London is not a healthy place to live even by the standards of our biggest city rivals around the world. We have the highest rate of childhood obesity of any major city and more than half the adult population are obese or overweight. More than one million Londoners will experience mental ill health this year – the total economic and social costs are estimated at £26bn annually. And these issues disproportionately affect the poorest – those in some of the richest wards can leave a full 25 years longer than those in the poorest. London comes 7 out of 14 in health rankings of global cities.
We imagine how London as a city would look if it did no harm. For many, London is a harmful place: in the air we breathe, the food we eat, the violence we fear, the gap between the richest and poorest, and much more, our city can be bad for us. A city that does no harm would be made up of healthy communities, full of knowledgeable people.
To build communities that promote good physical and mental health the next Mayor must:
1) Tackle inequality: A more equal city would be healthier for us all. The living wage, a rise in the minimum wage, company pay ratios, stronger unions and more. We explored this in our third London Paper: A Fairer City.
2) Promote friendly communities and good neighbours: Severe loneliness is as detrimental to health as smoking 15 cigarettes a day7, whereas living in a supportive community increases our chances of good health by 27%. Well designed streets, good transport, benches to share, plotting sheds and locally-delivered services: just some of the ideas we considered in our second London Paper: the Good City.
3) Make it easier and safer to cycle and walk: If more of us took more exercise we could prevent 4100 deaths each year. Only 13% of Londoners walk or cycle to work, yet in Copenhagen 50% commute by bike. This is about large scale investment in safe infrastructure – cycling lanes, pavements, crossings – closing roads and encouraging people to walk at least some of their journey.
4) Clean the air: The back of a car is far more deadly than the front: 4,500 people died from the effects of air pollution last year. London’s air is officially dangerous – in breach of EU safe limits. A determined Mayor could tackle this in the same way other cities have: strict emissions limits, retrofit vehicles, target hotspots. Build on the tradition London pioneered with the ground-breaking congestion charge but has let lapse since.
5) Make London safe: Violence and the threat of violence damage our health and wellbeing. A city that did no harm would be one in which we felt safe and free from harassment. City-wide women only nights – inspired by their successful adoption in Bogota – would send a powerful signal about our intentions, and should be backed up by detailed, practical work to make women and girls safer – and feel safer – in our city. Fear of crime has a dramatic impact on health, and should be brought down through careful work in communities.
6) Promote healthy food: Banning fast food outlets near schools, and lobbying for a national sugar tax, would be two important ways to make unhealthy food harder to access.
7) Ban smoking in parks: We support the London Health Commission’s call for a ban on smoking in outdoor public spaces like parks. It should be accompanied by increasing support for people to give up, and efforts to prevent children taking it up. Banning it outside hospitals would be a good first step.
8) Build decent housing: Good health comes from good housing. The new houses London desperately needs must be well designed and built so they improve our health rather than exacerbate our health problems.
And the next mayor must ensure we have the information to keep ourselves and others healthy
1) Tackle mental health stigma: The best thing a new mayor could do would be to “speak openly and unsqueamishly about mental health”. One in four people have mental health problems11 – more than voted for Boris Johnson in the last election. Public advocacy should be combined with practical support – training for TFL and shop staff on how to support people with hidden disabilities, and a more generic version of the ‘baby on board’ badge.
2) Introduce health traffic lights on restaurant food: Following New York’s example, to allow diners to make healthier choices about their meal.
3) Learn the signs and symptoms of cancer and the importance of screening: So that the one in three of us who will get cancer can catch it early on and get it successfully treated.
4) Learn first aid: Between 10 and 15 people die in every borough every week, who might have been saved if those around them knew first aid.12 It should be a compulsory feature on the school curriculum and available to all employees in workplaces.
5) Do it together in a Save Ourselves Week: Every year, a week in which the whole city collectively applies the discipline, the excuse, the pressure and the knowledge, to do the things we know we should but we’ve never quite got round to doing in the past, like checking for cancer or learning first aid.
New York has become a public health mecca for many over the last few years, as Republican Mayor Bloomberg’s determined, evidence-driven assault on causes of ill health – cigarettes, trans-fats, sugary drinks, a lack of walking and cycling infrastructure – was regularly mocked and attacked by right-wing critics but hailed as revolutionary by public health professionals worldwide and led, over the course of his three terms, to a three year increase in life expectancy, almost double the US average. Can London’s next Mayor steal his crown, and London become – in the words of the London Health Commission – the healthiest major global city?