Health in a global city is local: how diversity and deprivation affect health

I had the privilege of taking part in an event in March where Guy’s and St Thomas’ Charity shared its new focus. One of the Charity’s themes is tackling health in urban, diverse and deprived areas.

At the event we heard how Louisville, Kentucky, was transforming health in a city with similar patterns of deprivation and diversity to Lambeth and Southwark (the home of Guy’s and St Thomas’ NHS Foundation Trust and the Charity). And we also heard how history sticks in places – the geography of Louisville’s health inequalities today is rooted in the decision to segregate the city following the end of World War I. This emphasised vividly what I already know intellectually from our own work and that of others: that the history of place matters in neighbourhoods, whether that’s in cities or elsewhere. And it served to remind me that closer to home, much of east London’s current diabetes prevalence can be mapped against Booth’s map of poverty in Victorian London.

But we also saw how individual the experience of health is, and how the effects of living in a diverse and often deprived inner city manifest in different individuals in complex, often unpredictable ways. As an example of this we were presented with an early taste of research commissioned by the Charity to understand how health is shaped and experienced in Lambeth and Southwark today. The story of Fang, a Chinese student, was an eye-opener for me: Fang has not registered with a GP, uses Chinese medicine from home that she trusts more than western medicine, and also uses online communities to help manage her health. Fang is healthy and exists entirely outside of our health system.

The report on the research includes many others’ experience. Isobel, for example, who has a long-term condition that means she tires very easily; she believes she benefits from being in the dense centre of a major city as it means she can travel and enjoy life much more than if she lived elsewhere. But Lambeth and Southwark is also home to Teresa, who has lost her social networks and support system, which we know are very important to our health, since moving here from Brixton. The area is home to many others featured in the report too, including Tessy, who spends her life almost entirely within Southwark. She struggles to make ends meet, with little spare time and difficulty in motivating herself; she cooks in the oven rather than frying food in an effort to stay healthy, but gives up when her children refuse to eat it. She lives her life very locally, with the family making just one or two big trips to Oxford Street every year to shop as a treat.

This shows how unique every experience is, and how living in diverse, often deprived, inner city areas can be challenging to health, but also supportive. What links all the diverse experiences of people featured in the report is: first, they have little time to think about or plan their health in the way that services usually expect them to; and second, despite this, they show extreme resilience and creativity in going about their daily lives.

The Charity wants to use this experience to help it fulfil its new strategy, which includes a focus on helping to reduce the incidence and impact of multi-morbidity on local residents. At the heart of this is understanding not how deprivation, living in the inner city and diversity impact on health and decisions about health separately, but the complex interactions that result from considering them together. While that is a big ask, there is a wider interest in this, from people-powered health, to community-centred approaches to health and the emerging academic discipline of ‘super diversity’.

So, on the research side, there is much for the Charity to learn from and contribute to. The big question is how this knowledge can be used to help the health system adapt to this reality? The Charity has a head start in this given its relationship with Guy’s and St Thomas’ NHS Foundation Trust, whose chief executive also happens to be the lead for the South-East London sustainability and transformation plan (STP). As South-East London and other STPs and place-based plans in urban, deprived and diverse places around the country start being implemented, they would do well to more deeply understand, reflect on and respond to the range of experiences of Fang, Isobel, Teresa, Tessy and people like them. Only then will we know that they have been transformative.

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Comments

#549821 Julie
Associate Director
Scottish Improvement Science Collaborating Centre

This highlights the beautifully the complex interactions around Inequalities - we are trying to highlight this and the improvements that can be made at individual practitioner level in our free online course Tackling Inequalities though health and social care design on FutureLearn.

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