Understanding urban health: Thinking large and small

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Improving population health in towns and cities requires both an overarching city-wide strategy and a granular understanding of the needs of local neighbourhoods, as Chris Naylor and Kieron Boyle explain.

Cities are places where close neighbours can inhabit almost entirely separate worlds. Most of us know this intuitively, but you can also see it clearly in health statistics. 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.

There are no borderlines on the roads, but differences in health outcomes between these two small neighbourhoods – each comprising around 3,000 households – are very real. Inequalities like this suggest that working with very local factors, as well as addressing city-wide determinants of health, should be a key part of efforts to improve the health of urban populations.

Four in five of us in the UK now live in towns or cities, so understanding how the urban environment shapes our health and wellbeing is of national importance. The King’s Fund and Guy’s and St Thomas’ Charity, the urban health foundation, are working together to help advance the knowledge in this area. By combining our efforts, we can connect many different perspectives on urban health and find ways to exchange ongoing learning.

At our joint conference in June, we will be bringing together civic leaders, health professionals and community members from cities and towns across Europe and America to share their insights. There are real opportunities for places big and small to learn from each other and to collaborate on shared challenges.

A neighbourhood and city-wide view is needed

This sharing of ideas comes at an opportune time. Warren Heppolette has made the case that we are witnessing a re-emergence of civic leadership in England’s towns and cities. This is a welcome development – there are many opportunities for co-ordinated city-wide action to improve population health. International examples described in The King’s Fund’s work on cities and health show the importance of taking a whole system approach to population heath underpinned by a coherent long-term strategy.

Our sense is that this renaissance in leadership at a city-level needs to be complemented by a more granular understanding of specific local neighbourhoods and – in particular – how the lived experience of people within them shapes their health and wellbeing. Context, as they say, is everything.

For example, a recent study published in Nature highlights how the relationship between place and health is both incredibly local and two-way. There are selection effects (those who are healthier and wealthier have greater choice in where they live) but also causal effects (our health is influenced by the neighbourhoods we live in).

These causal effects matter. They indicate that neighbourhood-level interventions are vital elements of strategies to improve population health and reduce health inequalities. This is exactly what Guy’s and St Thomas’ Charity is exploring through its Neighbourhood Schemes in in Faraday, Walworth, Waterloo and North Lambeth – showing how concentrating efforts and layering activities in a small geographical area can impact big health issues like childhood obesity and multiple long-term conditions.

Similarly, The King’s Fund’s Vision for population health stressed that public services need to focus, not only on helping individuals, but also on strengthening the places and communities we live in – in part because social relationships, norms and networks have such a profound impact on our health and wellbeing. 

Many factors interact to shape urban health and wellbeing

This focus on place means understanding how various risks and protective factors come together at a local level. Poor and unstable housing, high population churn, air pollution and crime are common health risks present in cities and towns. At the same time, there are many health benefits to living in cities – for example, access to cutting-edge medical care, good transport links and better employment options.

Through its place-based approach, Guy’s and St Thomas’ Charity seeks to understand how these characteristics interact in complex ways to shape health and wellbeing in its local boroughs of South London, sharing learnings with those facing similar challenges elsewhere.

For example, the charity’s From one to many research on progression to multiple long-term conditions shows that people living in the most deprived areas of Lambeth and Southwark develop conditions on average 10 years earlier than those in the least deprived areas. We need a much better understanding of the pathways that lead to such different health experiences.

At our conference next month, we’ll hear from key voices on examples of towns and cities where communities have come together to improve outcomes for the whole population. We hope those attending will take inspiration from the examples we will showcase and will come away with new ideas for overcoming the gaps between different communities and neighbourhoods in their own towns and cities.

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Pearl Baker

Carer/Independent Mental Health Advocate and Adviser,
Comment date
12 May 2019

My response was lengthily, but an accurate account of the here and now. It doesn't appear to have been posted?

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