Devolved powers could help tackle London's health inequalities

This content relates to the following topics:

London’s leaders should be empowered to take stronger action to boost public health in the capital and reduce the city’s stark health inequalities, a new report by The King’s Fund argues.

The role of cities in improving population health warns that economic inequality in London is leading to inequality in health outcomes. It highlights evidence of shocking variations in health inequalities in the capital:

  • healthy-life expectancy varies between boroughs by as much as 19 years for women and 15 years for men 
  • London’s most deprived children are twice as likely to be obese than the least deprived
  • death rates from common causes such as heart or lung disease are twice as high in some boroughs as others. 

The King’s Fund’s report draws on case studies and interviews with local leaders in 14 world cities including New York, Madrid and Copenhagen to find examples of successful action to improve residents’ health. It 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. Examples include:

  • 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).

London Mayor Sadiq Khan has made a high-profile commitment to improving air quality and has consulted on a new health inequalities strategy. The city has also recently negotiated new devolved powers over some aspects of health and care, through a devolution agreement with national bodies. However, the report calls on the government to consider devolving further powers to London and other cities to boost efforts to improve public health and tackle health inequalities. Compared with similar cities around the world, London has limited autonomy from national government and less control over revenue raising, with 90 per cent of tax revenues in England being raised centrally. 

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

'The same characteristics that make London an engine of growth, innovation and creativity often lead to inequalities and concentrations of poverty and ill health. This won’t change unless more is done to reduce health inequalities and tackle growing health problems caused by bad housing, poor air quality and other public health issues. 

'The Mayor and borough leaders can have an impact on the health of Londoners by working together and taking co-ordinated action to tackle the issues that affect the health and wellbeing of people across the city. Internationally, the cities that have made the fastest progress are those where leaders have invested their own political capital in improving the health of the population. Policy-makers should look at giving London new powers to help the city’s leaders tackle the health problems it faces.'

To improve public health in London, researchers recommend:

  • strengthening connections with other cities in the UK and beyond, to share learning and to work together on issues of common concern
  • investing in additional public health expertise at city level to help co-ordinate work across the city 
  • building links between city government and London’s world-class universities, research organisations and businesses to help to drive innovation
  • making it easier for successful approaches to tackling public health issues to be shared and spread between boroughs
  • ensuring the Mayor’s Transport Strategy is implemented successfully. This aims to make promoting health a central concern in decisions about the city’s transport system.

Notes to editors

For further information, or to request an interview, please contact the Press and Public Affairs team on 020 7307 2585 (if calling out of hours, please ring 07584 146035).

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.