We focus on four complex health issues more prevalent in urban areas
With the Social Progress Imperative, we've developed the first neighbourhood level, health-focused social progress index of its kind.
With Wellcome Trust
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We've been working with the London School of Economics and local residents to map what the next decade could look like for our inner London boroughs.
We worked with LSE Cities to map future scenarios for London, and in particular Lambeth and Southwark, as we begin to recover from the COVID-19 pandemic.
Together we analysed the current social and demographic characteristics of the boroughs. By looking at several factors likely to influence them in the short-to-medium term, we then evolved a series of ‘scenarios’ designed to help shape future policy in a post-COVID-19 world.
The lived experience of the 650,000 residents in Lambeth and Southwark was central to our research. Alongside a traditional literature survey and analysis of published data, we interviewed community researchers who live and work in our boroughs to truly capture the social realities of the communities we are working with.
Insightful interviews with both community researchers and borough leaders were integral to shaping these scenarios and helping us to think about policy change in a way that centres health equity, taking into account the social, spatial and cultural context that should guide policymaking.
Young and educated
Compared to the rest of the UK, and a lesser degree London, residents in Lambeth and Southwark are quite young and very well-educated. The majority of the borough’s residents are working age and a notably high number of them have a degree. This has important implications for the future workforce, migration, and social care.
Lambeth and Southwark are very diverse, both culturally and ethnically. Looking at ethnicity and Country of Origin data we see that both boroughs have big communities of residents from sub-Saharan Africa and South America.
Constantly in flux
The boroughs experience significant population churn, each year gaining many new residents (primarily international) and losing existing residents to other parts of the UK. This means that the boroughs’ populations can be significantly different from year to year, and the mix of residents should be considered as a constantly changing, rather than static, feature of the area.
Unequal access to opportunity
Finally, Lambeth and Southwark are marked by social and spatial inequalities, and access to services, resources, and opportunity are not evenly distributed throughout the boroughs. Each borough has some of the most deprived areas in London, but also some of the most affluent.
Even though the boroughs rank relatively high in educational attainment compared to the country as a whole, they rank quite low when it comes to income and employment. Taken together, this suggests that larger social and systemic inequalities may be affecting the success or prosperity of many residents.
The first scenario imagines a future in which the world largely returns to where it was in January 2020, with little to no medium or long-term disruption of London’s economic, social, or spatial organisation. This scenario also serves as a control case to which the other scenarios can be compared.
London maintains its positive pre-COVID-19 economic growth, with increasingly unequal impacts. Despite rapid increases in wealth for many, pre-existing social and spatial inequalities are deepened as older, minority, and poorer Londoners are often excluded from the city’s recovery.
Brexit means there are fewer European migrants, but economic growth continues to pull young, highly skilled workers from within the UK and internationally (non-EU) into London. London’s development and entertainment sectors continue to cater to these younger and wealthier residents, further transforming the city into a cultural hot-spot. Older, poorer, and more marginalised residents are implicitly and sometimes explicitly excluded from this cultural growth as locals are put out of business by high rents. Parts of social housing estates and ex-industrial sites are redeveloped into luxury flats, retail and leisure facilities.
Economic growth is still the primary motivator in public policy, but increasing emphasis is put on measures to ‘green’ the city. These policies build out from existing initiatives, like incentivising private developers to include green space and traffic emissions schemes. But many of these actually increase social inequality, while only making modest environmental gains.
Existing social and spatial inequalities are made worse as the boroughs become increasingly popular areas for young, affluent professionals.
Lambeth and Southwark see an influx of residents and businesses made up of young (predominantly white) UK knowledge workers and entrepreneurs who relocate from other parts of the country. At the same time, people from non-EU countries, particularly parts of Africa, South Asia and Latin America, continue to move into the boroughs
Financial unevenness grows over time as areas like Brixton and Peckham continue to gentrify. The influx in new residents puts a strain on the already limited housing in the area, and new developments are prioritised over refurbishment or social housing as part of the economic recovery plan, pushing some long-term residents to other, lower-cost boroughs.
Britain becomes a booming offshore banking and services location, like Ireland, but far bigger. The tech sector keeps expanding as public and private sectors move towards full digitisation post-COVID-19. Smaller existing firms, having been left weakened by multiple lockdowns, either close or are absorbed by larger corporations.
There is a radical change in the employment on offer, leading to fewer ‘entry-level’ jobs. Economic success pulls migration from both inside the UK and internationally, with a focus on young highly skilled workers.
Planning regulation is loosened to facilitate increased private sector investment, and the quality of public space and services (including affordable housing) is put under greater pressure.
Attracted by economic opportunity in London, the boroughs see an influx of people, made up of young (predominantly white) UK knowledge workers who relocate from other parts of the country, and (predominantly non-white) international migrants from non-EU countries.
Spatial inequalities that existed before the pandemic are made worse, particularly as more affluent residents move into poorer neighbourhoods. Population increase and ‘churn’ continues to put a strain on the already limited housing in the area, while new developments have to be prioritised over refurbishment or social housing as part of the economic recovery plan.
Over time, more deprived areas of the boroughs become less physically attractive creating market and electoral pressure to redevelop/gentrify them as a way of improving ’quality of life’.
The London economy stagnates with a lot of work remaining remote rather than returning to central London offices. As a result, London sees a significant number of wealthier households leave the inner city.
