GLA Group Public Health Unit - Inaugural Annual Report 2024

The GLA Group Public Health Unit (GLAG PHU) has been working directly with the Mayor, London Assembly and teams across the GLA Group to embed health into their work. This brief report outlines progress since the Mayor launched the GLA Group Public Health Unit in 2022.  

The GLAG PHU is a shared service. Our GLA Group-wide remit is to improve Londoners’ health and wellbeing, and contribute to reducing health inequalities by taking a ‘health in all policies’ (or HiAP for short) approach. Our work is based around five thematic public health portfolios that align closely with GLA Group functions and Mayor’s strategic priorities. These themes intersect with the key building blocks of health and drivers of health inequalities. 

Forewords

Dr Tom Coffey OBE, Health Advisor to the Mayor of London 

The Mayor’s vision is that no Londoner’s health should suffer because of who they are or where they live. That is why he set the goal of putting health at the heart of his administration. This means making sure that policies and programmes not only shape a safer, fairer and more prosperous city, but a healthier one too.

The GLA Group Public Health Unit (GLAG PHU) has been working directly with the Mayor, London Assembly and teams across the GLA Group to embed health into their work. The COVID pandemic followed by the cost-of-living crisis has put more people under pressure which has had a continuous impact on health.

Together, the GLA Group has collaborated to establish the GLAG PHU. This shared service works across the group to progress and embed the health in all policies approach. It will be the cornerstone of work over the next four years to maximise the group’s collective efforts to tackle the Mayor’s top priorities. This approach will strengthen his leadership towards making London the world’s healthiest global city.

The GLA Group organisations are ‘anchor institutions’. As such, they need to look outwards and play a role in the wider community as employers, and commissioners of services. Together, the GLA Group plays a major role in the lives of Londoners by influencing the building blocks that impact a healthy life: housing, education and training, transport, financial security and our public places and green spaces.

London is the most diverse city in Europe. It’s dynamic and always changing. But that change is not always uniform or equal. Our diversity is reflected in our vibrant cultural fabric, but also in the deep social and economic disparities experienced by different groups. These disparities are among the biggest drivers of health inequalities in the capital; they impact a person’s quality of life. That’s why the work we do to improve Londoners’ health has to be about tackling health inequalities.

Professor Kevin Fenton CBE, Statutory Health Advisor to the Mayor of London, GLA and London Assembly

The GLA Group Public Health Unit was set up in 2022 to strengthen capacity and collaboration on public health across the group. It is a step-change in partnership working across London, providing an important channel to integrate the group’s work with the capital’s wider public health system in London. Together, it will help us work towards our shared ambition to make London the world’s healthiest global city.

Healthy life expectancy is the main health inequalities indicator. London has better healthy life expectancy than other regions. However, there is inequality within London and between boroughs, and evidence that improvement is stalling. The latest London Health Inequality snapshot shows that improvements have slowed and in some cases are worsening.

London has taken huge steps in tackling poor health over the last few years, examples include: work on air quality; services for women and girls who have experienced violence; improving mental health through workplace, community and school programmes. All show the GLA Group’s impact on Londoners’ health.

GLA Group Public Health Unit

Vicky Hobart, GLA Group Director of Public Health and Deputy Statutory Health Adviser

The GLA was set up in 2000 and has matured into a group of organisations working for the city under the policy direction of the Mayor of London. These include Transport for London, the Mayor’s Office for Police and Crime, London’s Violence Reduction Unit, the London Fire Commissioner, and Old Oak and Park Royal Development Corporation.  Over the years, we’ve discovered incredible opportunities to improve Londoners’ health and shape a healthier city through our policies and programmes across the group.  For example, creating better conditions for Londoners to live in good health, such as healthy streets and clean air.  Active collaboration and seeking co-benefits across the group’s work is key to progressing this health in all policies approach.

This brief report outlines progress since the Mayor launched the GLA Group Public Health Unit in 2022. It is a shared service hosted by the GLA Communities and Skills directorate.  We have recruited experienced public health professionals and a talented team, and the unit is now resourced to the target operating model.  We organise our work through five thematic portfolios (details below). These reflect areas where we can make big health gains by building health considerations into policy, strategy and programmes.

We have established a health in all policies skills development programme, with our first masterclass in October 2023. This was followed a webinar in March 2024. Going forward, the unit will provide in-depth quarterly sessions and online resources as the foundations for wider workforce awareness of the health in all policies approach.

