Key information
Publication type: General
Contents
1. Executive Summary
This 2022 Annual Report provides a high-level summary of the action taken by the Mayor of London and partners to tackle health inequalities in London – focusing on pan-London action. It follows on from the latest Health Inequalities Strategy implementation plan.
The last three years have seen two major crises. Both have impacted Londoners’ health and will continue to do so for many years to come. The COVID-19 pandemic and the cost-of-living crisis which followed soon after, both disproportionately affected specific groups, including those on the lowest incomes and those in insecure work. The impact of these crisis can be seen in London’s (and England’s) health inequalities data. While are there signs of positive change in healthy life expectancy – the headline measure of the strategy – there are some areas of concern in other important outcomes, including school readiness and children’s excess weight.
Despite these challenges, the Mayor and partners have made significant progress, with organisations working together to make a difference to Londoners’ lives. The Mayor, along with local authorities, faith, voluntary and community organisations, NHS, the public health system, businesses, and others, have all played their part in driving forward action to improve Londoners’ health and tackle inequalities. Collaborative action in London is supported by the London Health Board, chaired by the Mayor, and London’s Health Equity Group, co-chaired by the Mayor’s statutory health advisor and Regional Director for Public Health and the London Councils Chief Executive health lead.
This report is structured around the five themes of the HIS – Healthy Children, Minds, Places, Communities and Living. For each theme, the Mayor has made a key commitment - a priority project focused on a London health inequalities challenge, which the Mayor will deliver with partners. The report updates progress on each of the six key commitments (see below) by the Mayor and partners and indicating next steps.
Summary of progress on Mayoral Key Commitments
This tells just some of the story of how the Mayor and partners are influencing health inequalities. To give a flavour of the extensive work happening over the city, the report also includes some illustrative examples of other pan-London achievements the Mayor has had a role in. This reflects some of the many commitments in the 2021 implementation plan.
The report also highlights some of the wider work the Mayor and partners are doing to enable further action. As part of the Mayor’s commitment to health in all policies, he has invested in a public health unit for the GLA Group, to help ensure he is using all his levers to improve health. He is also collaborating with Professor Sir Michael Marmot’s Institute of Health Equity, to build the evidence base for “what works”, to help inform what action to prioritise in London.
The Mayor and partners will continue to work together to tackle London’s stark health inequalities, during 2023 and beyond. A refreshed Health Equity Group and a new London Partnership Board will bring cross-sector focus, insight, and commitment to London’s key health inequalities challenges. The report also signals some of the other opportunities on the horizon – with London’s five Integrated Care Systems and NHS England and NHS Improvement putting tackling health inequalities at the heart of their plans.
In the year ahead the Mayor will continue to work with partners to deliver the commitments set out in the HIS Implementation Plan, as well as new commitments made since. These include the Mayor’s £130m investment to ensure all primary schoolchildren in London can receive free school meals for the 2023/2024 academic year. October 2023 marks the halfway point of the ten year HIS, and an important time to reflect on what has been achieved in London.
2. Introduction
All Londoners should have the opportunity to live a long life, in good health. The London Health Inequalities Strategy (HIS) sets out the Mayor's ambitions to improve Londoners' health and reduce health inequalities across the city. It recognises that differences in health between individuals and groups of people are often unfair and avoidable.
People’s heath is influenced by a wide range of factors. While the health and care system play a major role, much of our health is shaped by other factors in our lives[1]. The ‘wider determinants of health’ — the conditions in which we are born, grow, live, work and age — affect our chance of living a long, healthy life. These include things such as income, housing, jobs, education, relationships, access to green spaces and amenities, and air quality. Income and health are strongly linked. Discrimination, based on our personal characteristics, such as race, gender age, disability or sexuality, can also influence our life conditions and opportunities. As such, they also influence our access to the resources and life circumstances which are linked to better health. This unfair disadvantage is compounded when people experience multiple, intersectional aspects of social exclusion.
The HIS, sits alongside and draws together other Mayoral strategies. The aim is to create the opportunity for health and equity as part of everything the Mayor does. It was developed with the insights and support of partners across London health, public health, local government and voluntary and community sector organisations. It seeks to provide a framework for London action which builds on and extends the work of those with an important role in shaping the health and wellbeing of Londoners.
3. This report
The latest HIS Implementation Plan (Dec 2021), outlined the actions the Mayor committed to take during this mayoral term, working with a range of partners to tackle health inequalities. This 2022 annual report provides a high-level summary of progress made in the year since the plan was published. Like previous progress reports (2021 and 2019) it focuses on the Mayor’s role. It also recognises the vital work of other organisations, including local government, the NHS and the voluntary and community sector.
The report is published in the context of the still unknown longer-term impact of the COVID-19 pandemic. In addition, it takes into account what we know so far about the impact of the cost of living crisis. It describes how London partners work together to tackle health inequalities at London level, before updating progress and achievements of the last year. It focuses on the Mayors’ six key commitments and provides examples of wider work.
The final section looks to the future, and the evolving health inequalities policy environment at national, regional, sub-regional and local levels. It considers the forthcoming challenges and opportunities as we enter the final year of this Mayoral term. This also marks the mid-point of the 10-year HIS strategy.
4. Context - health inequalities in London
The last three years have seen two major crises. Both have impacted Londoners’ health and will continue to do so for many years to come. The COVID-19 pandemic and the cost of living crisis which followed soon after, both disproportionately affected specific groups, including those on the lowest incomes and those in insecure work. The Institute of Health Equity, in a report for the Mayor on the impact of the Cost of Living crisis on health inequality in London concluded, ‘There has been a rapid decline in real incomes, hitting those on low incomes hardest, and this is likely to contribute to widening inequalities in health and life expectancy between the richest and poorest in London.’
Current data
In 2022, the Mayor and partners published the Snapshot of Health Inequalities in London, building on the HIS population health indicators (see below). The full impact of the pandemic on people’s health will become clearer over the next few years. However, this important report provides a “point in time” picture of Londoner’s health – an indication of the direction of travel, and a benchmark to guide future activity. It highlights what we know about the pandemic’s devastating impact on London, which had the highest excess mortality ratio of all English regions. It also provides a clearer picture of what many suspected - that the pandemic has widened and worsened existing health inequalities.
Life Expectancy and Healthy Life Expectancy are important measures of health. However, over the last decade increases in life expectancy in London and England have slowed, and even decreased during the pandemic period. The latest data (2021) showed life expectancy of 78.8 years for boys born in London (similar to the England average) and 83.4 years for girls (higher than the England average). These averages vary between different populations and between different geographies. This is demonstrated by Figure 1, which illustrates how steeply male life expectancy varies across stops on the new London Elizabeth line – a gap of over 15 years for boys born in Custom House compared to Liverpool Street.
Figure 1: Male life expectancy at different locations on the Elizabeth line.
The key measure of the HIS is Healthy Life Expectancy. This provides an estimate of how much of a person’s lifetime is spent in "very good" or "good" health, based on how people perceive their general health. In 2018-20, healthy life expectancy was similar in London to England for males at 63.8 years and above the national average for females at 65 years. Figure 2 shows how this has changed over time.
HIS Population Health indicators
A set of population health indicators were included in the HIS implementation plan 2018-20 to provide an overview of health inequalities in London. It was agreed that these indicators would be monitored to track changes in population health outcomes over the 10-year period of the strategy.
Population indicators are not targets – they are affected by a range of external factors that are mostly beyond the Mayor’s control. We recognise that these outcomes can be influenced by the policies and interventions of a range of organisations, public sector bodies and communities, and so we want to see improving trends, which show reductions in the gaps between communities affected by health inequalities and wider London populations.
