Devolved powers could help make cities healthier

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Metro mayors and other city leaders should be empowered to take greater responsibility for improving the health of the nation’s cities, a new report by The King’s Fund argues.

The role of cities in improving population health draws on case studies and interviews with local leaders in 14 world cities including New York, Madrid and Copenhagen to find new ways of tackling public health challenges in England. It finds that the same characteristics that make cities engines of growth, innovation and creativity often lead to inequalities and concentrations of poverty and ill health.

With two in every five people in England now living in an area covered by an elected mayor, the report highlights the role that further devolution could play in boosting public health and reducing health inequalities. Compared to other cities around the world, England’s cities have limited autonomy from national government and less control over revenue raising, with 90 per cent of tax revenues being raised centrally. The report calls on the government to consider extending further tax-raising and regulatory powers to cities. 

The report finds that international cities that have stronger powers have been able to use them to have a positive impact on the health of their populations, including:

  • introducing new regulations, for example, to control the advertising and sale of unhealthy foods (eg, New York and Amsterdam)
  • using planning powers to create public spaces that encourage physical activity (eg, Paris and Barcelona)
  • investing in public transport and cycling/walking routes to reduce traffic and improve air quality (eg, Copenhagen and Berlin)
  • empowering local people to create health-promoting neighbourhoods with strong social ties and vibrant community life (eg, Tokyo and Madrid).

The report argues that cities in England need to take a more co-ordinated approach to tackling population health challenges, bringing together the efforts of different public bodies, charities and other organisations. For example, in Amsterdam a 20-year initiative on childhood obesity involving city leaders, education and health professionals, the food industry and others has showed encouraging signs of success, with childhood obesity rates in the city falling by 12 per cent over three years.

Chris Naylor, Senior Fellow at The King’s Fund and lead author of the report, said:

'Around the world, cities are looking at what they can do to help residents live longer, healthier lives. Increasingly, leaders in cities such as Amsterdam, New York and Paris are using the powers and resources at their disposal to drive improvements in the health of their populations.

'The cities that have made the fastest progress are those where mayors and other local leaders have invested their own political capital in tackling public health issues, and where they are given the decision-making and tax-raising powers they need to take action. Granting England’s cities greater powers could help to reduce health inequalities and address growing problems caused by poor housing, air quality and other issues.'

Notes to editors

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The King's Fund is an independent charity working to improve health and care in England. We help to shape policy and practice through research and analysis; develop individuals, teams and organisations; promote understanding of the health and social care system; and bring people together to learn, share knowledge and debate. Our vision is that the best possible health and care is available to all.