MD3031 Health Inequalities Strategy Work Programme 2022-23

1.1.    The London Health Inequalities Strategy (HIS) sets out the ambitions for London to be a healthier, fairer city, with all Londoners having the best opportunities to live a long life in good health. Working together with the wide range of organisations that have a role to play in tackling the causes of health inequalities, we want to create a city where nobody’s health suffers because of who they are or where they live. 

1.2.    The HIS was published in 2018 to support this vision. A progress report on the first three years of implementation was published in August 2021, and a new implementation plan for this Mayoral term was published in December 2021. The new plan reflects commitments published in the 2021 manifesto; the health inequalities priorities which have arisen from the pandemic to date; and the London Recovery programme.

1.3.    The 10-year HIS provides an evidence-based framework for action on health inequalities in London. It is framed around five aims: 

• Healthy Children: every London child has a healthy start in life
• Healthy Minds: all Londoners share in a city with the best mental health in the world
• Healthy Places: all Londoners benefit from an environment and economy that promotes good mental and physical health
• Healthy Communities: all of London’s diverse communities are healthy and thriving
• Healthy Living: the healthy choice is the easy choice for all Londoners.

1.4.    COVID-19 has had a significant impact on London’s health inequalities, and the GLA Health and Wellbeing team’s work programme (see MD2650, MD2688, MD2704, MD2799 and MD2906) has been reviewed to ensure that work is focused on the ongoing and emerging needs of Londoners. The London Recovery programme has been established in response to the impact of the COVID-19 pandemic and seeks to restore confidence in the city; minimise the impact of COVID-19 on communities; and build back the city’s economy and society. The programme has established nine recovery missions, two of which focus explicitly on health. Health and wellbeing is also a cross-cutting principle for consideration across all the missions.

1.5.    The GLA Health and Wellbeing team published an updated Implementation Plan for the HIS in 2021. The Implementation Plan details actions to be taken by the Mayor and partners to tackle health inequalities, between 2021 and 2024. The five aims of the HIS (listed at section 1.3) remain the core framework for action. Each aim has a key commitment, mirroring the original HIS – though Healthy Places now has two (six key commitments in total). The Healthy Children and Healthy Minds key commitments are aligned with the two GLA Health and Wellbeing team-led recovery missions; the Healthy Living commitment on active travel, and the Healthy Places commitment on Air Quality, have been continued from the original HIS; and a new second Healthy Places commitment has been introduced focusing on income inequality (London Living Wage), as well as a new commitment under Healthy Communities, focused on structural racism. These two new commitments were informed by the intelligence over the pandemic period. 

1.6.    Activity to tackle health inequalities is progressed through partnership working, with the Mayor of London having a health leadership role. The London Health Board (chaired by the Mayor) and the Health Equity Group (co-chaired by the statutory health adviser) are key bodies to drive forward and support London activity. 

1.7.    The items in this decision relate to GLA Health and Wellbeing team activity to support implementation of the HIS. However, this represents only a small part of the HIS delivery, which also sits in other parts of the GLA and the wider GLA Group, and with partners. A fuller summary of the delivery was published in the HIS Implementation Plan in 2021, as indicated in MD2906: Health Inequalities Strategy Work Programme.

1.8.    The table below gives an indicative breakdown of activities for this programme and the decisions being sought for 2022-23. The exact allocations to each of the work areas, as set out below, may change as priorities and opportunities shift through the remainder of the year. As part of programme monitoring, the Assistant Director will sign off any significant changes between allocations and record this through a record in writing.

1.9.    The expenditure detailed below is in addition to the programme outlined in MD2906, which set out expenditure for the HIS implementation for 2021-22, 2022-23 and 2023-24.

1.10.    Expenditure will take the form of grant awards or payment for services procured, depending on the nature of the work concerned and in line with relevant GLA procedures, including the GLA’s Contracts and Funding Code. 

London HIS implementation 

2.1.    This work programme supports the Mayor’s leadership-for-health role; and comprises activity to support pan-London activity to tackle health inequalities, including through supporting, mobilising and empowering a wider range of partners to act. Further detail on each work programme is provided below.

HIS data and measurement: building the evidence for health inequalities programme

2.2.    Providing resource to support the development of the evidence base of health inequalities in London, in the context of London priorities. In MD2906, £75,000 was assigned to deliver this work in the form of a grant to University College London’s Institute for Health Equity, led by Professor Sir Michael Marmot. The Institute for Health Equity is made up of leading experts in health inequalities, who have done extensive work at city, national and international levels. The “building the evidence for health inequalities” programme supports collaboration with the Institute, whose members were keen to apply their extensive expertise and evidence-based frameworks to London. The Institute is developing a series of evidence reviews, focused on “what works”, to make a difference to health inequalities in London. This work programme links to the partnership work of the London Recovery programme.  This will inform the evidence base for London partnership work on health inequalities.