The latest available data on these indicators is included in Appendix A. In most cases, it is still too early to tell what impact longer term COVID-19 and the cost of living crisis may have had on these indicators. However, there are signs of increasing health inequalities in some outcomes including school readiness, excess weight, and mortality amongst people with serious mental illness. The data also signals a worrying widening of the gap in the proportion of babies born with a low birth weight. Alongside the signal of an improvement in healthy life expectancy pre-pandemic, there are other positive signs: such as a decrease in smoking rates among all Londoner’s included decreasing inequalities, as well as in suicide rates.
Current health inequalities challenges
Hundreds of thousands of Londoners are affected by the cost of living crisis. The recent Institute for Health Equity report (Ibid.) suggests that “The rising cost of living may accelerate an existing trend of stalling life expectancy in England and falling life expectancy in some groups in the poorest communities. A decade of austerity is among the causes of this trend, disproportionately affecting the same groups who are the most exposed to the impacts of inflation, including children, women, people living with disabilities and long-term conditions, people from minority ethnic groups, lone parents, and people who are socially excluded, such as rough sleepers, undocumented migrants and sex workers.”[1]
The cost of living increases have impacted the wider determinants of health, thereby driving worsening health outcomes. Examples include housing and childcare costs rising as a percentage of income, fuel poverty, and reduced access to healthy food due to less disposable income. All of these increase the risks to Londoners’ health with the poorest experiencing the biggest impacts. Trust for London data (September 2022) showed the poorest 20 per cent of households experiencing inflation rates 1.8 times higher than the richest 10 per cent of households[2]. As such, the case for action on health inequalities remains urgent.
The enduring impact of the pandemic, exacerbated by the cost of living crisis, are also affecting London’s health and care system - a system that is already stretched and facing several challenges. For example, long waiting lists, difficulties in timely access to care, workforce issues including recruitment and retention, as well as continuing financial pressures. COVID-continues to circulate too, and the public health system remains vigilant and committed to efforts to manage the disease.
Further challenges to Londoners’ health include the twin dangers posed by air pollution and the negative impacts of climate change, such as extremes of temperature and surface water flooding.
5. Partnership: Working together in London
The Mayor of London and his Health Inequalities Strategy play a significant role in taking and driving action to tackle London’s health inequalities. However, they represent one part of a larger picture of committed, hardworking people and organisations, dedicated to making a difference. While the Mayor uses his powers to tackle health inequalities where he can, to really make a difference, collaboration is needed across a range of organisations.
The Mayor seeks to support such collaboration across the city, bringing organisations together to work towards a shared goal of improving health and reducing health inequalities. Rather than provide a top-down blueprint for action, the HIS provides an evidence-based framework. It shines a light on key challenges for the city, and encourages and enables local, sub-regional and London-level action. The Mayor recognises that much of the activity to tackle health inequalities takes place at borough and neighbourhood levels. This work is led by local government, voluntary and community organisations (including faith groups), the NHS, and businesses amongst others.
While this was already the ethos of the HIS, this was further strengthened by the experience of the COVID-19 pandemic. This tested yet reinforced the relationship between health and care partners and wider community support networks – leading to new and innovative ways of working together. Working with communities, for example through Community Champions programmes has transformed the way the NHS, councils, and others engage with and listen to communities now and in the future.
The GLA Health, Children and Young Londoners Unit (HCYL) and the GLA Group Public Health Unit continue to work closely in partnership with London Councils, NHS London, Office for Health Improvement and Disparities (OHID) and UK Health Security Agency (UKHSA) through the London Health and Care Partnership. In addition, the teams work with a wide range of partners including the voluntary and community sector, Transformation Partners in Health and Care (formerly Healthy London Partners), London Associations of: Directors of Public Health, Children’s Services, Adult and Social Services, academics, businesses, and others.
Health and care governance and leadership
The Mayor chairs the London Health Board (LHB). This brings together London’s health and care leaders to drive improvements in London's health, care, and tackle health inequalities, where political engagement at this level can uniquely make a difference. It uses its collective leadership and influence to help champion and drive change across the health and care system. The LHB has oversight of major London partnership work, including the HIS, and the London Health and Care Vision.
In 2022, responding to the asks set out in Building a Fairer City[1] – a Mayoral-funded, community-led action plan for tackling structural inequalities in London. The LHB appointed Marie Gabriel, Chair of NE London Integrated Care Board as its champion for tackling structural racism. It also set out a work programme for the health and care system, with the anti-racist practice learning hub (a key commitment of the HIS) at its centre. This is designed to support partners in their ambitions to be actively anti-racist organisations.
The London Health Equity Group (HEG) convened in 2020 as part of the strategic response to the pandemic’s disproportionate impacts on certain groups. This has continued to provide cross-sector expert advice on London’s health equity challenges, and support and inform the implementation of the London HIS. A review of the HEG was undertaken in late 2022/early 2023, to ensure that it was fit for purpose as the leadership group for tackling London’s changing health equity challenges. Following its relaunch in April 2023, the HEG will continue to build on the learning from the COVID response. It will harness these insights and build ever-stronger partnerships to take on London’s big health equity challenges.
The Mayor and London’s health and care partners are determined to build on this partnership approach. Together they will ensure that future work is informed by, and involves, London’s diverse communities. There are also opportunities to build on the partnership work taking place at neighbourhood, place/ borough, system/Integrated Care System (ICS) and London-wide as we move into the final year of the current HIS Implementation Plan. These are considered in further in the changing health inequalities landscape section below.
6. Overview of progress on the HIS in 2022
The HIS has five themes: healthy children, healthy minds, healthy places, healthy communities, and healthy living. The 2021-24 Implementation Plan included a Mayoral Key Commitment for each of these themes (two in Healthy Places), which he would work to achieve with partners. This included two key commitments continued from the original HIS, and four new key commitments. These build on the achievements made in the first term, while reflecting the changing landscape and priorities. This plan was published alongside a longer list of commitments – made by the Mayor and partners, demonstrating the wide range of activity happening in the city.
Indeed, a huge amount of work is taking place in London to reduce health inequalities; led by the Mayor (across the GLA and GLA Group) by local authorities, the NHS, the voluntary and community and businesses. This annual report does not try to be comprehensive in capturing the array of activity. Rather, in the following section, it updates progress against each of the six Mayoral key commitments, together with a few illustrative examples of achievements and partnership work linked to the wider theme. This section also provides an overview of some of the cross-cutting work taking place to strategically support London action on health inequalities.
7. Key Mayoral Commitments
Healthy Children
Why is this important?
Rates of childhood obesity in London are amongst the highest in the country. This and our city’s polluted air, have severe impacts on young Londoners’ health. Further both disproportionately affect minoritised and low-income Londoners.
School Superzones aim to support children and families to live healthier lives. By creating healthier environments around schools, they hope to offer more opportunities to make healthier choices, and with fewer risks to health. This is vital in schools in more deprived neighbourhoods for several reasons. For example, they are more likely to be in places with lots of fast-food shops, poorer air quality, higher traffic volumes, and lack access to green and safe community spaces.
Progress
The Mayor is committed to expanding School Superzones across London. He has already invested over £1m in the programme. School Superzones take a holistic approach, seeking to tackle multiple issues in an area. Children and young people are central to the approach and are involved in identifying issues and delivering and measuring the impact of activities. Mayoral funding supports local authorities to work with school communities to deliver a wide range of interventions. These will help to protect children and families’ health and promote healthy behaviours. For example:
- Using the Healthy Streets approach to improve air quality and road safety. This will help to reduce rates of respiratory illness and road traffic collisions.