The reality is though, that for many Londoners it’s become harder to live in good health. So, over the next four years, working together, we must be focused, innovative, bold and collaborative in how we tackle health inequalities.

We will continue to work very closely with the Mayor’s Health, Children and Young Londoners Unit led by Jazz Bhogal, and partners in the Office of Health Improvement and Disparities, local government, and the NHS.

This report illustrates the breadth of what we’re doing through our portfolios of work and we look forward to working with colleagues into the future.

Mission

London has the potential to become the world’s healthiest global city, where all Londoners have the best opportunities to live a long life in good health and no one’s health suffers because of who they are or where they live. 

Our mission is to help the GLA Group improve Londoners’ health and wellbeing, by keeping them safe, preventing ill health, and reducing health inequalities. This includes identifying opportunities for health and wellbeing co-benefits across GLA Group policies, programmes and strategies. This is called the health in all policies (HiAP) approach. We have developed the GLA Group Levers Framework to support this and to improve the social, economic and environmental conditions that people live in. We work across the group providing specialist public health skills and expertise to improve Londoners’ health and reduce health inequalities. 

We serve the Mayor and London Assembly and Assembly Health Committee, and we work closely with the wider London public health system as outlined below.  

 As the GLAG PHU, we aim to add value to the GLA Group’s work through: 

• strategic group-wide collaboration to embed the health in all policies approach 
• providing access to consistent, high quality public health advice and support 
• influencing and networking to help tackle complex and ‘wicked’ problems 
• development of a ‘centre of excellence’ for global city public health practice – attracting education, research and development resources 
• providing a more resilient public health function with capacity, organisational memory and continuity.  

GLA Group Public Health Forum governance 

The GLA Group Public Health Forum was launched in July 2022. It is a new strategic forum underpinning action to improve public health across the GLA Group. The co-chairs are Professor Kevin Fenton and Dr Tom Coffey.  

The forum brings together the Mayor’s most senior health advisors, the GLA Group Director of Public Health, and senior representatives from each group organisation. The aim is to maximise the contribution their organisations make to improving health and tackling health inequalities in London, both individually and collectively. See Appendix 1 for GLA Group Public Health Forum members and observers. 

Group members and observers come together to: 

• shape the strategic direction of the PHU’s work 
• identify current opportunities to improve health and reduce health inequalities 
• collaborate on public health issues within and across the GLA Group.

The forum also oversees the two core work programmes of Health in All Policies and Resilience. Forum agendas have included seasonal preparedness, mental health, the Serious Violence Duty, smoking cessation and health inequalities.  

The GLAG PHU also reports to the GLA Group Collaboration Board, which steers GLA Group shared service arrangements.

The health of Londoners is an asset: it enables people to reach their potential; reduces service demand; boosts economic growth; and fosters stronger communities. The Mayor of London made a manifesto commitment to tackle the health inequities faced by Londoners through his Health Inequalities Strategy. He wants to ensure the group, along with our partners, consider health impacts across all of our work. The GLAG PHU was set up to support this and help the wider group play its part in full.

The GLAG PHU has developed and started to rollout a strategic approach for activity across the group. The Health in All Policies (HiAP) programme recognises that GLA Group activity can have a significant impact on the health of Londoners. It seeks to harness that potential to address the causes of ill-health, promote good health and reduce health inequalities.

HiAP is already influencing the Mayor’s approach to transport, housing and urban planning, the environment, education, finance, community safety and economic development. More detail on this can be found later in this document.  During 2022-2024, we worked with many teams across the group to embed public health benefits into policies and programmes. We also launched our HiAP skills building programme with a masterclass (October 2023), and later held two webinars for the wider GLA Group.

Health Resilience

A core function of our unit is strengthening the GLA Group’s role in ensuring London is resilient to health shocks and stressors. This includes responding to health threats.

We work closely with health system colleagues in the UKHSA, OHID, and the NHS to assess public health risks and threats. We also provide technical support across the GLA Group to ensure responses are effective, proportionate, and based on evidence. This includes preparing for extreme weather events (both cold and heat), addressing infectious disease risks, and managing environmental hazards. In 2024, we agreed on standard protocols with the GLA Group Public Health Forum for responding to health protection incidents such as COVID-19, flu, and measles. This will ensure a consistent approach in the future.

To support Londoners’ health, the PHU works with the NHS and partners. We use the Mayor’s communications channels and voice to raise awareness on issues like Hepatitis C and to promote vaccination and seasonal health advice. Beyond immediate responses, the unit is also dedicated to supporting long-term resilience against future health threats, including those posed by climate change.

