises sustainable change. We think this comes from empowering families as citizens and consumers, and from making the case that tackling childhood obesity is good for business, good for education and good for public spending

Healthy Places

We support the Mayor’s ambitions of creating a healthy environment, society and economy. We recommend that the strategy:

  • Sets SMART targets on all ambitions with tangible and measurable outputs
  • Commits to reducing the prevalence of multiple long-term conditions and promote a much greater degree of self-management
  • Actively measures and monitors the increase in the number of people who have care plans and who feel supported
  • Commits to increasing the number of people who report they have full and productive lives

Healthy Communities

We support the Mayor’s ambitions to ensure that London’s diverse communities become healthy and thriving. We recommend that the strategy:•Create SMART targets to address the factors that underlay the health inequalities of urban health. This might helpfully focus on:

  • Businesses: addressing the commercial determinants of health in London (for example, the advertising of unhealthy foods and promotion of unhealthy convenience food especially to children and young people)
  • Housing: supporting suitable accommodation for families and young people to aid their health and to maintain the positive impact of diversity within the city
  • Parks, Open spaces and recreation grounds: protecting park and open spaces to ensure that all Londoners have equal access to good quality open spaces for physical activity, good health and mental well being

Sharing insights

We have commissioned research that may be of interest to you that examine this in more detail:

  • Ethnographic research by user centered design and research specialists Us Creates to dig beneath the data and explore the lived experience
  • Research into the impact of long-term conditions on our communities, exploring people’s journeys to several chronic conditions. In partnership with King’s College London we are drawing one of the most comprehensive pictures of prevalence, risk factors and the impact of deprivation on people living with multiple health conditions in our area
  • Our Child Obesity report is due in February 2018, it will outline key principles for how to tackle childhood obesity –drawing on insights from our boroughs, subject experts and research from the behavioural insights team