- Working with local fast-food takeaways and convenience stores to increase the range and sales of healthier options. This will help to improve the diet of local children and families. This complements the new policy in the 2021 London Plan to restrict new hot food takeaways within 400 metres walking distance from schools;
- Improving lighting and signage to help people feel safer and get out more. This will help to increase physical activity and social contact and improve their health and wellbeing;
- Providing cycling infrastructure and cycle training for children and parents to promote active travel, reduce car journeys, and get children active; and
- Creating tobacco free zones around schools which reduces child exposure to cigarette smoke and 'de-normalises’ smoking around children. This is part of a wider approach to cutting rates of smoking – a major cause of health inequalities.
Partnership working
The Mayor is providing funding of over £1m to support a partnership approach to the Schools Superzones work which is delivered in partnership. The GLA and local councils work together on this programme – using local authority powers and place-shaping potential. Southwark Council hosts the School Superzones Coordinator, who works with the boroughs delivering the programme. Engagement with schools and the wider community along with co-production of action plans ensures that actions are supported and helps to build longer term partnerships and sustainability.
In addition, London boroughs have introduced more than 500 School Streets since the start of the pandemic to reduce air pollution and create safer environments around schools. Almost six out of ten primary schoolchildren are now walking (as their main mode) to school. The STARS scheme, a TfL programme to encourage active travel to schools and nurseries, currently has 747 STARS Gold-accredited schools - with a target of 1,000 by the end of the 24/25 academic year.
Forward look for 2023/24
- Funding of £600,000 from the Mayor will be made available to boroughs for a further 20 grants in the financial year 2023/24.
- The focus of the programme will move to capturing the impact and plans for sustainability of the School Superzones. Funding of £150,000 will be used for an independent evaluation that will look at the impacts of the programme on children and young people’s health and health inequalities in London. The learning from the evaluation will inform the further development and roll out of School Superzones.
Examples of other Mayoral and partnership achievements in 2022
- The Mayor has supported the health and wellbeing of over 157,000 children and young Londoners through investing £45m in the Young Londoners Fund (YLF). The YLF has reached 157,000 young people so far, almost 50,000 more than its lifetime target of 110,000. 81 per cent of young people who completed community projects funded through Rounds 1 and 2 of the YLF achieved positive outcomes, including improved mental health, relationships, and educational attainment. The fund supports a wide range of local community projects providing activities for young Londoners, especially those at risk of getting caught up in crime.
- The New Deal for Young People (NDYP) was created to give 100,000 disadvantaged young Londoners access to high quality mentoring opportunities, and all young Londoners access to quality local youth activities. Through this work, the Mayor has provided over 46,000 disadvantaged young Londoners with high quality mentoring support. Mentoring builds trust with a young person. Over time this leads to improved outcomes such as increased confidence, aspiration, coping strategies, and resilience. It also helps to boost their mental health and wellbeing and provides access to new opportunities and social networks. Working with Bloomberg and Action for Race Equality, the Mayor has also worked to improve the quality of mentoring for young Londoners – over 300 organisations have already downloaded the new Mentoring Quality Framework. The Mayor has also launched a Mentoring Support Programme to provide training, accessibility grants and develop a community network. This will support mentoring organisations to access and use the framework.
- The Mayor continues to support Londoners to have the best start in life, by helping support more children and families to become healthier through Healthy Early Years London and Healthy Schools London. In 2022, almost 100 (97) new early years settings and 58 new schools registered with each, bringing the totals engaged to 2,292 and 2,291, respectively.
- Further investment in London’s early years sector has been made through the Mayor’s Strong Early Years London programme. Between June 2021 and March 2022, it provided specialist business support to 1,344 early years providers, across all London boroughs, aiming to help them survive and thrive in the aftermath of the pandemic.
- The Mayor is investing in creating environments which support, encourage, and empower children, parents and schools to reduce sugar intake and cut down on fizzy drinks. This can help to tackle obesity and improve concentration levels during lessons. He has launched the schools toolkit, and recruited ‘water only’ schools champions from every borough. The Mayor also tapped into young Londoners’ creativity with the ‘water advertising challenge’, a competition to design an advert for water that has been shown across London. This builds on previous mayoral work including the ban on junk food advertising on the Transport for London Network in 2018.
Healthy Minds
Why is this important?
pandemic widened existing inequalities. It created and exposed vulnerable groups, including children and young people, and Black and minoritised ethnic groups. Mental health quickly became one of the most talked about health issues and remains so as we face the cost of living crisis. The Mayor is one of many Londoners who has found themselves speaking more openly about mental health and recognising that at times we can all struggle.
Since 2016, hundreds of thousands of Londoners have undertaken training to help them support others’ mental health and wellbeing. This stepped up even more during the pandemic. The Mental Health and Wellbeing recovery mission was established in recognition that we all have a role to play in supporting mental health and wellbeing, not only as individuals, but through our communities. The mission enables even more Londoners to champion wellbeing, by taking an active role in supporting their families, friends, neighbours and colleagues, and signposting to services and support.
By taking up training and other knowledge-building opportunities, Londoners can increase their understanding of what enables better mental health and wellbeing and help to reduce the stigma experienced by people with mental ill health. Through the mission, Londoners are being provided with tools, making connections, and building confidence, to support their own and others’ mental wellbeing.
Progress
Achievements have included:
- 342,000 Londoners taking the free 20-minute #ZeroSuicideLDN training helping to raise awareness of warning signs to look out for, supporting conversations, reducing stigma and signposting to sources of support. The training seeks to enable Londoners to have lifesaving conversations if they encounter someone in crisis.
- Suicide prevention training delivered across 350 Further and Higher Education settings, equipping staff and institutions with the knowledge and skills to better understand suicide and develop appropriate safeguarding procedures for vulnerable students
- Youth Mental Health First Aid training rolled out to 4,000 education and youth sector staff, helping them spot signs and symptoms of poor mental health, and to be confident in talking to children and young people about their mental health. An additional 11 topic-focused booster sessions were delivered in 2022. These aim to deepen understanding of specific issues including bereavement, suicide and self-harm, racial diversity, and finances.
- Resourcing community and grassroots projects that support the mental health and wellbeing of those who are experiencing higher levels of unfair treatment and discrimination through the Right to Thrive Programme and Innovation Fund. A £150,000 investment in 2022/23 has funded a further five innovative projects. It has also helped establish a community of practice network and event, an upcoming evaluation, and programmes that focus on communities most impacted by the cost of living crisis. This investment has allowed for targeted reach into communities more at risk of worse mental health. It has funded projects delivered by and for Black and minoritised ethnic groups, LGBTQ+ Londoners, young Londoners and their parents or carers, and those with a long-term health condition.
- Development of the Help Yourself and Others space connecting Londoners with wellbeing resources, training, talking therapies and crisis support all in one place.
- London’s World Mental Health Day festival hosted at City Hall in October 2022 was designed and created by young people, for young people. The day was an opportunity to empower young Londoners with information and build their confidence around accessing mental health and wellbeing support services in London.
- Rollout of new training offers focused on key issues impacting Londoners mental health. This includes interactive training for frontline workers and community champions, to support open and meaningful conversations about mental health alongside a comprehensive training programme on trauma-informed approaches, available for free to all Londoners. In addition, there is training for London’s local government councillors to help them take meaningful action to improve mental health in their communities. In the first six months, over a quarter of all councillors have been trained.
Partnership working
The Mayor collaborates with the Thrive LDN partnership to deliver support for Londoner’s mental health and wellbeing programme. Thrive LDN is a coalition of organisations, including the NHS, local authorities, and public health organisations, working together to ensure all Londoners have an equal opportunity for good mental health and wellbeing. Thrive LDN work collaboratively with London’s voluntary and community organisations to ensure that their voice is central to the programme.
