Share your views: Health and Wellbeing Strategy 2023-27

The Joint Local Health and Wellbeing Strategy (JLHWS) describes the vision, priorities and actions agreed by the Health and Wellbeing Board (HWB). 

The vision, priorities and actions were designed to:

• meet the needs of our communities as identified in the Joint Strategic Needs Assessment (JSNA)
• to improve the health, care and wellbeing of local communities
• and to reduce health inequalities

The JLHWS is the footprint of the local authority (with Children’s Social Care, Adult Social Care and Public Health responsibilities).

The City of London HWB is a partnership that works together to improve the health and wellbeing of people in the City of London. The HWB is responsible for:

• assessing the health and wellbeing needs of their population and publishing a Joint Strategic Needs Assessment (JSNA), and
• publishing a Joint Local Health and Wellbeing Strategy (JLHWS), which sets out the priorities for improving the health and wellbeing of its local population and how the identified needs will be addressed, including addressing health inequalities, and which reflects the evidence of the JSNA.

Both of these ensure that people's needs and how the local area affects their health are identified and agreed. They are not an end in themselves, but a regular process of strategic assessment and planning.

A person’s health and wellbeing are influenced by many different things. Every person’s health will be influenced by various interacting factors. Everything from an individual’s behaviour and choices, to the broader social, economic, cultural and environmental conditions will affect someone’s health.

During the development of this strategy, we have been using the King's Fund Population Health Framework to group some of the things that can influence health and wellbeing and help define who might be involved in taking action.

What are wider determinants of health?

They are all of the things in a person's life that may affect their health, but they might not be able to directly control them. There's now lots of evidence that wider determinants have the biggest impact on health. They include:

• income
• wealth
• education
• housing, transport
• our physical environment (such as the built and natural environment, air quality and green spaces)
• leisure facilities
• opportunities

Evidence shows that problems with money can have an impact on all determinants of health and wellbeing:

Wider determinants:

• Households from minority-ethnic backgrounds are more likely than white households to live in overcrowded homes and to experience fuel poverty.
• Parental income is important for children’s health, because of the long-term consequences in terms of their future social and economic circumstances as adults, and their resulting health.
• Low health leads to low income.
• The quality of work, including exposure to hazards and job security, determines the impact that work has on health.
• Unemployment is associated with a shorter life expectancy and poorer physical and mental health, both for unemployed individuals and their households.
• Living on a low income is a source of stress.
• People from minority-ethnic backgrounds experience higher levels of work stress than those from white backgrounds.

An integrated health and care system:

• Stress, work hazards and health behaviours increase the use of health services.
• It is hard for those most in need to access services at times.
• People in poverty have higher risks of poor health but often only interact with services when they present with more acute, complex needs.

Our health behaviours and lifestyles:

• Income determines people’s ability to buy health-improving goods, from food to gym memberships.
• Emerging evidence suggests that being on a low income affects the way people make choices concerning health-affecting behaviours.

Our communities and places we live in:

• Community life, social connections and having a voice in local decisions are all factors that affect health and wellbeing. These community determinants build control and resilience and can help buffer against disease and influence health-related behaviour.
• As well as having health needs, all communities have health assets that can contribute to the positive health and wellbeing of its members, including:
  • the skills, knowledge, social competence and commitment of individual community members
  • friendships, inter-generational solidarity, community cohesion and neighbourliness
  • local groups and community and voluntary associations, ranging from formal organisations to informal, mutual aid networks such as babysitting circles
  • physical, environmental and economic resources
  • assets brought by external agencies including the public, private and third sector.

We define health inequalities as the avoidable and unjust differences in health outcomes between groups of people and communities.

The rising cost of living means that more people are having to make their money go further. People on lower incomes and with fewer savings/higher debts are effected the most by this.

The City of London JSNA and the 2021 Census data shows that City of London residents and workers will be impacted by money concerns that will have direct and indirect impacts on their health and wellbeing.

Due to this, the priority for the strategy is to address the economic determinants (income, wealth, education, housing, transport and life opportunities) to improve health equality for residents and workers in the City of London.

Groups facing high risks from rising costs include people on universal credit, private renters, and young adults. People from black, mixed, and Asian backgrounds, people with children, disabled people and people with a mental health condition also face rising risks.

We know from the JSNA that:

• 40% of City residents are private renters
• 13% are social renters (1200 according to Census 2021)

46% of those in the highest rate of poverty are social renters (4.9 million people). 67% of social renters are on the lowest 40% of incomes combined with the higher costs of paying rent compared with housing costs paid by owner-occupiers.

The Indices of Multiple Deprivation in 2019, outlined in the JSNA, identified the City of London’s most deprived ward, Portsoken, as among the top 20% in the country for levels of income deprivation, including income deprivation affecting older people. The Mansell Street and Petticoat Lane area is the most deprived in the City falling into the 40% most deprived in England. Portsoken is also the most ethnically diverse ward of the City of London.

The Census 2021 release shows that an estimated 1034 residents described their health as fair to very bad. Whilst an estimated 948 residents assessed their day-to-day activities as limited by long-term physical or mental health conditions or illnesses are considered disabled. A further estimated 1637 people were not employed but had worked in the last 12 months (this does not include those that are retired (arouns 12% of the population)). Roughly 300 people were seeking employment or due to start employment within the next two weeks. Nearly 130 people are on long-term sick leave or not working due to disability.

Although a range of support has been offered in relation to the cost of living, it is known that some will not be eligible for this and will still be struggling financially.

• Focus groups with residents
• Stakeholder engagement, which includes:
  • Health services
  • Social services
  • Community and volunteer sector
  • Housing services
  • Employment services
  • Relevant City of London Corporation committees and groups
  • Residents
• Extensive advertisement of the consultation page and questionnaire
• The consultation will support the production of the strategy action plan

• Please review the draft strategy
• Please take a moment to complete the survey to provide feedback on the draft strategy
• If you would like to be involved in focus groups on the strategy, please provide your email address when asked as part of the questionnaire. The focus groups will be organised for both face-to-face and online discussions
• If you are a resident, please help us build a better picture of our communities by answering a few questions in our cost of living action plan survey

• All feedback will be used to produce the final version of the Joint Local Health and Wellbeing Strategy 2023-27.
• The final version will need to be signed off by the Health and Wellbeing Board in June 2023 and published on the City of London Corporation Website.
• The action plan for the strategy will continue to be populated with stakeholders, and will be reviewed by the Health and Wellbeing Board.