A year in progress: reflections from the 2022 Health Inequalities Strategy annual report

London is the most diverse city in Europe. It’s dynamic and always changing. But that change is not always uniform or equal. That can be challenging in a city of 9 million people, where our diversity is not only reflected in our vibrant cultural fabric, but also in the deep social and economic disparities experienced by different groups. These disparities are among the biggest drivers of health inequalities in the capital. They impact a person’s quality of life and can result in early death for some. That’s why the work we do to improve Londoners’ health has to be about tackling health inequalities – so we can get to the heart of the things that make people ill.

It’s also why I was pleased to attend yesterday’s (26^th April) London Health Board, where the Mayor unveiled a new report showcasing the progress made to date on his
Health Inequalities Strategy Implementation Plan from 2021. Over the last year, the plan has enabled partners across systems to laser focus their efforts on six key commitments in order to address some of the causes of ill health and inequality in London:

1. Establishing 50 School Superzones to support healthy children.
2. Ensuring all Londoners can access mental health and wellbeing support for healthy minds.
3. Encouraging more employers to provide the London Living Wage in support of healthy places.
4. Tackling London’s toxic air to support healthy places.
5. Establishing an anti-racist practice learning hub with partners to encourage learning, allyship and support healthy communities.
6. Encouraging Londoners to take on 20 minutes of active travel, to reduce obesity, incidence of heart disease and risk of dementia as part of healthy living.

I would encourage you to visit the Health Inequalities Strategy page for more on these themes. Here and now, I want to reflect on my biggest highlights and celebrate what’s been an incredible journey.

By now, many will be familiar with the bold action taken to improve air quality for Londoners by introducing and expanding the world’s first Ultra Low Emission Zone (ULEZ). The fact is that we would all be healthier if the air we breathed were cleaner. Air pollution increases the risk of developing conditions such as heart disease, strokes and lung disease, including asthma and lung cancer, and it reduces life expectancy. In 2019, air pollution contributed to the premature deaths of around 4,000 Londoners. The introduction of the ULEZ has helped clean up our toxic air and resulted in Londoners experiencing significant reductions in both nitrogen dioxide (NO2) and fine particulate matter (PM2.5) pollution. These are the key air pollutants which affect the health of Londoners throughout their lives.

Good progress has been made, yet there is much more that needs to be done if we are to make London’s air safe for all. That requires action from partners at the national, regional and local levels. The expansion of the ULEZ across all London boroughs from August 2023 is a step in the right direction. This will help bring improved air quality and its health benefits to the five million people living in outer London. What’s more, this will help tackle the health inequalities that exist in communities hit the hardest by toxic air around London.

As we reflect on the COVID-19 pandemic, one of the most challenging things for many of us to come to terms with was the extent to which structural racism meant that some communities were left worse off than others. The 2021 Health Inequalities Strategy Implementation Plan, committed to taking action to address structural racism as a determinant of health. Since then, partners across the healthcare system, including the Office for Health Improvement and Disparities (OHID), the Greater London Authority (GLA) and the NHS, have worked together to become anti-racist organisations, and invest in the creation of a London “hub” to support learning and improvement. The hub builds on what each organisation is already doing locally, and with the Mayor of London’s leadership, it has been scoped and designed – and will be implemented with - communities. This will make the hub sustainable, fit for purpose and meaningful. I look forward to the launch of the hub this summer 2023.

I want to touch on one last progress area, because it goes back to my earlier point about economic disparity and the role it plays in widening health inequalities. Income and health are closely related. How much money you earn determines where you live, your ability to afford essentials and access services. Being on a low wage can limit your social interactions and connections and impact a person’s mental health. That’s why the work to boost uptake of London Living Wage accreditation is so vital – especially in a cost-of-living crisis.

Income improvements are associated with health improvements across the social gradient. Although work has traditionally been seen as a source of financial stability, and should be a way out of poverty, for many Londoners this is not the case. It forms one of the greatest contradictions of our city, which is that while it’s the financial capital of the country, it has some of the starkest poverty rates in the nation.

Since 2022, the Mayor has been working with the London Living Wage Foundation to champion fair and decent wages for all Londoners. The foundation has helped to boost the number of accredited Living Wage employers in the capital by around 25% and helped generate over 41,000 pay rises onto the real Living Wage. In real terms, it’s helping Londoners not just afford basic essentials but save money too.

What I’ve shared here is just a snapshot of what we’ve done. There is incredible work going on behind the scenes every day to build on this. One major example of this is the Mayor’s health in all policies approach, which is being supported by the GLA Group Public Health Unit. This approach is helping to ensure that good health is at the heart of all policies and programmes helping to shape our city. Together, with OHID, the NHS, the GLA, the Mayor and City Hall’s partners, we have exceeded much of what we said we would do. And it’s only strengthened our resolve to do more, because Londoners’ lives depend on it.