When I had the opportunity to become regional director of London for Public Health England, as a London resident myself I didn't need to dwell too long on the decision. London is a leading world city and a truly exciting place but one which has a complex landscape in terms of its public health challenges. But such challenges are there to be met, not avoided.
Now, six months after PHE opened for business, there’s no doubt that this particular big city will be keeping us on our toes and pushing us to keep up with it if we are to make a difference as public health professionals.
The casual day visitor to London may often be startled at the change of pace as they come into the capital. The speed of travel, the scale of the buildings, the volume of people, the variety of cultures, languages and ethnicities, the differences from borough to borough giving the impression of towns within towns, the poverty and wealth living side by side. Equally so, the health of Londoners is a mixed picture reflecting this diversity and it is important to understand this.
A visitor will notice the younger age of Londoners – the population is growing fast, due in part to a rising birth rate - and is growing at a faster rate than any other region in England. Between 2001 and 2011, London’s population grew by over one million people, or roughly the size of Birmingham. This is putting serious pressure on housing for young families and coming over the hill is the need for tens of thousands of school places in practically every borough of the capital. So when I speak with councillors and chief executives in local government, their serious worry lists include homelessness, poverty and providing schooling and jobs for young people.
The combination of its scale and nature as a capital means that London has a higher prevalence than other regions of health conditions that are both high volume and costly. For example, over 1.5 million Londoners suffer from mental ill-health which costs the city £2.5 billion in health and social care costs. More than 50% of people with HIV live in London and the rate of acute sexually transmitted diseases is over 50% higher than any other region. Forty per cent of the nation’s tuberculosis cases are in London residents and we also have a greater prevalence of diseases that are rare in others parts of the country such as malaria and sickle cell thalassemia. Add to this the fact that London has the highest prevalence of childhood obesity in England in both reception and year 6 children, and that almost a quarter of London’s adults are now obese, and we have serious health challenges. My integrated London regional and Centre team at PHE are helping me to address these issues with good partnerships throughout the city.
Like all areas, London has seen some positive improvements in recent years. In the first decade of the new millennium, infant mortality declined in London and life expectancy increased by more than two years - good news. The ‘Jubilee line’ of health inequality has narrowed; every two stops east on the Jubilee line - rather than one - now represents a year of life lost, with the narrowing possibly reflecting the regeneration around Canning Town tube station. But folk are beginning to quote other tube lines now instead – take the route of the District line eastwards and you run into premature mortality pretty quickly.
On the world stage, London will compete economically, socially and educationally as a major player, wishing to attract the best as a good place to reside and succeed. We will help this through our work on improving and protecting the health of Londoners. I and my team also want to give a message that London is an inclusive place, one where we care about unfairness of opportunity particularly for young people.
However, the average life expectancy in our capital continues to lag behind several other world cities like Tokyo, Paris, Sydney and Shanghai. Health inequalities exist between boroughs and, in the past 13 years, there has been a widening in the gap between those with the highest and lowest life expectancies. We know there is much more to do on people’s sense of wellbeing in the city. We separate the health of body and mind at our peril.
PHE’s recent Longer Lives website has provided a tool for local authorities and the public to be able to easily compare differences in life expectancy across the country and between London boroughs. Fifteen London boroughs are ranked green for having low rates of premature deaths compared to other local authority areas and 10 are ranked red for having high rates.
Good health and access to high quality health and social care are major factors in contributing to a better quality of life for our residents. However, population growth in London, as well as economic, technological and financial pressures, are now combining to present unprecedented challenges. Radical change will be needed in the next few years if we are to be able to continue to support people to make the most of their health and their lives.
The public health system in London includes local government, London Councils, ourselves in PHE, the NHS, research and teaching institutions, voluntary and charitable sectors, business, the Mayor of London and City government. Together, we are aiming to be innovative and work across our organisations to target interventions at where they can have the biggest impact on people’s lives.
Local partnerships in London – focused through Health & Wellbeing Boards, local authorities and Clinical Commissioning Groups (CCGs) – are strengthening and co-ordinating the leadership for health in their areas. At a London level, key partners from local bodies such as local authorities and CCGs have started to come together with regional and sub-regional partners like Public Health England, NHS England, Local Education & Training Boards, and city-wide government, to work together to support local plans and shared priorities. The London Health Board, a partnership of key players across local government and health, chaired by the Mayor of London, and which includes Public Health England, has been created to provide a vehicle for strategic and political engagement across London where this can add value to local activity and help to lever change. This is all positive action.
I perceive an energy and ambition in London among these partners to work to face up to the challenges we know and to take the opportunities that these times offer us. The people in sight are the vulnerable, the young, the lost and the brilliant. We also include you and me who live, love, remember, grieve, err, wish and hope. We are all London.