Forward look for 2023/24
- The Mayor will continue to encourage and celebrate London’s wellbeing champions who are accessing and benefiting from mental health and wellbeing resources, activities, and training. This will include sharing case studies of local activity, campaigning for more Londoners to sign up to training and support and encouraging existing wellbeing champions to apply what they have learnt.
- Greater focus on the mental health and wellbeing of children and young people, looking at opportunities with Heathy Early Years and Schools programmes, and working with young Londoners to mark World Mental Health Day in October.
- Upskilling of community organisations to build on the Right to Thrive Programme, including providing more targeted support for Londoners most at risk of poor mental health.
Examples of other Mayoral and partnership achievements in 2022
- Supported young Londoners to develop the 2.8 Million Minds Manifesto. This sets out how young people use art and culture to create change in their mental health and change how mental health care is imagined, delivered, and funded.
- Prioritised and helped to improve understanding of the value of adult education for mental health and wellbeing, by building measures in the London Learner Survey – to measure the mental health and wellbeing impact of London’s £318m Adult Education Budget.
- The Violence Reduction Unit (VRU) delivered ‘Your Choice’ – a new programme upskilling youth practitioners and young people in Cognitive Behavioural Therapy (CBT) tools and techniques. This will provide 2,500 children and young people at greatest risk of violence in every London borough with this therapeutic support. The VRU’s Young People’s Action Group were involved in co-producing Your Choice and provided regular feedback to ensure a young person’s perspective was central to the programme’s design and delivery. At the most recent Inclusive Summit, emphasis on the intersection of race, special educational needs and children in the criminal justice system was a key focus.
- The Mayor has partnered with Department for Education (DfE), OHID and Thrive LDN to facilitate two webinars for primary and secondary school staff on the benefits of taking a whole school approach to mental health. Over 350 participants learnt how to access DfE grant funding and heard from London school staff about their experiences of implementing the approach in their settings.
Healthy Places (1)
Note: while this commitment is wider than air quality, that is the main focus of this section.
Why is this important?
Every year, thousands of Londoners are dying prematurely from long-term exposure to air pollution. Communities which have higher levels of deprivation or a higher proportion of people from Black, Asian and minority ethnic backgrounds are more likely to be exposed to higher levels of air pollution.
Despite the progress outlined, further, urgent action is needed to improve London’s air quality. In 2021 the World Health Organization (WHO) updated its health-based guidelines for air quality. These WHO clean air targets are globally recognised measures to protect public health. The changes, the first since 2005, were made in the light of new evidence of the health impacts of air pollution, even at levels previously considered to be low. The WHO’s updated guidelines for NO2 and PM2.5 were not achieved anywhere in London in 2019. They are unlikely to be achieved in the future without much greater action at both local and national levels.
Progress on Air Quality
The Mayor’s ambitious policies over the last seven years, have resulted in Londoners experiencing significant reductions in exposure to both nitrogen dioxide (NO2) and fine particulate matter (PM2.5) pollution (see Headline Progress above).
In October 2021, the Mayor expanded the world’s first Ultra Low Emission Zone (ULEZ) up to but not including the North and South circular roads – an area 18 times the size of the original zone. This has seen a reduction in vehicle and traffic flows in the zone and has achieved a dramatic reduction in emissions and air pollution, including[1]:
- Harmful NO2 concentrations alongside roads are estimated to be 46 per cent lower in central London and 21 per cent lower in inner London than they would have been without the ULEZ and its expansion.
- Carbon savings of 290,000 tonnes in the zone, a four per cent reduction since 2019 – a significant contribution to the net zero carbon 2030 goal.
The ULEZ and the Mayor’s other policies have reduced air pollution London-wide and helped to narrow the ‘exposure gap’ between the most and least deprived areas of the city, as well as between areas where Black, Asian and minoritised communities in London are most and least likely to live, which is helping to tackle health inequalities. The health benefits such as reductions in coronary heart disease, lung cancer and dementia of these mayoral policies are expected to save the NHS and social care system around £5bn and prevent more than one million air pollution related hospital admissions over the next 30 years. In addition to the policy areas controlled by the Mayor, if no wider action is taken by the Government to reduce air pollution, the cumulative cost to the NHS and social care system in London is estimated to be £10.4bn[2].
Progress on climate change
Wider measures to reduce health inequalities while tackling the climate emergency include:
- The Mayor’s Future Neighbourhoods 2030 programme has awarded a combined £4.4m of funding between two London neighbourhoods, Somers Town, in Camden, and Notting Dale, in Kensington and Chelsea, both located in disadvantaged and climate-vulnerable areas. By delivering projects that help tackle the climate and ecological emergencies and toxic air quality, whilst creating jobs and developing green skills, this programme is taking a place-based approach to some of the wider determinants of health. The programme has also funded 10 other London neighbourhoods to produce environmental strategies. Some of the health-related objectives from the Future Neighbourhoods include improved air quality and increased active travel.
- Since 2018, a total of 3,806 homes have been upgraded with improvements to heating, insulation and ventilation through the Mayor’s Warmer Homes programme. In the financial year 2022-23 a total of 1,744 homes have been improved. These improvements save Londoners’ money and improve health particularly if you have a long-term health condition that is made worse by the cold. However, current rates of delivery will not deliver the Mayor’s net zero targets until the next century, so through the London Partnership Board we are reviewing the delivery systems and funding and finance required to drive the market to meet the targets.
- Green infrastructure and climate resilience funding programmes focus on supporting projects in areas with poor access to green space and high vulnerability to the impacts of climate change, while reducing health inequalities. For example, the Grow Back Greener Fund has supported 101 community projects to plant trees for shade, create and improve green spaces and boost climate resilience. Projects are being delivered in areas of low tree canopy cover, high climate risk, or poor access to green space. An additional 56 projects have been funded through this fund and will deliver in January 2024.
Partnership working
The Mayor works with a wide range of partners across the city to drive forward action to improve London’s toxic air. The mayor is working across the GLA and GLA Group – especially transport for London (TfL), as well as with boroughs, London Councils, suppliers, business organisations and the taxi trade, to deliver the following:
- Working to keep London at the forefront of the electric vehicle revolution, delivering more than 300 rapid charge points. London now has over 12,200 charge points (around a third of the UK’s total), of which almost 900 are rapid or ultra-rapid.
- Ensuring that all new buses in TfL’s fleet will be zero emission, accelerating a plan of delivering a ‘100 per cent zero emission at tailpipe’ bus fleet by 2034 brought forward from 2037. With government support this will be brought forward to 2030. As of March 2023, over 950 zero emission buses had been introduced in London. London now has a fully ULEZ compliant bus fleet (c 9,000 buses), cutting bus-related NOx emissions by 90 per cent.
- Transforming London's taxi fleet by no longer licensing new diesel taxis since 2018 and reducing the age limit for older cabs with over 6,500 zero emission capable taxis now on the street – 43 per cent of all taxis.
- Calling on London’s businesses to make their buildings net zero carbon by 2030. Accelerating the scale up retrofit action on homes and workplaces across London also helps to support improvements to air quality and reducing exposure to outdoor air pollution. It also brings benefits of reduced energy bills and takes us a step further to a net zero carbon city.
Forward look for 2023/24
- Further action across all levels of government is needed to tackle emissions from both transport and non-transport sources of air pollution, such as wood burning. This will help to meet WHO air quality guidelines and protect health.
- The Mayor announced in November 2022 that the ULEZ will be expanded across all London boroughs from 29 August 2023. This will help to bring improved air quality and associated health benefits to the five million people living in outer London.