Our specialist public health support is based on five thematic portfolios that align closely with GLA Group functions and Mayor’s strategic priorities. These themes intersect with the key building blocks of health and drivers of health inequalities.

Community safety and vulnerable young people portfolio

Led by Farrah Hart, this portfolio programme supports the Mayor’s Office for Policing and Crime (MOPAC) and London’s Violence Reduction Unit (VRU).

This case study example shows how public health input can shape strategic activity and build system-wide stakeholder relationships. We worked with MOPAC to frame and set out the public health approach to inform the Police and Crime Plan, and Violence Against Women and Girls (VAWG) Strategy. Our expertise helped to:

• establish a preventative and system-wide agenda on VAWG service delivery by starting engagement with the health sector. This resulted in NHS led workshops, conference and VAWG summit with pledges made by health and public health stakeholders, including the Association of Directors of Public Health London.
• ensure that health ICB stakeholders are now actively engaging with the VAWG programme. This includes commenting on service specifications and participating in procurement panels for MOPAC’s commissioned services. 
• support the strategic pan-London approach to drugs and establish the London Drugs Forum. The forum’s work has been recognised as best practice nationally by the Association of Police & Crime Commissioners/APCC Deep Dive on Combating Drugs Partnerships. This forum’s activities included convening London Coroners to improve the timeliness of drugs deaths reporting. There is also improved partnership working on drugs in local areas, as well as cross-London between police, community safety and health partners.

We also helped to link and amplify the work of London’s VRU to raise its visibility with wider public health system stakeholders and increase its visibility. This has led to more engagement with the health sector, including:

• working with London’s Directors of Public Health for the appointment of a lead DPH for violence reduction.
• greater engagement with the Child Death Overview Panel (CDOP) professional network in London. There is also more system awareness of the VRU’s role in helping to reduce child mortality in London.
• Input to the VRU’s trauma informed research project. This will develop a consistent, collaborative approach to understanding and putting in place trauma informed and trauma-responsive practice across London.

Housing and vulnerable adults portfolio

Led by Emma De Zoete, this portfolio works across housing and a range of social policy areas. This builds on the legacy of COVID work and relationships with housing and health stakeholders.

In the past two years, we have worked in partnership to improve outcomes for people experiencing homelessness, and other housing issues including:

• reviewing London's guidance for those experiencing rough sleeping in extreme hot weather. In addition, brokering a pan-London approach on communal sleeping and escalation process for partnership action in extreme cold weather. Both contributed to protecting people experiencing sleeping rough in extreme weather.
• working jointly with OHID London securing continued pan-London funding and commissioning of the inpatient detox unit at St Thomas’s hospital for rough sleepers. In addition, a range of other pan-London drug and alcohol partnership work including on co-occurring mental health and drug conditions.
• led GLA and public health input to a successful partnership bid for £1.6m to fund pan-London specialist step down beds. These provided support for people experiencing homelessness or at risk of it. Other regional enabling activity included a pan-London inpatient audit which identified gaps in health, housing and social care provision for this group.
• working with London Councils, GLA, NHS to convene a Homeless Health and Care Summit (Sept 2023) bringing together housing, health and social care to discuss homelessness. Joint sponsorship was secured from Directors of Housing, NHS England, Directors of Adult Social Services (ADASS). Outputs are supporting further discussions on housing, health and care partnership work.
• using the Institute of Health Equity’s review on Housing in London, to support housing and health priorities in London.
• securing DHSC funding for work to build an understanding of the needs, gaps and barriers to providing Specialist and Supported Housing for adult Londoners experiencing mental health needs, and support market development by identifying opportunities to bring together partners, capital and revenue funding to meet the needs of this group of people.

We have improved services to support asylum seekers health and focus on understanding poverty:

• following reports of Londoners struggling to access healthcare, including the COVID-19 vaccine, we raised the issues identified with NHS and Public Health colleagues. As part of learning from the pandemic, a new Migrant Health Task and Finish group and the London Legacy and Health and Equity Partnership was developed. This aims to improve accessible and suitable healthcare provision for migrants and asylum seekers. Our support includes providing leadership on issues spanning the wider London Strategic Migration Partnership.
• supporting the healthcare system to respond to the findings of the the Institute of Health Equity’s report on The Rising Cost of Living: a review of the interventions to reduce impacts on health inequalities in London.
• development of section within the London Health Inequalities Snapshot on poverty in London, and mapping of information available and gaps.

