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  • A 3-year programme funded by the Health Foundation, accelerating action to tackle health inequalities in English devolved urban regions – covering 40% of the population. 
  • Project funded by the Health Foundation and run by Greater London Authority, Greater Manchester Combined Authority and West Midlands Combined Authority. 
  • Ran from February 2019 to April 2022. 

 The UK is home to stark and growing health inequalities. The COVID-19 pandemic put these inequalities into sharp focus, impacting our most disadvantaged communities hardest. The drive to address these inequalities at regional level is stronger than ever. Improving people’s health and addressing longstanding health inequalities is vital to increasing prosperity, a growing economy and levelling up between and within regions.  

Addressing health inequalities through devolution 

The Cities Health Inequalities Project was a 3-year Health Foundation-funded project to explore opportunities for devolved English regions to tackle health inequalities. Its steering group included senior leaders from the Greater London Authority, Greater Manchester Health and Social Care Partnership, West Midlands Combined Authority, and the Association of Directors of Public Health.

  • The 3-year project saw the impacts of the COVID-19 pandemic and the rising awareness of health inequalities and opportunities presented to regional authorities and mayors in shaping action. It aimed to accelerate action by providing a means to reflect, share and learn how to approach the population health challenges consistent across cities and metro regions through improving understanding of regional priorities, contexts, challenges and approaches to tackling health inequalities, identifying the levers of change, power and influence at our disposal  
  • engaging all cities/combined authorities in seeking best practice and sharing knowledge  
  • creating a mandate for action by identifying policy that works, shaping how health inequalities are framed and utilising the opportunities of devolution  
  • facilitating conversations, develop ideas, build relationships, collate evidence and link partners to build consensus on taking action 
  • championing improvements to accelerate activity in tackling health inequalities through developing guidance, toolkits, networking, expertise and support. 

A network for those with an interest in improving health and reducing inequalities was established, with a series of webinars (see below) and workshops taking place. An appreciative enquiry approach was adopted which enabled a number of themes to be generated, which were then developed into a set of guiding prompts, to help regions identify local assets, opportunities and levers for change.  

Findings and learning

The project explored the different ways in which work at a regional level can build a mandate to address the social, economic and structural drivers of inequality. The project found that all the regional bodies were facing similar challenges, but that each has its own devolution, political and strategic contexts, so there are no blanket solutions. However, it found it was possible to collate and share inspiration, ideas and learning from how each region is navigating these challenges. 

This project has shown how some mayoral and combined authorities are already taking action to shape wider determinants of health, through local leadership and place-based approaches, highlighting areas for mutual learning. There is an opportunity to support regions with less mature health inequalities agendas to rapidly develop policy based on learning captured through this project.  

Dr Tom Coffey OBE, Mayoral Health Advisor, said: “Health inequalities have been laid bare in the capital and cities across the UK following 10 years of austerity, the pandemic and now the spiralling cost of living hitting the health of those from most deprived and vulnerable communities. It is vital that we continue to work together across regions and learn from each other to tackle these equalities and reduce the pressure on our NHS.” 

A new Improving health and reducing inequalities: Combined Authorities Programme, led by the West Midlands Combined Authority, has been launched to investigate how combined authorities can be more effective at tackling health inequalities by taking systemic action – continuing the work of the Cities Health Inequalities Project.  


Action to address health inequalities in Greater London and the mayoral combined authorities 

This research report explores the powers, responsibilities and activities of regional authorities. Developed by Shared Intelligence, it provides an overview and comparison of each of the devolved regional authorities, clarifying their responsibilities and powers as well as levels of activity on health inequalities action.  

Tackling health inequalities in mayoral and city regions: impact report 2022 

This report sets out what the Cities Health Inequalities Project did and the learning generated and shared. It highlights a range of regional approaches to leveraging and prioritising opportunities to ensure a fairer and more equal society, showing how collective learning can galvanise action within and between regions. It will be useful for people working in the regional administrations, including mayoral teams, health and care system colleagues and national policymakers, along with academics and researchers. 

Appreciative enquiry framework 

This framework was developed by the project policy team, using learning from the three sponsor regions. The team analysed a range of case-study examples of regional approaches to addressing health inequalities, led by mayoral combined authorities. This generated a number of themes, which were then developed into a set of guiding prompts, to help regions identify local assets, opportunities and levers for change. The framework includes examples, to support cross-regional learning. 


A series of webinars shared project learnings and experiences from across all regional authorities. Slides are available below:   

Watch the final project webinar, Learning and next steps (July 2022). This webinar summarised the learning outcomes of the project, presenting how the appreciative enquiry framework was applied successfully in the West Midlands to help identify opportunities for partnership engagement and action. 


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