Rowena Estwick, Partnerships Manager, Guy's and St Thomas' Charity
Dec 15, 2017
The interplay between the urban environment, diverse communities and high levels of deprivation is a driving factor behind health inequalities in our boroughs and the lens though which we’ve responded to the Mayor of London’s draft Health Inequalities Strategy.
Evidence overwhelmingly supports the Mayor’s view that the most vulnerable of our communities are disproportionally affected by poor health. Our own programmes are focussing on two health issues that have inequality at their core. Childhood obesity and multiple long-term conditions are exacerbated by deprivation. On both issues, we see higher rates in the poorest areas and onset of long-term conditions at least 10 or 15 years earlier than those in richer areas.
We’ve developed our programmes in partnership with local stakeholders, community groups and others to understand the complexity of these issues and how they’re contributing to the health inequalities in our boroughs. Using the insights gained from this process, we responded to the following sections of the Mayors draft strategy: Healthy Children; Healthy Places and Healthy Communities.
The Mayor’s new strategy has a welcome focus on the issue of child obesity.
Our own work shows that childhood obesity is primarily not a problem of individual knowledge, motivation or self-discipline. Rather, it is ‘a normal response to an abnormal environment’. The spaces in which many of London’s children and young people spend their time have more barriers to healthy eating and activity than they do opportunities. This is especially true for those living in disadvantaged circumstances.
Unless we start from this assumption, we are unlikely to make significant impact, and risk exacerbating existing inequalities. Our childhood obesity programme is therefore designed around a belief that improving these environments is crucial if we want to create long-term sustainable impact.
Our challenge, therefore, is whether the strategy for childhood obesity can do even more to recognise the importance of the environments children live, study, eat and play in.
Health inequalities in London are strongly linked to wider socio-economic, environmental and cultural inequalities.
We therefore welcome the Mayor’s ambitions to look at the disparities between and within differing populations in London. Going further, our own work suggests there is little understanding anywhere of the cumulative impact of urban environment, deprivation and complex diversity on health. Other cities in the UK and indeed across the world face the same issues.
The urban environment has both protective and risk factors for health. On the one hand, there is proximity to services and social networks. On the other, there is competition for resources and the transitory nature of much inner-city living can affect the development of social capital. Our multiple long-term conditions programme aims to prevent vulnerable people from being disproportionally affected by these factors and supporting a better quality of life.
Underpinning all of this is our commitment to understand the drivers and contributors of urban health. Working with others, we aim to unpack the layers of cause and effect at the point where urban environments, diverse communities and socio-economic inequalities converge to impact on health.
We’re committed to working with others with similar aims and ambitions to scale the impact of our work. As such, we strongly support the Mayor’s ambition to spread best practice across London boroughs; and to build energetic partnerships between communities, business and the statutory sector.
We will support the Mayor in his ambitions to:
With leadership and staying power, we are confident that this strategy can be a real honest commitment to leading the way to tackling health inequalities for Londoners.
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Erica Levine from the Arnold Institute for Global Health writes about our learning partnership, comparing efforts in improving health in New York and London.
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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.
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Improving population health in towns and cities requires both an overarching city-wide strategy and a granular understanding of the needs of local neighbourhoods, as Chris Naylor and Kieron Boyle explain.