Cities with devolved powers can improve public health, finds King’s Fund

Cities with strong local leaders and devolved powers are able to drive improvements in public health, a report has found.1 Giving cities greater control over resources could help to reduce health inequalities, the authors said.

The report’s lead author, Chris Naylor, senior fellow at the think tank the King’s Fund, said, “Around the world cities are looking at what they can do to help residents live longer, healthier lives. Increasingly, leaders in cities such as Amsterdam, New York, and Paris are using the powers and resources at their disposal to drive improvements in the health of their populations.”

He added, “The cities that have made the fastest progress are those where mayors and other local leaders have invested their own political capital in tackling public health issues and where they are given the decision making and tax raising powers they need to take action. Granting England’s cities greater powers could help to reduce health inequalities and address growing problems caused by poor housing, air quality, and other issues.”

The authors analysed case studies and interviewed local leaders in 14 cities, including New York, Madrid, and Copenhagen. They explored the range of roles that city governments could have in improving population health, whether directly or indirectly, and the factors that contributed to effective urban health governance.

Their findings showed that leaders of some cities had made extensive use of resources and regulatory levers to drive health improvements.

In Amsterdam a 20 year initiative involving city leaders, health and education professionals, and the food industry has helped to reduce the prevalence of childhood obesity in the city by 12% over three years.2 And New York has introduced new regulations to control the advertising and sale of unhealthy foods.

City leaders in Paris and Barcelona have used their planning powers to create public spaces with the aim of encouraging physical activity. And measures have been introduced in Tokyo and Madrid to create health promoting neighbourhoods with strong social ties and community activities.

“City and local governments are in a prime position to tackle the social determinants of health because of the breadth of their responsibilities over a defined geographical area, with powers cutting across different areas of public policy,” said the authors.

They pointed out that the fiscal regime in the UK is highly centralised in comparison with other countries, with more than 90% of tax revenue being raised at the national level.

“Policy-makers should explore the case for giving cities further fiscal and regulatory freedoms to enable them to tackle population health challenges more effectively,” they suggested, adding that the creation of seven new combined authorities and “metropolitan mayors” in the UK offered important opportunities to develop large scale approaches to population health.