Rowena Estwick, International and National Partnerships Manager, Guy’s and St Thomas’ Charity
Oct 04, 2019
Since we launched our new strategy three years ago, we’ve been building our understanding around urban health – what it is, who can impact it, how it shapes our lives.
In June this year, we partnered with The King’s Fund to contribute to a growing global conversation about how cities shape our wellbeing and how health may thrive in urban areas.
We also often find ourselves being approached by policy-makers, foundations, practitioners and academics from cities all around the world, interested in learning from our urban health programmes.
We are now building on that with an ambitious two-year international learning project to help us understand the opportunities and barriers to equitable health in urban areas. Working with Innovation Unit, the initiative starts from the premise that there are neighbourhoods elsewhere in the world which face very similar health challenges to our boroughs in inner-city London. And that we can all learn from each other.
Through a mix of in-depth analysis and learning exchanges, we want to learn about how people in other cities, from system leaders to community organisations, are addressing the health impacts of living in urban environments. We plan to build dialogue and connections with people and places working with peers globally to grow our understanding of the issues and share lessons widely in 2020.
Our boroughs are densely populated with a rich and diverse mix of cultures and ethnicities. There is a wide variation of household income, with affluence and poverty living side by side. When we say ‘urban health’, we mean exploring how these characteristics interact to provide both opportunities and barriers to good health.
Starting from that premise, we took a data-led approach to finding similar places to ours across the globe.
To help identify cities like London we used data from the UN-Habitat’s City Prosperity Initiative (CPI). The CPI is a global initiative that has been applied in over 400 cities. It’s a composite index that measures a city’s overall achievements in key areas including prosperity, infrastructure development and quality of life. It’s used by decision-makers and others to design clear policy interventions. While it’s not exhaustive, it’s probably one of the best datasets out there.
Based on this CPI data, we ranked cities for closest comparison to London, our boroughs and the specific neighbourhoods we work in. However, one area the CPI data didn’t help us was in assessing diversity. The next challenge was how do we compare and measure diversity and cultural mix globally?
We found that, what we see as a diverse population in London and the UK, may not look the same elsewhere in the world. Trying to find a measure for diversity that worked globally raised fundamental questions: what are we saying is the impact of diverse communities on health? Is it about cultural understanding of health and good health? Is it language barriers? Are particular populations prone to particular health issues? Has history left certain groups more disadvantaged than others?
There was no perfect answer to these questions and no specific data set to measure any of the above. We’re also very action orientated and focused on workable solutions. So, we chose to focus on proxies that looked at differences between migrant and indigenous populations (percentage of foreign-born population) and language barriers (number of non-native languages spoken).
When layering our diversity data proxies to the original list, two things became apparent:
As we start our global exploration, diversity will continue to be a focal point. If it’s true that it plays such a key role in determining health outcomes in urban communities then understanding what underlies its impact feels key. Dr Brandy Kelly Pryor (Humana Foundation) and Alonzo Plough (Robert Wood Johnson Foundation) recently wrote about this issue for us.
Using the CIP and diversity sets of data, we’ve come up with a final list of cities in our learning project:
The first seven cities on this list are comparators to London. The next two (Glasgow and Detroit) are comparators to the London boroughs we work in, Lambeth and Southwark, with similar sized populations and poor health outcomes. The final city (Birmingham) contains the most similar neighbourhoods to those we focus most of our work in.
Our sense is that as well as being good fits for the data sets available, these cities also give us global spread and are places with interesting initiatives we can learn from and build connections with.
We’ve started on our first learning exchange, to Birmingham, visiting neighbourhoods similar to some of the wards of our boroughs. We had an excellent visit to Glasgow last month and next year we’ll be taking our learning visits to Australia and North America.
This is a really exciting project and we’ve designed it so that the knowledge gained from connecting across the world benefits anyone working on improving health in urban communities across the system at every level.
I encourage you to follow our journey from now to the launch of our findings in Autumn 2020 through our website and social media; and to contact me if you have examples of work, networks or good people doing good things on health in any of our identified cities.
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24 September, 2019
Our Programme Director, Kate Langford, explores the issue of air pollution in cities, how we can learn from others making headway towards change and the opportunities available to find innovative solutions in London.
04 June, 2019
We asked some of the international experts speaking on at our joint event with the King's Fund what actions must happen today to make sure that future health in cities is equitable and thriving.