Other Mayoral and partnership achievements (on creating a greener city)
- In March 2022, the Mayor awarded £4m of funding to six projects and 13 development projects. The fund supports large-scale, innovative enhancements to green and blue spaces and the wider public realm. This will strengthen London's climate resilience, increase biodiversity, improve access to green space, build green skills and promote health and wellbeing. A £3m second round of the fund will be delivered in 2023.
- In August 2022, £4m was awarded from the Mayor’s Green and Healthy Streets Fund to boroughs to deliver innovative and exemplar greening projects, with significant potential to increase uptake of walking/active travel. The programme is delivered in close partnership with TfL and targeted in areas of highest climate risk and the greatest potential to increase walking.
- In December 2022, the Mayor awarded £2m funding to 56 community-led projects through the third round of the Grow Back Greener Fund. The fund supports London’s communities to plant trees to provide shade, create and enhance green space and increase climate resilience. The fund has prioritised projects in areas with low tree canopy cover, where Londoners live further than a 10-minute walk from green space and at high climate risk.
- London’s ICSs published their sustainability or ‘Green’ Plans (March 2022) which include steps to ‘green their fleet’, support staff and visitors to use active travel options (walking, cycling and public transport) more often and increasing energy efficiency in their buildings.
Healthy Places (2)
Why is this important?
Income is one of the most important determinants of health and wellbeing. People with lower incomes are more likely to report their health as 'bad' or 'very bad'[1] . Living on a low income is associated with a greater risk of limiting illness and poor mental health including maternal depression[2]. An increase in average net annual income of £1,000 is associated with a 0.5-year increase in male healthy life expectancy.[3]
The London Living Wage (currently £11.95) is an hourly rate of pay independently calculated to reflect the cost of living in the capital. It gives a worker in London and their family enough to afford the essentials and to save.
[2] depression.[1] PHE & UCL Institute of Health Equity. Local action on health inequalities: Health inequalities and the living wage. Health Equity Evidence Review 6: September 2014.
[3] Health Foundation. 2021. Available at: Relationship between income and health - The Health Foundation
Progress
With the support of the Mayor, the London Living Wage campaign has:
- Launched the Making London a Living Wage City (MLLWC) Action Plan. Health & Social Care and Hospitality & Service Provision leadership groups have been established (among others). This will help to support change in those sectors, addressing specific aspects of the low paid economy across London.
- The NHS and social care sector are amongst the largest employers in London. The LLW Health & Social Care Action Strand formed in May 2022. Fifteen NHS trusts have since become accredited Living Wage Employers with the Living Wage Foundation. This has resulted in a pay uplift for 2,890 workers. Some 29 primary care organisations, including GP surgeries, have also achieved accreditation. A form of recognition has been developed for newly formed Integrated Care Systems (ICSs) to commit to the Living Wage, which will be piloted.
- Almost 90 business, civil society, and third sector leaders in London have joined action strands or the steering group to promote the living wage through their networks and supply chains.
- Held 10 training and learning events, to support and equip community and worker leaders, to further develop their skills and knowledge and get more involved in the campaign.
Partnership working
The Mayor co-chairs the MLLWC Programme’s Steering Group, alongside the Rt Rev and Rt Hon Dame Sarah Mullally DBE, the Bishop of London, and Anna Purchas of KPMG. The steering group brings together large and small employers, investors, third sector organisations, trade unions, faith leaders, educational institutions, local government at city- and borough-level, and worker leaders with experience of low pay. Members use their influence, networks, and expertise to expand the real Living Wage across the city. The programme is administered by Citizens UK and Trust for London, in conjunction with the Living Wage Foundation and with support from the GLA.
Forward look for 2023/24
- Stretch targets have been established by May 2024:
- to lift 75,000 more Londoners onto the real Living Wage and
- to ensure 10,000 people benefit from Living Hours – a related campaign[1] –which seeks to set a standard for what good looks like in terms of working hours
- A MLLWC Cultural & Creative Action Strand is due to be launched in spring 2023.
- NHS England is committed to 75 per cent of trusts becoming fully accredited or working towards accreditation by spring 2023.
Other Mayoral and partnership achievements (on income, housing and homelessness)
- Thousands of vulnerable Londoners received advice and support through the Warmer Homes Advice Service.
- The Mayor launched Energy Advice London in partnership with the Energy Saving Trust to provide advice to Londoners on managing energy bills.
- The Mayor’s Advice in Community Settings (AiCS) programme is increasing access to vital social, welfare and legal advice. By embedding support in community settings, the programme is more accessible to women, young people, and those from Black or Black British backgrounds. At the end of December 2022, over 2,862 Londoners had been supported by the programme, with recorded financial gains of £1.3m, ranging from £35 food vouchers to several thousands of pounds of debt being written off. The largest financial gain valued at just over £27,000.
- The GLA along with borough and NHS partners secured over £7m investment to implement and learn from ‘Out of Hospital Care Models’ (OOHCM) for people experiencing homelessness. The funding has supported the development of specialist housing advice in hospital discharge and step-down provision from hospital, much of which has continued beyond the life of the national fund. The Mayor, boroughs, the NHS, and voluntary sector partners such as Groundswell continue to work together to improve access to healthcare for people experiencing homelessness, and to ensure that nobody is discharged from hospital to the street.
- Over 1,300 long-term homes for rough sleepers, with associated support, will be delivered by March 2023, through funding secured by the Mayor for the Rough Sleeping Accommodation Programme. In addition, over 2,000 people were supported to leave rough sleeping by the Mayor’s services in 2022/23.
- The Rough Sleeping and Mental Health Programme (RAMHP) was piloted by the GLA between 2020 and 2022 in four London NHS Trusts, covering 16 London boroughs. Since the end of pilot period in 2022, it is now successfully embedded and funded through the health system in those areas. The programme has significantly improved access to mental health services for people rough sleeping, providing assertive outreach from multidisciplinary teams based within the local mental health trust. RAMHP will also be extended to a further eight London boroughs in 2023.
- Over 245,000 people work for a Good Work Standard employer, in sectors as diverse as retail, construction, transport, local government, design, media, charities, law, finance, football and social care. To achieve the Mayor’s Good Work Standard at least 32 employers have successfully become London Living Wage accredited during 2022.
- Funded by the Mayor, the Institute of Health Equity (IHE) undertook a rapid evidence review, setting out the context of housing in the capital and how it is shaping Londoners’ health. It considered the evidence for housing interventions that support health and that can contribute to reducing health inequalities. It highlights the fact that the shortage of good quality and affordable housing is a significant contributor to health inequalities, and sheds light on the further risks posed by the cost of living crisis. It calls on Government to act rapidly and invest in good quality and secure homes. It also sets out a series of recommendations for London level action which are feeding into the work of the GLA and partners.
- The Mayor has continued to deliver new genuinely affordable homes, including council homes and homes for social rent. In the year to the end of December, 5,360 affordable homes were completed. That is almost 900 more than in the same period last year. He has taken tough action to raise standards in social housing leading to the freezing funding to three social housing providers after failures to maintain acceptable standards.
Healthy Communities
Why is this important?
People from minoritised ethnic communities experience disproportionately worse health outcomes (for example in maternal health, where Black women and women living in the most impoverished areas are more likely to die from childbirth, and experience mental ill health) in London and worldwide. Though racialised health disparities have long existed, the COVID-19 pandemic and the Black Lives Matter movement in 2020 have driven awareness of the need for much more concerted action on these injustices. In particular, the need to tackle the structural and institutional racism and discrimination which drives health inequalities.
To tackle structural racism, to earn back the trust of London’s Black, Asian and minoritised communities, and to allow Londoners to feel confident in how organisations and services are provided, requires us to reflect on whether the systems and the structures we work within, are compounding inequalities for Black, Asian and minoritised communities. By addressing structural racism, we will improve access to health and care services, and help level the playing field in terms of accessing the opportunities that influence health.