Planning, climate and resilience

Led by Emer OConnell, this portfolio brings together work to progress public health benefits via the planning system and applying a Health in all Policies approach to environmental policies across the GLA. Emer also leads the Resilience work programme.

We have worked strategically at the London system level to build capacity for climate and health:

• providing support to the Mayor’s independent London Climate Resilience Review for London (July 2024), including both public health and topic-specific expertise. In addition, supporting and coordinating input from health and care partners in London. This included coordinating and chairing a Climate Resilience for Health workshop to engage health system partners in the review. The workshop had excellent representation and engagement from across Integrated Care Boards, NHS emergency planning and the NHS London Estates Development Unit.
• presentations on climate and health to the London Clinical Executive Group, Greener NHS Programme Board, and NHS Trust sustainability network to build capacity and make the case for action.
• capacity building and engagement with the boroughs through co-chairing the London Climate and Health network, which is supported by the Association for Directors of Public Health.

We have supported the GLA Group through HiAP and health capacity-building:

• GLA Environment teams by delivering training on the impact of noise on health, and thunderstorm asthma implications for climate adaptation in London, and providing public health expertise to the “Properties vulnerable to heat impacts in London” report. We also convene the GLA Environment and Health Officers group to coordinate and collaborate across health and environmental issues, including air pollution, the London Environment Strategy and climate change.
• TfL on emerging vector-borne diseases
• London’s health resilience on the development of Exercise Helios to test emergency preparedness for an extreme heat event in London; and update of London’s emergency planning framework for pandemic flu
• convene the GLA Measles Coordination group and delivered a lunch and learn on measles to support an organisational response to the London outbreak
• OPDC on their suite of planning guidance documents ensuring public health considerations are embedded.

Air quality and transport portfolio

Led by Katie Hunter this portfolio supports work with TfL, transport and environment teams where there is an established history of the public health approach exemplified by Healthy Streets.

The GLA and GLA Group organisations have a track record of working together to deliver the Mayor’s air quality policies, this includes:

• supporting 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.
• working with the GLA Air Quality team to deliver a successful Mayoral Air Quality and Health Summit (February 2022) with active participation by senior leaders from the health and care system. As a result, stakeholders committed to take further action to address the recommendations in the coroner’s Prevention of Future Deaths Report.
• PHU co-authored the London case study for the Chief Medical Officer’s Annual Report 2022 on Air Pollution. This showcased London’s strategic approaches to improving air quality, actions taken and the impact of interventions.
• PHU worked with London’s health and care system to establish the London Air Quality and Health Programme Office. This has collaborated with partners across the capital’s healthcare system to develop the UK’s first targeted air pollution alerts for health professionals. The alerts for health professionals in London’s GP practices and emergency departments were launched in February 2024. The aim is to provide advice for high pollution episodes.
• alongside efforts to tackle air pollution, the Mayor continues to support the work of partners across the system. This includes endorsing Healthy London Partnership’s annual #AskAboutAsthma campaign, which we support as part of the Healthy London Partnership's annual Ask About Asthma week.

We support delivery of a wide range of TfL and GLA Group transport priorities in the Mayor’s Transport Strategy. The aims are to boost sustainable transport mode share, increase the proportion of Londoners doing at least 20 minutes of active travel each day, and reduce road danger in London by eliminating all deaths and serious injuries from London’s streets by 2041 (Vision Zero).

• the NHS is one of the largest employers in London and increasing active travel in both staff and patients would lead to significant health benefits. We have worked with the London health system to promote and increase active travel across the health sector. This includes presenting the health case for increasing active travel at strategic events such as; the NHS London Sustainability Summit for Health and Climate Leaders, webinars and Association of Directors of Public Health (ADPH) London meetings.
• we worked with OHID (national) to include a slide on active travel in the national training slide pack used by Physical Activity Clinical Champions to deliver training on physical activity to health professionals.
• together with TfL, we worked with NHS England’s Greener NHS and Net Zero Travel and Transport teams to help develop the NHS Net Zero Travel and Transport Strategy (October 2023) to include active travel recommendations.
• supported the development of TfL’s Equity in Motion plan (February 2024) which aims to make London transport fairer, more accessible, and inclusive
• with TfL, we convened a reducing road danger and health inequalities workshop (October 2023) for Directors of Transport, Directors of Public Health and NHS sustainability leads. The aim was to enable public health teams to support borough work on Vision Zero.

Economy, culture and children portfolio

Led by Alice Walker this portfolio provides specialist PHU support to children and young people programmes and work with the GLA Skills and Employability team and Culture and Creative Economy team.

