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Putting prevention at the heart of decision making: Why I fought hard for London’s devolution deal

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The Mayor of London, Sadiq Khan has made no secret that addressing inequality, and particularly health inequalities, is one of the major ambitions of his tenure. There is huge disparity in the quality of life experienced by Londoners.  The causes of this disparity is complex but is linked to differences in people’s homes, education and employment, childhood experiences, local environment, access to public services, and lifestyle habits. You can read more on health inequalities in London in my recent blog.

Like any global city, London faces a set of unique health and care challenges on top of a constantly growing and changing population. Decision making at a local level has the potential to bring many improvements to health and care, and can lead to more joined-up and sustainable services that better meet people’s needs.

Recognising this opportunity, a landmark devolution deal for London was signed in November by the Mayor of London, Secretary of State for Health Jeremy Hunt, London Councils and NHS, Public Health England and wider health and care leaders.

What this means for Londoners

The London Devolution Memorandum of Understanding (MoU) is the largest of its kind in England with over 100 organisations involved in shaping it over the past two years. It confirms Westminster’s commitment to accelerating local decision making in London.

The MoU brings with it many benefits however the most exciting aspect from a public health perspective is that it places prevention at the heart of decision making , providing new opportunities to act early in preventing some of the city’s biggest health challenges.

Firstly, the MoU allows us to explore innovative solutions to address childhood obesity by restricting the advertising and marketing of unhealthy food and drink in specific locations, such as close to schools, based on health harm.

We will also be working closely with the Department for Education to develop guidance to assist with how the revenue from the soft drinks industry levy is allocated to schools, so that this important resource is used to generate good value for young Londoners.

Secondly, the MoU provides a unique opportunity to address illegal tobacco and counterfeit alcohol by the establishment of a dedicated city-wide enforcement team to grapple with these issues that exacerbate health inequalities.  This is another win for young Londoners for whom these issues affect the most.

Thirdly, the MoU gives us significant opportunities to improve the employment opportunities for people living with long term health conditions and disabilities in London.

We will be working actively with the Department for Work and Pensions and local partners to raise the profile of early intervention and develop new models to integrate health and employment support.

London’s position now

With the signing of the devolution deal, London is now in a stronger position than ever before to support its 8.6 million inhabitants to be as healthy as possible, for as long as possible. The capital can take more action to tackle the childhood obesity crisis and to significantly reduce health inequalities through a focus on the consumption of alcohol and illegal tobacco.

The city now has control over the services that the Mayor has long argued is required to improve life, meet the needs of local communities, and ensure that all Londoners have adequate access to services now and in the future.

I fought hard alongside our partners for the devolution deal because I believe this is a huge step forward in achieving London’s aspiration of being the healthiest major global city.

Opportunities to do more to prevent ill health, improve how services are provided, and release money and land from the NHS estate in London have been unlocked.

The challenge now will be to strengthen partnerships and work to turn the potential opportunities of devolution into tangible improvement in the quality of life of all Londoners.

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