This project therefore seeks to support London health and care organisations in their commitment to becoming anti-racist approaches in all they do, changing the way they work as employers, service providers, procurers, and policy makers.
Progress
This project will create and support opportunities for peer-learning, networking and collaboration across health and care organisations in London. The work will focus on amplifying and connecting existing good practice around anti-racism work, as well as encouraging development, and embedding of good practice across the system. This approach is informed by evidence which suggests that supporting organisational action is effective in changing behaviours and processes, which in turn will impact on how services are provided to Londoners, and how employees are treated.
The approach taken to developing the hub is emergent and iterative, putting communities at the centre. This approach contributes to development of better policy and practice as well as greater trust and accountability in public services. The hub design that is being tested involves online resources and online and in-person activity. It will share knowledge, evidence and good practice through networking and events. It will support collaboration across sectors and organisations, enabling us to build on the work that is already happening, and to learn more, go further and do better together. The Mayor has convened a partnership group, made up of race equity, VCSE and health and care organisations to guide the project’s development – through the scoping stage in 2022 (which was led by Inchange), and now the design phase (both funded by the Mayor). Funding for the first 18 months of delivery has been agreed from the Mayor and health and care partners, working closely with the London Health Board.
Partnership working
The anti-racism hub project was developed, and is being delivered, in partnership. It was proposed by the London Health Equity Group and is a key output from the Building a Fairer City Plan, which was launched by the London Recovery Board (now the London Partnership Board). It builds on and demonstrates the commitment to anti-racism and tackling structural racism as a driver of health inequalities of organisations in London’s health and care sector.
The project is being co-developed with the NHS London, Office for Health Inequalities and Disparities (OHID), the Association of Directors of Public Health London, London Councils, voluntary and community sector networks such as HEAR Human Rights and Equality Network and London Plus, and race equity organisations. The design phase is being undertaken by the Race Equality Foundation, who have received a grant from the Mayor. The approach has been intentionally systemic and power-informed to ensure the way the Anti-Racism Hub is being created and delivered is aligned to anti-racism principles.
This work builds on and links to work being undertaken within different organisations and sectors already. It is also being developed in alignment with other pan-London work. This includes the structural racism and health inequalities in London evidence review (led by the UCL Institute of Health Equity), the development of a Strategic Approach to Anti-Racism in London Health and Care System, and the Building a Fairer City programme tackling structural inequalities.
Forward look for 23/24
The design phase is due to complete in May 2023, and delivery will begin in summer 2023 – marked by a stakeholder event. The delivery will be led by an organisation(s) with race equity expertise, who will work closely with London’s health and care organisations.
Other Mayoral and partnership achievements
- Through the Building Strong Communities fund, the Mayor has provided three rounds of grant funding, totalling £915,000 to equity-led community organisations to support and enable their recovery from COVID-19. These projects have involved almost 1000 volunteers across 88 projects. A further £200k is to be awarded in 2023.
- The Mayor has been working in partnership with London Funders and other public and independent funders and equity infrastructure organisations to develop a collaborative fund offering grants to London’s civil society groups. This collaboration is called Propel (londonpropel.org.uk) and the first round of Mayoral investment, through the New Deal for Young People, focused on improving outcomes for young Londoners by increasing access to high quality mentoring.
- The Mayor published a new Policing and Crime Plan in March 2022, including a focus on reducing and preventing violence affecting young people; making London a city in which women and girls are safer and feel safer; and tackling the harm caused by drugs). As part of the PCP, the Mayor committed to working with communities to address structural racism, as per the London Recovery Board’s plan to tackle structural inequalities.
- The Mayor also published his Violence Against Women and Girls (VAWG) strategy, which takes a public health approach. The strategy includes commissioned services to ensure that victims and survivors of violence and other crimes can cope, recover and thrive, playing an active role in their communities. The strategy brings together the Mayor’s Office for Policing and Crime, the Violence Reduction Unit and the GLA with the VAWG sector, local authorities, police, Crown Prosecution Service, National Probation Service and the NHS, working as equal partners across London. This support recognises the disproportionate impact of the pandemic on victims and survivors of violence against women and girls - an effect which was labelled a ‘shadow pandemic’ by the UN and the Domestic Abuse Learning Partnership/Women’s Aid. The normalisation of VAWG has devastating consequences and disproportionately impacts women and girls from Black, Asian and minority ethnic communities. For example, Black girls are often ‘adultified’ and are seen as being less in need of support, nurture and protection as well as being seen as more sexual, which influences the way they are seen and supported by services in society.
- The Mayor launched the Dementia Friendly Venues Charter in partnership with Alzheimer’s Society. Over 100 organisations have been accredited including City Hall where over 750 GLA staff have attended Dementia Friends sessions. The Charter is helping Londoners with dementia stay active for longer and keep doing the things they love. Mental stimulation, physical activity and social interaction can all help to slow the progression, delay onset, and even prevent, dementia.
- The Mayor has championed keeping PrEP universally available free of charge on the NHS, helping reduce the risk of further HIV transmission. Public health data show that new HIV diagnoses are reducing faster in London that the rest of England[1].
- The Mayor, the NHS and National Aids Trust has developed a HIV friendly charter for NHS staff, and in 2023 will roll out anti-stigma training.
- The Mayor has continued to work with partners to build capacity in social prescribing as a means of reaching more Londoners with health-promoting support and resources. In 2022, the Mayor funded Bromley By Bow Centre to provide generalist and specialist Social, Welfare and Legal Advice training to social prescribing link workers, to enable them to support patients regarding benefits and finances. The Mayor also continues to support the VCSE to play their vital role, funding London Plus to continue to grow their network, and collaborating with Transformation Partners in Health and Care to support commissioning of VCSE services through a community chest model. The model is designed, developed, and owned by local partners and joins up funding from the NHS and Local Authorities to commission VCSE activities in response to unmet local needs.
Healthy Living
Why is this important?
Staying physically active is essential for good health and wellbeing. The link between physical inactivity and obesity is well established, increasing the risk of cardiovascular disease, diabetes, and some cancers. Physical inactivity is not only linked to obesity. It is also one of the top ten causes of all disease and disability in England.
Active travel is the most accessible and inclusive form of physical activity, and it can be easily built into everyday routines. Increasing the use of active travel and public transport remains a key priority for the Mayor. This will help meet his target for London to be net zero carbon by 2030. There are many co-benefits of action on health and climate risk and increasing levels of active travel is an important example of this. This leads to health benefits through increased physical activity and environmental benefits through reduced emissions.
Progress
The relaxation of all pandemic-related restrictions in early 2022 has led to a gradual increase in overall trips throughout 2022, with an estimated 24.2 million daily trips, by all modes, in the quarter between July and September. This is still 11 per cent lower than in 2019 but is the highest estimated travel demand since the pandemic began.
The gradual increase in public transport trips in 2022, coupled with high levels of walking and cycling has led to an increase in active, efficient, and sustainable model share measure, to 62.4 per cent in the quarter between July and September 2022. This is the highest level since the pandemic began, only 0.8 percentage points lower than in 2019.
The latest TfL Travel in London report found that cycling on weekdays in autumn 2022 had typically been around 20-25 per cent higher than pre-pandemic levels, despite less commuting, and around 90 per cent higher at weekends. Walking continues to be central to how many people travel in London, with levels still noticeably higher than before the pandemic.
Activity has included:
- Over 75 km of cycling lanes have been created since 2019. The proportion of Londoners living within 400 metres of a high-quality cycle route is now almost double what it was in 2019, with 22 per cent of Londoners now living near one, compared to 12 per cent in 2019.
