The State of Urban Health

Urban life expectancy is shorter – and urban areas contain some of England’s starkest health inequalities. People living in urban areas can expect to live on average two years less than those in rural areas. And in urban areas the range of average life expectancy is much wider.

Living in deprived urban areas can more than double your risk of poor health. People living in the most deprived urban neighbourhoods experience preventable mortality rates more than two and a half times higher than those in the least deprived.

Poverty in urban areas is widespread – and for many children, it is the norm. In England’s urban areas, an average of around one in five children come from families living on low incomes, but in some areas, this rises to as many as nine in ten.

Health inequalities are structurally driven and shaped by racism and discrimination. Inequalities for people who experience racism persist across multiple outcomes related to health, including child mortality, housing, and employment, where people from minoritised ethnic groups experience worse outcomes.

Everyday environments and systems are undermining health. Overcrowding is higher in urban areas, air pollution remains a major health risk, and healthy food is often inaccessible or unaffordable.

Communities are clear on what needs to change. Some of the conditions needed for good health are trusted local relationships, accessible services, and stable community spaces.

Urban health inequalities are not inevitable – they are systemic and preventable. Urban health inequalities are not random. They are deeply concentrated within places and shaped by the conditions people live in every day, clustered within specific communities.