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Urban health

By 2050, nearly 70% of the world’s population will live in cities. In the UK, over four in five people already live in urban areas. And so, we believe an understanding of urban health is more relevant than ever.

The places that we grow up, live and work impact how healthy we are. Living in urban areas, like inner-city London, carries distinct health challenges, many of which start early in life and are influenced by the wider determinants of health and wellbeing.

We seek to understand the deep causes of these health issues and explore different ways of addressing them through combining the best sources of data, robust evidence, lived experience and practical interventions.

We believe that by removing the obstacles to good health, we can make urban areas healthier places for everyone to live.

 

Defining urban health

The health challenges in urban areas are distinct from those elsewhere – in cities, the best health outcomes exist alongside the worst. Comparing two adjoining neighbourhoods of Clapham in South London, men in one area live in good health for an average of 12 years longer than those a few streets away. For women, the gap is 7 years.

The reasons for this are complex and sit at the intersection of urban diversity, the built environment and income inequalities. We spend our time exploring these intersections.

For example, if you are from a minority ethnic background you are more likely to live in an inner-city area. If you live in an inner-city area, regardless of ethnicity, you are also more likely to:

  • have low paid employment or be unemployed
  • be exposed to high levels of air pollution
  • live with multiple long-term health conditions from an earlier age
  • have access to fewer affordable, healthy food options in your local food retailers, restaurants and take-aways

These intersections also lead to challenges for health equity. Health risks and assets are not experienced equally by everyone in cities, and often much of the burden falls on the most vulnerable groups.

Urban health is not just one sector’s responsibility. It goes much wider than the healthcare system and public health authorities, and includes urban planners, civic institutions, investors, employers and residents.

For a city to be healthy, it also needs to centre the voices of all urban communities. However, many existing processes – from public engagement to policy-making and planning – disproportionately exclude organisations that are led by people from minority or lower-income backgrounds.

Life expectancy varies more in urban areas

Targeting urban health issues to work on

Urban health is a developing discipline, with initiatives like WHO European Healthy Cities Network pushing forward thinking and action around cities and health. The UN’s Sustainable Development Goals have also shone a light on sustainable cities and the importance of urban health.

Trying to improve health in cities is a complex task which involves co-ordination across sectors, over time, with different areas of focus. In order to have the most impact, we focus on a few health issues that disproportionately impact people living in cities.

These issues are exemplars of types of urban health challenges. We think of them as coordination, exploration, innovation and targeting questions. As a portfolio they engage across the commercial, social, environmental and digital determinants of health.

And while we focus on health issues prevalent in our inner-city place, our programmes also target global health problems. By focusing on global issues in a typical inner-city environment, we believe we can identify both specific insights as well as broader lessons for those acting on urban health elsewhere.

Lower incomes are linked to worse health - and we see a bigger range of incomes in urban areas

The health issues we work on are global problems

The London boroughs of Lambeth and Southwark, where we are based, are like so many other urban places. We wanted to understand how cities like ours are tackling health inequality, so we identified 10 of the most comparable cities to London and our boroughs, and over the last two years have been exploring the approaches they take to improving health, collecting data and case studies about what they’ve tried, and what was working to bridge their health gaps.

Halfway through our initial research, the COVID-19 pandemic hit. Though we were no longer able to be with our international counterparts in person, the pandemic gave us insight into the true depth of the structural and racial inequalities that are driving poor health outcomes for people living in urban areas.

We worked with Urban Institute to understand how these inequalities were playing out in real-time and understand what might be needed to rebuild environments, systems, and policies with equity at their core. What was becoming more apparent was that cross-sector collaboration is key to achieving health equity.

Understanding that large scale, systemic reform is needed to progress health equity in the recovery of the COVID-19 pandemic, we are working with the London School of Economics to develop future scenarios for what London could look like post-pandemic.

We hope that by creating a picture of potential futures for Lambeth and Southwark, those working in public policy in London and cities similar to London across the world, will consider new approaches, map out bold ideas, and see clearly the role they play in working towards an equitable and health-focused future.