- In autumn 2022, 500 e-bikes were added to the Santander cycle scheme to help address barriers to cycling including fitness and journey length, meaning that cycling is more accessible. One in four Londoners have now used the Santander cycle scheme.
- TfL was able to restart cycle training following the funding agreement with government and increased funding for free cycling training in London to £5.4m (2022-2024).
- The Mayor and TfL are committed to enhancing outer London’s bus network. In March, the Mayor launched the Superloop – a proposed bus network that would circle outer London and connect key town centres, hospitals and transport hubs, faster. The Superloop compliments other enhancements that TfL are planning for outer London. Taken together, these add millions of kilometres to outer London’s bus network.
Partnership
- London’s boroughs set out how they plan to deliver the Mayor’s Transport Strategy via their Local Implementation Plans. Boroughs are responsible for around 95 per cent of London’s streets including 70 per cent of the strategic/core bus network, and are central to delivering a high quality, connected London-wide cycle network.
- Low Traffic Neighbourhoods (LTNs) and School Streets are two key programmes used to support more active travel. More than 100 LTNs and over 500 School Streets (372 of which were funded with support from GLA and TfL) have been delivered across London.
- TfL and the London Marathon Charitable Trust have awarded more than £416,000 of funding to 87 new projects run by community and not-for-profit groups, as part of the transformative London Walking and Cycling Grants programme. The projects aim to increase participation in walking and cycling among traditionally underrepresented groups such as people with disabilities, people from minority ethnic backgrounds, people experiencing homelessness, refugees, and asylum seekers.
- TfL and GLA are working with the London NHS Sustainability Network to increase active travel among NHS staff, and the GLA and OHID are working with national Physical Activity Clinical Champions, to support the delivery of training on physical activity to health professionals.
Forward look in 2023/24
- TfL’s recent Business Plan commits to an average of £150m a year of funding, until 2026, for safe and active travel schemes, including borough-led programmes. This funding will expand our cycle network and increase the number of safer junctions, school streets and cycle parking facilities.
- Publication of the Action on Inclusion Plan in 2023. This recognises that wide inequalities exist in physical activity participation, with deprived communities, ethnic minorities, disabled people and older adults disproportionately less likely to achieve the target. Understanding the reasons for this will help us to find the right solutions.
- Improve engagement with stakeholders and communities in the design of new walking and cycling programmes and schemes.
- Continue to expand the network of safe cycle routes across London, including in Outer London and in areas of high deprivation. This also includes new cycleways to be launched mainly using new low traffic local streets connecting more Londoners to a high-quality cycle route.
- Reduce road danger by accelerating the roll-out of lower speed limits to 220km of the TfL road network by 2024 and working with boroughs to introduce a default 20mph limit on their roads.
- Enhance and expand leisure walking routes and better connect London's communities with green spaces, through the Leisure Walking Plan.
- Following the announcement of the Superloop, further consultations will be forthcoming in 2023/2024 to complete the network and the first new route will enter service.
Other Mayoral and partnership achievements
- The Mayor has supported the launch of the new London Tobacco Control Alliance in October 2022 that will drive forwards the partnership commitment for a Smokefree London by 2030.
- To inform future policy on gambling and health inequalities in London, the GLA Public Health Unit commissioned the University of Sheffield and University of Glasgow to produce independent evidence briefing on the relationship between gambling advertising, gambling related harms and health and social inequalities.
- In 2022 the Mayor set up the London Drugs Commission to look at the effectiveness of the UK’s drugs laws, focusing on cannabis. The LDC will review evidence regarding the impacts of cannabis on peoples’ lives and communities, present conclusions about the effectiveness of UK drugs laws on reducing any harmful impacts associated with cannabis and make recommendations for action.
- The Mayor of London, London Marathon Charitable Trust, and Sport England, with strategic guidance from London Sport and London Marathon Events, have come together in a new GO! London partnership. GO! London is a unique collaboration and the biggest community sport fund in London. This fund will use sport and physical activity to transform the lives of children and young people aged four to 24 in London.
8. Other strategic activity on health inequalities in the GLA
The preceding sections of the report capture progress made against the commitments in the HIS Implementation Plan 2021-24. The following sections provide progress on cross-cutting initiatives, which are being delivered to support and strengthen London’s approach to tackling health inequalities, in the GLA and GLA group, and across partners. These focus on supporting the health in all policies approach, taking an evidence-based approach to action, and working with London’s communities.
Enhancing our 'health in all policies' approach: GLA Group Public Health Unit
The GLA Group Public Health Unit was launched in November 2022. It aims to strengthen capacity and collaboration on public health across and within the GLA Group – taking a further step to embedding and accelerating the Mayor’s manifesto commitment to put improving health and tackling health inequalities at the heart of all areas of GLA policy.
The new Unit and the new GLA Group Director of Public Health role, work across GLA teams (such as Environment, Housing, and Transport) and the wider GLA Group of organisations – consisting of the Mayor’s Office for Policing and Crime and the Violence Reduction Unit; Transport for London; the London Fire Commissioner; and Old Oak and Park Royal Development Corporation. The Unit serves as an important channel to integrate the work of these organisations within the wider public health system in London, as we work together towards our shared ambition to make London the world’s healthiest global city.
Examples of the Unit’s work includes:
- Working alongside the Environment Team to maximise the health gain from air quality improvements, and climate change mitigation and adaptation.
- Joint work with housing on the homeless health programme for London.
- Advising on and supporting the next iteration of the London Plan to ensure health and wellbeing are at its centre.
- Collaborating with MOPAC on a public health approach to priority areas such as Violence Against Women and Girls, drugs (and alcohol), and mental health
Building the evidence for health inequalities in London
Work began in 2022 to refresh and renew the evidence base for health inequalities in London. The programme, which is led by the GLA, and overseen by a partnership Advisory Group, will build understanding of the current and future health inequalities across London and what can be done to address them. This will inform strategic development and enable further action on the wider determinants of health.
As part of this work, the Mayor of London provided a grant to University College London’s Institute of Health Equity – led by health inequalities expert Professor Sir Michael Marmot – to support their internationally recognised work to draw out the evidence on what works to tackle health inequalities, focused on the London context.
Progress in 2022 includes:
- Housing and health inequalities evidence review and data pack (Sept 2022)
- Mitigating the impact of cost-of-living evidence review and data pack (Jan 2023)
- A snapshot of Health Inequalities in London providing an overview on health inequalities in London (Jan 2023).
- State of London report Chapter (pp 120-130) on health.
Work continues into 2023 to explore the findings and recommendations and identify opportunities for action with London organisations, for example, a health and care partnership task and finish group has been setup to explore recommendations around the cost of living. Further reviews are planned for 2023: 1) Skills, work, and health inequalities; 2) Climate change and health inequalities; and 3) Structural racism and health inequalities.
Working with London's diverse communities
Collaborating effectively with communities is crucial to improving health and to health equity. It sits at the heart of achieving our strategic ambitions, supporting residents through the cost of living crisis and reducing health inequalities. Covid-19 Champions programmes, which emerged across London during the pandemic, showed how important – and possible – it is for boroughs, the NHS, and others to work directly, openly, and regularly, with communities. Champions programmes have transformed the way Councils, the NHS and others engage with, and listen to, communities, now, and in the future.
The Mayor and partners are committed to develop and innovate in how we engage, collectively, with all communities across London to improve health outcomes. The two-way, continual dialogue that we achieved in the COVID-19 Champions programmes needs to be one of the ways that communities and statutory health partners continue to come together to address inequalities.