We provided initial and continuing technical advice and leadership for:

• monitoring and evaluation of the Mayor’s Free School Meals policy.
• co-chairing the School Superzones Steering Group, providing strategic oversight on expanding the programme (including awarding 50 grants to create 85 zones across London and commissioning an evaluation). In addition, providing leadership on the programme’s future.
• leading collaboration between World Health Organization (WHO) and the GLA Culture and Creative Industries team. This includes piloting and providing feedback on the WHO Health in All Policies tool and supporting strategic vision for Creative Health City Approach. As part of continuing support to the Culture team, we are trialling embedding a public health policy officer within Culture. This will support with applying HiAP across the Culture and Creative Industries portfolio, including London Borough of Culture and 24-Hour London teams.
• supporting the Skills and Employability team to respond to emerging national policy, including the Work Well pilot. We also work with Integrated Care Systems to develop funding bids to DHSC on early intervention and support, this offers participants an expert assessment of their health-related barriers to work.
• working with OHID on the child health agenda – supporting work and perinatal mental health, baby-friendly initiatives. We provided strategic and technical input into the Reducing Child Mortality Strategic Action plan.

Data and evidence

We have helped to strengthen data within the GLA Group and across London, including:

• co-leading production of the Snapshot of Health Inequalities in London. This is accessible to all on the London Datastore as a resource for data-informed action.
• co-chairing the London Health Equity Data Collaborative. This brings together key partners to enable and inform action to achieve health equity in London through innovative use of population-level data.
• working with the Institute of Health Equity to build the evidence base with reports on housing, skills and cost of living, and the relationship to health inequalities.

Academic and research collaboration

There is much evidence of how national and international, regional and city–wide strategic interventions can help to improve health. We are involved in several academic and research collaborations. This will help to support our city-wide strategic role to lead system level change. It will also support our aspiration to be a centre of excellence for public health professional development across London. Examples of our collaboration include:

• a submission to WHO’s pilot project on city indicators for the prevention and control of non-communicable (chronic) diseases and injuries. This includes the development of a London case study on Air Quality Monitoring.
• the international Partnership for Healthy Cities Summit in London (March 2023) and the Partnership for Healthy Cities Air Quality Monitoring workshop in London (July 2023). This included contributions from Professor Kevin Fenton and the GLA Air Quality team (Good Growth Directorate).
• collaborating with academic partners on UK Research and Innovation research funding proposals to address evidence gaps (mental health and community development).
• collaborating with other Mayoral combined authorities as part of the Combined Authorities Programme, with a £1.3m Health Foundation grant, led by West Midlands Combined Authority. This helped identify areas for collaboration and mutual learning for strategies to address regional health inequalities work.

GLA Group Public Health Forum Members, March 2024

• Dr Tom Coffey - Co-chair: Mayor’s Health Adviser, GLA
• Prof Kevin Fenton  - Co-chair: Mayor’s Statutory Health Adviser, OHID London
• Will Balakrishnan: Director of Commissioning and Partnerships, MOPAC
• Kenny Bowie: Director of Strategy and MPS Oversight, MOPAC
• Jazz Bhogal: Assistant Director, Health, Children and Young Londoners, GLA
• Nicholas Coombe: Head of Service Support Prevention and Protection, London Fire Commission
• Peter Farnham: Team Leader, Development Plans, OPDC
• Philip Graham: Executive Director Good Growth, GLA
• Vicky Hobart: GLA Group Director of Public Health and Deputy Statutory Health Adviser, GLA/OHID
• Shakira Keddo: Chief People Officer, GLA
• Lilli Matson: Chief Safety, Health and Environment Officer, TfL
• Niran Mothada: Executive Director Strategy and Communications, GLA
• Tunde Olayinka: Executive Director Communities and Skills, GLA
• Lib Peck: Director, London Violence Reduction Unit
• Tim Steer: Executive Director Housing and Land, GLA
• Katrina Wayne Henry: Director of Strategy and Operations, London Violence Reduction Unit

GLA Group Public Health Forum Observers, March 2024

• Paul Brickell: Executive Director of Regeneration and Community Partnerships, LLDC
• Krupesh Hirani: Chair, Assembly Health Committee, London Assembly (2022)
• Natalie Honeybun: Senior Adviser Health and Young People, GLA
• John Martin: Chief Paramedic and Quality Officer, London Ambulance Service
• Joseph McDonald: Metropolitan Police Service
• Dr Onkar Sahota AM: Chair, Assembly Health Committee, London Assembly (2023)