HIS communications and engagement

2.3.    Providing resource to support work to enhance communications and messaging around the HIS and health inequalities in London. This includes supporting the dissemination of key messages and key data emerging from the “building the evidence for health inequalities” programme. This might include: data visualisation and creating engaging narratives on complex health inequalities issues; strengthening the way we communicate and engage with the voluntary and community sectors on health inequalities priorities; and support for a London health inequalities event, aligned with the HIS annual report, to recognise progress and celebrate success.

HIS commitments

2.4.    Providing resource to support the delivery of HIS priorities and commitments, as outlined in: the HIS implementation plan; the Mayor’s manifesto; and as arises from collaboration with heath and care partners around shared health inequalities priorities. The resource will be allotted to the below three areas: 

• Mobilisation of structural racism work programme: work is currently being undertaken to engage stakeholders and scope options for the HIS key commitment to develop an anti-racist practice learning hub for London. This will be co-produced with partners. This is part of a wider programme on structural racism and health inequalities, closely aligned with the London Recovery Board – the Building a Fairer City programme – and involves collaboration with the GLA Communities and Social Policy team. This resource will support early development activity of the hub, following the development of an options paper. 
• Progressing HIS commitments: an audit of HIS commitments is under way, aiming to understand where the most value could be added through additional work – for example, carrying out evidence reviews, convening partners, or looking at more strategic opportunities (such as building the HIS into developing integrated care system equity plans, or enabling the voluntary, community and social enterprise sector as a key health system partner for health inequalities). 
• Building on HIS workshops/partner engagement programmes: as outlined in MD2906, a series of HIS workshops are being undertaken that will bring together stakeholders to focus on key health inequalities priorities – for example, how we might take action to mitigate the impact of the cost-of-living crisis on Londoners. This resource will support any actions for the GLA following these workshops (at least two held in 2022-23), to support and build on the partnership collaboration on such critical issues. 

3.1.    Under section 149 of the Equality Act 2010, as a public authority, the GLA must have ‘due regard’ of the need to: 

• eliminate unlawful discrimination, harassment, and victimisation
• advance equality of opportunity and foster good relations between people who have a protected characteristic and those who do not. 

3.2.    The Mayor’s Equality, Diversity, and Inclusion (EDI) strategy sets out how the Mayor will help address the inequalities, barriers and discrimination experienced by groups protected by the Equality Act 2010. There is considerable alignment between the EDI strategy and the HIS, with both seeking to act on the drivers of inequalities – such as income, air quality and housing – that are framed in the HIS as the economic, social and environment determinants of health. The population groups outlined in the EDI strategy – those with protected characteristics – are often the same as those we focus on in the HIS, who experience poorer health outcomes. As well as this alignment, there are a number of objectives in the EDI strategy on which the Health and Wellbeing team specifically provides updates as part of the EDI action plan, and which feed into the Mayor’s Annual Equality Report (MAER). This includes objectives on mental health. Publication of the MAER is a legal requirement, and outlines the arrangements put in place by the GLA over the last financial year to demonstrate that due regard has been paid to the principle that there is equality of opportunity for all people in the exercise of the Mayor’s general powers.

3.3.    An Integrated Impact Assessment – which included an Equality Impact Assessment within its scope – was conducted as part of development of the HIS. This identified: major positive and negative impacts of the programme for groups protected under the Equality Act 2010; and proposed ways to strengthen benefits and mitigate negative impacts, and to identify issues concerning the four cross-cutting themes under the GLA Act 1999. The HIS was adopted in October 2018, and a refreshed Implementation Plan was published in 2021.

3.4.    A series of 14 population health inequalities indicators are monitored and published as part of the implementation of the HIS. These demonstrate the gap in outcomes between different populations on key metrics. There is some overlap between these measures and those reported on for the EDI strategy, e.g. child obesity. 