As part of this commitment, London’s health partners have launched next phase of the Community Champions Development Programme. Together, the Association of Directors of Public Health London (ADPH), Office of Health Improvement and Disparities London (OHID), UK Health Security Agency London (UKHSA), Greater London Assembly (GLA) and London Councils have invited colleagues from every borough for Local Government and every place for the NHS to come together again. The programme builds on what we’ve learned from the past two years of the COVID-19 Champions Co-ordinators programme and will support partners to continue to learn and improve together, further empowering the communities we work with. To accompany the next phase the Association of Directors of Public Health London (ADPH London) has published a report[1] showcasing the lessons learnt from the previous work has been published.
Building a Fairer City - tackling structural inequalities
The Building a Fairer City Plan aims to reduce the structural inequalities/racism that drove the disproportionate impact of the pandemic and those that were created by it. This partner-driven plan was launched by the London Partnership Board’s Structural Inequalities Sub-group in May 2021, which is chaired by Kim Wright, the CEO of Brent Council. Communities most impacted have played a key role in defining the vision statements which informed the action plan. The ambition is that a collective focus on the plan across our organisations will help to drive tangible improvements in inequalities for Londoners.
Taking a cross sectoral approach to development and implementation, the aims of the Building a Fairer City programme are to assist partners to:
- Increase their understanding and awareness of the impact of structural inequality/racism on Londoners when developing services, programmes, policy, and practice.
- Clearly demonstrate how the action that they are taking align with the priorities and actions in Building a Fairer City.
- Develop and deliver a support programme to accelerate, deepen and widen learning and good practice as well as tackling barriers that may impede progress over years two and three of the Implementation programme.
- Measure and publish their progress annually against agreed metrics and outputs
- Develop effective mechanisms to engage with the voluntary and community sector
- An Anti-Racism Practice Learning Hub is currently in its design phase. This was a key commitment from the Health Inequalities Strategy and the Building a Fairer City Plan. The Anti-Racism Hub was agreed by the London Health Board and the Health Equity Group, building on the evidence-based strategic approach to London’s health and care sector. For more information, please see the Mayoral key commitments section above.
The GLA has recently appointed a delivery partner, Shared Intelligence, to take forward the first year of a three-year implementation phase of the Building a Fairer City Plan. This programme will support organisations to understand, adopt and implement actions in the London Partnership Board’s Structural Inequalities Action Plan. There are 14 actions within this plan and each fall under one of four priority areas – labour market inequality, financial hardship and living standards, equity in public services and civil society strength. A support programme is being developed and will be announced in late spring 2023.
9. The changing health inequalities landscape
There has been considerable change in the health inequalities landscape since the HIS was published in October 2018; including changes in government, the reprioritisation of efforts driven by the COVID 19 pandemic and continuing health system and public health system reform.
As we move into the fifth year of the 10-year strategy, the landscape in which it sits, and in which the Mayor and partners act, continues to change. These changes influence priorities, and offer new challenges and opportunities for how, and on what, different organisations collaborate for change. The following section sets out some of the key changes at national, system and borough level, and some in the London infrastructure which influence the health inequalities programme this coming year, and beyond.
The national, regional and local landscape
The national public health system has undergone significant reform. As of 1 October 2021, Public Health England was replaced by the UK Health Security Agency (UKHSA) and the Office of Health Improvement and Disparities (OHID), now part of the Department of Health and Social Care. In London, Professor Kevin Fenton was appointed OHID Regional Director, and continued as Statutory Advisor to the Mayor, providing welcome stability for the London system. OHID is working across the health and care system to drive forward action on prevention and health inequalities, including improving access to health services, and at national level, coordinates with government departments to address the wider drivers of good health, including employment, environment, housing, education, and work.
The proposed Health Disparities White Paper (2022) was unfortunately never published. In early 2023, the Minister for Health and Social Care (Steve Barclay) announced the intention to publish a Major Conditions Strategy, aiming “to alleviate pressure on the health system, as well as support the government’s objective to increase healthy life expectancy and reduce ill-health related labour market inactivity.” This signalled the government’s continuing commitment to the Build Back Better: Our Plan for Growth and the Levelling Up White Paper commitment to improving healthy life expectancy by five years by 2035 and narrowing the gap between the areas with the best and worst health.
Core20PLUS5, published in late 2021, set out the NHS England and NHS Improvement approach to supporting the reduction of health inequalities at both national and system level (see figure 3). The focus is on the 20 per cent most deprived and with plans being developed around five clinical priorities: Maternity, severe mental illness, chronic respiratory disease, early cancer diagnosis and hypertension.
Figure 3
Action on this is led by the five London Integrated Care Systems (ICS) – partnerships of NHS organisations, local authorities, VCSE organisations and others, who have collective responsibility for responsibility for planning services, improving health and reducing inequalities, in a geographical place. In 2022, ICSs were formalised as legal entities, with statutory responsibilities. ICSs are made up of two statutory bodies – an Integrated Care Boards (ICB) which are responsible for planning and funding. and Integrated care partnerships (ICP), committees which bring system partners together to create a health and care strategy for the region.[1] The ICB 5-year plans are being published in spring 2023 and present a major opportunity for strong place-based partnership working on health inequalities.
Partnerships to support health and wellbeing and tackle health inequalities will continue also at a borough, or “place” level, led by local authorities. The cost of living crisis and ongoing funding challenges, such as for Public Health Grant, will continue to create challenges for local delivery.[2]
At a London level
In early 2023, the London Recovery Board, which since 2020 has taken a cross-sector, partnership approach to delivering a set of London “missions” - transitioned into London Partnership Board. The new Board will maintain a focus on the missions, including the Superzones and mental health HIS key commitments, and will continue to prioritise action on structural inequalities, through the Building a Fairer City action plan.
The London Anchor Institutions’ Network, which emerged from the LRB, will continue. Network members, from across London’s public, private and not for profit sectors, are delivering on commitments to use their procurement, recruitment, and estates management capacity to support more underrepresented Londoners into decent work, mentor young people, decarbonise their estates and buy more goods and services from local, small, medium-sized and diverse owned businesses. Work is underway to develop and support a primary care anchors network recognising the unique links general practice has with local communities and harnessing its potential to do more.
As flagged above, a refreshed Health Equity Group for 2023 will also provide an important opportunity, as a forum for support collaboration across London leaders, to inform and drive action on London’s health inequalities.
10. Looking ahead
The Mayor and partners are committed to continuing to work together to tackle London’s stark health inequalities, during 2023 and beyond. A renewed Health Equity Group and a new London Partnership Board will bring cross-sector focus, insight, and commitment to London’s key health inequalities challenges.
In 2023 we will reach the halfway point of the current HIS. This milestone presents an opportunity to take stock of the progress made in London to tackle health inequalities; not only work the Mayor of London has led, but also to reflect on the wide range of action taken by ICSs, boroughs, in communities, to which contributes to achieving the aims and objectives set out in the HIS.
Meanwhile, the Mayor will continue to work with partners to deliver the commitments set out in the HIS Implementation Plan 2021-202, as well as new commitments made after it was published – including the Mayor’s £130m investment to ensure all primary schoolchildren in the capital can receive free school meals for the 2023/2024 academic year[1].
11. Appendix A: Population health inequalities indicators - London
Data tables update (February 2023)
[1] This indicator is a measure of the extent to which adults with a serious mental illness (SMI) die younger than adults without a serious mental illness (nSMI). A higher % rate indicates a higher death rate in adults with SMI than in adults without SMI. For example in 2018-20 Londoners with SMI were 3.9 times more likely to die. For further information on this indicator visit NHS Digital https://digital.nhs.uk/data-and-information/publications/statistical/excess-under-75-mortality-rates-in-adults-with-serious-mental-illness