As many jobs move online, central and inner London retail streets see a significant decline in activity. Reduced footfall and office working negatively affect local hospitality, particularly food and drink sectors, leading to lots of companies closing down as the city centre hollows out.
Councils and social services (including health service delivery) are put under pressure to keep up with rising needs. Levels of poverty and deprivation get worse as businesses and residents leave the city, which makes it even more difficult for councils to address local issues. The overall quality of the spaces people spend their time in is badly affected, with fewer new affordable houses. Existing housing is less safe as owners have less money to maintain them. Squatting returns as homes become abandoned.
London falls into an ‘orderly management of decline’ scenario much like that of the 1970s and early 1980s, but city-wide decline does create opportunities for local economies and new businesses in the cheaper space now available.
Lambeth and Southwark follow London into economic decline, losing middle- and upper-income residents as well as larger businesses to suburban areas in outer London and the surrounding counties. But certain changes create new opportunities for parts of the boroughs to succeed, albeit more slowly than before.
Some areas capitalise on the fact there are fewer large firms, leading to small but thriving pockets of hyper-local independent businesses operating on low-cost structures. Neighbourhood high streets like Rye Lane and Brixton prove to be adaptable and thrive as residents spend more time and resources shopping closer to home.
Local business development creates a sense of value and ‘ownership’ within communities, but overall perceptions of inner south London revert to 1970s-style narratives of deprivation and decline.
Brexit brings a major decline in globalisation and international trade, with Britain becoming more self-sufficient in sectors like agriculture, pharmaceuticals, science, manufacturing and energy.
The combined effects of COVID-19 and Brexit significantly change UK immigration, with low international migration continuing long after COVID-19 has been dealt with. With a relatively strong economy, internal migration into London (particularly by younger people) from the rest of the UK increases to compensate for low levels of international movement.
Fewer international residents and businesses leads to a less rich cultural experiences, and we lose the current unique eating and dining, arts, and entertainment experiences.
Lots of EU nationals leave the boroughs while UK citizens from outside London arrive. Over time, this change leads to a more British-born, though still diverse, Lambeth and Southwark. Both areas also see their population age become more closely aligned with the rest of the UK, meaning fewer working-age residents and more young and elderly people.
With less change in the boroughs’ population, there are opportunities to increase trust in local government, allowing services to be planned more sensitively. Lambeth and Southwark see fewer new cultural innovations and social movements and are more dependent on domestic investment as fewer international companies invest in them.
COVID-19 leaves society more economically and politically cautious as London and the UK prioritise stability in the face of global-scale crises. This response leads to a greater emphasis on quality of life and less on GDP growth.
The economy sees minimal growth, with government policy designed to deliver cautious economic development and environmental sustainability. This risk avoidance means there is a lack of investment by the business community, and lots of pandemic-mitigation measures become permanent, like less travel, remote working, and a desire for more household space.
Government at all levels prioritise access to health and wellness services, organising the economy around principles of care. More care is taken over the built environment, with new and redeveloped housing designed to promote physical and mental well-being and streets and public spaces reimagined to be greener, more welcoming, and more accessible.
Technology is used to deliver and optimise healthcare, made easier by increased citizen surveillance as COVID-19-related digital programs are rolled out long-term.
Public and political policies prioritise climate change action, as people become more conscious of the ‘global’ and ‘emergency’ implications of the pandemic.
The population changes drastically as immigration and travel policies that started in the pandemic become permanent.
Government at all levels creates new policies that take a different approach to quality of life, the environment and healthcare. In Lambeth and Southwark, this change means reprioritised spending on healthcare and quality-of-life like maintenance of public spaces, parks, and housing estates.
A series of policies are aimed at groups on lower incomes and others in need of specific attention. Relative deprivation in Lambeth and Southwark goes down, as the boroughs commit to early and effective health interventions, focused on reducing health inequalities like gaps in life expectancy.
Changes to the built environment, both in and outdoors, create more harmony between human and environmental well-being, including increased access to attractive and energy-efficient housing and an increase in green space per resident.
There is an emphasises on local hiring in the development of new civic projects, creating well-paying jobs for residents who no longer need to travel across the city to access work. However, taxes are higher and disposable incomes lower.
While these scenarios are not predictions, thinking through how imagined futures could play out over the short- and medium-term provides a useful tool for programme and policy planning. The following timelines highlight potential implications for each scenario at different timescales, with a particular focus on the issues and policy levers most relevant to our work: Public Health, Housing, Business & Retail, Public Space & Environment, and Young People (14-30 year olds).
Based on the stats, lived experience data and scenario mapping in this research, key recommendations include:
This research has been carried out during one of the most extraordinary periods of contemporary world history. The pandemic and Brexit between them will totally reshape the UK and its economy. Cultural and social norms may also change quickly, and a report of this kind provides an opportunity to stop and consider what has happened and how we should respond. Has “everything changed forever” or will we get back to normal as if nothing had happened? The truth will probably lie between these extremes, though it is almost certain there will be permanent changes to the economy and society.
Lambeth and Southwark have the assets they need to address health inequality, and develop policies, services and infrastructures that are economically beneficial for far more of their residents. Relatively small changes could deliver vastly improved outcomes. 2021 will provide an opportunity to re-set public policy for the better.
We hope this report provides the basis for debate and then action. We’re here to help put health equity at the heart of policy. For tailored briefings, help reaching community researchers, or to learn more about our local data insights, please get in touch.
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