3.5.    A range of work has been undertaken since 2020 to understand the impact of COVID-19 on health inequalities, exploring the health impact on different populations. Several research reports were also published that identified the impact on specific vulnerable cohorts. These included the PHE reports Disparities in the risks and outcomes of COVID-19 and COVID-19: understanding the impact on BAME communities. The Mayor commissioned a Rapid Evidence Review, Inequalities in relation to COVID-19 and their effects on London, to gain a better understanding of the impact for London. The Deputy Mayor for Communities and Social Justice convened a series of virtual roundtable conversations and community meetings with groups and community leaders between April and September 2020. The 21 roundtables and community meetings reached and engaged with 250 civil society and community groups. The report, Map of Community Views: COVID-19, summarises the findings. This learning informed the development of the London HIS Implementation Plan 2021-24, which prioritised action on income inequalities and ethnicity-related health inequalities caused by structural racism. This prioritisation is reflected in the work programmes included in this MD, for example, the “building the evidence in health inequalities” programme includes an evidence review focussed on structural racism, while ethnic inequalities are also a cross-cutting theme of that programme.   

3.6.    In June 2021, an equalities sub-group of the London Recovery Board (LRB) was formed to focus on the structural inequalities that caused certain communities to experience disproportionate impacts of the COVID-19 pandemic; and on new inequalities that have arisen because of the crisis. Building a Fairer City, the LRB’s structural inequalities action plan for London, was published in May 2022. It has many references to actions that partners will take in tackling ill health for Londoners.

Key risks and issues

4.1.    Risks are assessed and managed on a programme basis. Cross-cutting and major risks are reported quarterly through the GLA’s corporate performance management process. At the time of writing, the major risks are as follows: 

4.2.    The GLA health programme is directly related to delivery of the Mayor’s HIS, a statutory duty under the GLA Act 1999.

Impact assessment and consultations

4.3    Impact assessments have been conducted on the key elements of the programme, as detailed above.

4.4    The HIS was subject to extensive consultation to inform its development in 2017 and 2018. The work programme has further been informed by community engagement during 2020 and 2021. 

4.5    There are no known conflicts of interest to note for any of those involved in the drafting or clearance of this decision.

5.1.    Approval is sought for expenditure of £106,000 for the HIS implementation work as detailed in the below table.

5.2.    The £106,000 expenditure will be funded by the HIS Implementation budget held within the Health Unit.

5.3.    This is in line with the Health Unit budget allocations for 2022-23 financial year.

6.1    The foregoing sections of this report indicate that the decisions requested of the Mayor concern the exercise of the Authority’s general powers and fall within the Authority’s statutory power to do such things considered to further or which are facilitative of, conducive or incidental to the promotion of social development in Greater London and in formulating the proposals in respect of which a decision is sought officers have complied with the Authority’s related statutory duties to:

• pay due regard to the principle that there should be equality of opportunity for all people
• consider how the proposals will promote the improvement of health of persons, health inequalities between persons and to contribute towards the achievement of sustainable development in the United Kingdom
• consult with appropriate bodies.   

6.2    In taking the decisions requested, the Mayor must have due regard to the Public Sector Equality Duty; namely the need to eliminate discrimination, harassment, victimisation and any other conduct prohibited by the Equality Act 2010, and to advance equality of opportunity between persons who share a relevant protected characteristic (age; disability; gender reassignment; marriage and civil partnership; pregnancy and maternity; race; religion or belief; sex; sexual orientation) and persons who do not share it and foster good relations between persons who share a relevant protected characteristic and persons who do not share it (section 149 of the Equality Act 2010). To this end, the Mayor should have particular regard to section 3 (above) of this report.

Procurement and Grant Funding

6.3    In decision one above, the officers have sought approval of budget for the HIS implementation work programme for 2022-23.  The officers are reminded to ensure that all procurements and grants of funding required for the implementation of the said programme be undertaken in accordance with the requirements of the Authority’s Contracts and Funding Code.

6.4    The GLA has an existing grant agreement with University College London (“UCL”) for up to £100,000. MD2906 approved the initial tranche of up to £75,000 grant funding to UCL. Decision two above seeks approval of the balance of the grant funding under the said grant agreement. The legal comments in MD2906 continue to apply to the approval of the balance of the grant funding.

7.1    A business plan for the work of the Health and Wellbeing team has been developed. This sets out the full range of programmes, policy and advocacy work the team plans to undertake in 2022-23, alongside a timeline for each specific deliverable. The key milestones are listed below. 

•    The HIS Implementation Plan 2021-24
•    London HIS 
•    The London HIS Implementation Plan 2018-2020 
•    HIS Annual report 2018-19 
•    HIS progress report 2021 
•    HIS Consultation Integrated Impact Assessment 
•    Our Vision for London: The next steps on our journey to becoming the healthiest global city (2019)
•    Next Steps for Social Prescribing in London 
•    Disparities in the risk and outcomes of COVID-19
•    COVID-19 – Understanding the impact on BAME communities