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The GLA levers framework

Diagram of GLA levers framework summarising the different mechanisms (levers) that officers can use to promote health in their work. These are organised into three pillars: understand, influence, and act, corresponding to the stages of policy or programme development. There is an arrow to show that from working in each pillar in turn (understand to influence to act) activity will require more resources and/or intervention.

The GLA levers framework.

This diagram shows the GLA levers framework and summarises the different mechanisms (levers) that officers can use to promote health in their work, thus showing what we can do to improve health. In the diagram, the levers are organised into three pillars: understand, influence, and act, corresponding to the stages of policy or programme development.

  • The first heading is 'Understand', and the levers listed under it are: conduct or initiate research or evaluation; collect, analyse and share relevant health data; and provide training.
  • The second heading is 'Influence', and the levers listed under it are: produce guidance and best practice; educate and inform; and advocate. Two levers sit across both 'Understand' and 'Influence': provide technical assistance; and bring people together.
  • The third heading is 'Act' and the levers under it are: fund/implement projects and interventions; issue/revoke licenses and permits; regulate and legislate; raise/reduce taxes or fees; and support employees and colleagues.

Underneath the pillars and levers, there are three enablers which underpin and support all of our actions: corporate social responsibility; equality, diversity and inclusion; and community engagement.

The GLA levers framework is organised into three pillars: understand, influence, and act. The activity within each pillar is set out below, with examples. 

Understand 

These are levers that can be used to increase understanding of health and the factors that can positively or negatively impact it. 

Conduct or initiate research or evaluation 

This includes understanding the problems and opportunities – including health needs and inequalities, as well as whether a policy or programme is effective and what health co-benefits there may have been. 

Example: 

  • The GLA (funded by the Department of Health and Social Care) commissioned a specialist and supported housing (SSH) research and market development project.    
  • The project built an understanding of the needs, gaps and barriers to provision of SSH for adult Londoners experiencing mental health needs, and to support market development by identifying opportunities to bring together partners, capital and revenue funding to meet needs.   The work will inform the future of SSH provision in London. 
Collect, analyse and share relevant health data 

Gathering intelligence allows for definition of, and response to, an issue. Collecting health data means that changes in health and inequalities can be measured and understood. 

Example: 

  • The London Violence Reduction Unit (VRU) uses integrated indicators from the Public Health Outcomes Framework and so they are pro-actively considering the same data as health colleagues encouraging both sectors to work towards the same outcomes. 
Provide training 

Providing training may involve convening other teams or partner organisations to discuss and share learning about health risks and health improvement. 

Example: 

  • The GLA provided training to the GLA environment teams on a range of environmental hazards to health, including noise, thunderstorm asthma and high temperatures. This supported the teams to understand how health and health inequalities are relevant within their policies which cover climate adaptation, Green Infrastructure, and Net Zero.  

Two of the levers could be both tools to increase understanding and influence others: 

Provide technical assistance 

Technical assistance plays a role across the policy development, influence and delivery phases through taking the opportunity to notice problems, have conversations, and signpost to wider health offers. 

Example: 

  • The Public Health Unit supported the policy development and rollout of the London-wide expansion of ULEZ through, for example, developing mitigations for people with disabilities; engaging NHS organisations, health professionals and high-profile health stakeholders regionally and nationally in the consultation, and supporting with communications; and registration of London NHS trusts for the ULEZ patient reimbursement scheme. 
Bring people together 

Bringing the correct partners, including community and people with lived experience, around the table during policy development can ensure that they can support the process and highlight any potential risks or benefits to health. 

Example: 

  • The London Drugs Forum activities included convening London Coroners to improve the timeliness of drugs deaths reporting. The forum improves partnership working on drugs in local areas, as well as cross-London between police, community safety and health partners. 

Influence 

As well as the above, officers can influence a person, team or organisation towards health promotion through the following levers: 

Produce guidance and best practice 

This ensures that an approach/intervention is implemented consistently and reduces the variation that can happen when only some teams are aware of best practice.   

Example: 

  • The Mayor, working with London Councils, provides guidance and makes best practice policy recommendations for the delivery of Severe Weather Emergency Protocol (SWEP) and uses resources and influence to encourage councils to adopt these ways of working.  
  • SWEP is short-term, temporary shelter that is provided to anyone sleeping rough in extreme weather conditions, regardless of their local connections or recourse to public funds.  
Educate and inform 

Using communication channels to share knowledge can impact health through affecting people’s behaviour or organisations’ processes.   

Example: 

  • Comms messages on the Mayor’s communication channels such as X, Bluesky and LinkedIn include encouraging vaccination, informing about heat and cold weather risks, and promoting defibrillators. 
Advocate 

Working internally and externally (for example, with public and voluntary sector organisations) to advocate for policy direction that promotes and improves Londoners’ health.    

Example: 

  • The PHU and rough sleeping team worked jointly with ADPHL and OHID London to successfully advocate for pan-London funding and commissioning of inpatient detoxification provision for rough sleepers in London.

Act 

Through policy and programme delivery, action can be taken to improve health directly or indirectly: 

Fund/implement projects and interventions 

Implementing non-health projects can result in health co-benefits for recipients, for example if they link local communities up with employment and training opportunities or reduce costs of goods and services.  

Example: 

  • The Mayor’s free school meals programme is primarily addressing the cost of living for families but includes significant health benefits. The programme has both reduced family stress, and made a positive contribution to children’s nutrition at school. 59% of parents report that their children have tried new foods as a consequence of the policy, with 35% saying their children are physically healthier since the introduction of the policy. 
Issue/revoke licenses and permits 

Public sector organisations have a responsibility for a wide range of licenses and permits to authorise access to goods and services, and incentive schemes to raise standards. This also involves consideration of the benefits and harms of issuing or extending licenses for restricted goods. 

Example:

  • TfL’s direct vision standards requires all heavy goods vehicles (HGV) entering London to have suitable visibility through their cab windows to promote safe driving practices and reduce the risk to all road users, especially people walking and cycling. In 2024, TfL introduced a world-leading policy to strengthen the minimum requirements to further reduce road danger and save lives. 
Regulate and legislate 

Building health improvement into strategies on housing, transport, economic development, and spatial development. 

Example: 

  • TfL amended their advertising policy to ban advertisements of food high in fat and sugar on the entire TfL network, to support the healthy weight of children in London and reduce inequalities in childhood obesity. 
Raise/reduce taxes or fees 

Financial measures may be used to promote or discourage health related behaviours. 

Example: 

  • The Mayor offers free and discounted travel to specific population groups, such as young people, care leavers and the elderly. This incentive encourages active travel as part of a longer journey using public transport, for example by walking to the bus stop. 
Support employees and colleagues 

This includes championing safe and healthy working conditions at GLA Group and partner organisations, including considering ways of maximising employee health. 

Example: 

  • The public health unit worked with TfL occupational health to develop a smoking cessation pathway for employees, from their employer to community-based health services.  
  • The Mayor’s Good Work Standard has introduced criteria for supporting workers to stay safe during hot weather.  

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