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In Kensington and Chelsea, one of the wealthiest boroughs in the country, women living around a mile apart can face a 19-year difference in life expectancy.In the tree-lined streets of Holland Park, female life expectancy is 93 years. In Notting Dale, in the shadow of the Westway flyover and just a 20-minute walk away, it is 74.That finding, from Impact on Urban Health's new State of Urban Health research, should give policymakers pause. It illustrates something too easily lost in debates about regional inequality: the geography of poor health does not run neatly between London and the rest of England. It runs through our towns and cities too.That matters as the Government develops the next phase of devolution alongside its neighbourhood health reforms. Both are welcome. But both will fall short if "place" is understood only at the level of regions or mayoral authorities.Andy Burnham's decision to establish No 10 North captured an important idea: people should not feel remote from the institutions making decisions about their lives. But some of the communities most distant from power are geographically very close to it.London is a prosperous global city, yet wealth and opportunity sit alongside poverty and poor health. Our research, drawing on 120 national indicators alongside the lived experiences of people in Lambeth and Southwark, shows how stark those inequalities can be within a single urban area.They are not an inevitable feature of city life. They reflect decisions about whether homes are safe and affordable, work is secure, healthy food is accessible and the air people breathe is clean. They also reflect whether communities have the power and resources to influence what happens around them.London's overall prosperity can obscure that reality. Thousands of families live in homes affected by damp and mould, while around four in ten Londoners do not have enough income to achieve a basic standard of living.For local and national leaders, this goes to the heart of whether neighbourhood health and devolution can succeed. Bringing care closer to home matters, but neighbourhood health must mean more than moving NHS services into different buildings. If it is to improve outcomes and narrow inequalities, it must engage with the conditions creating ill health in the first place.Greater Manchester offers an important lesson. It has had greater devolved powers over health than many other parts of England and has pursued a determined focus on prevention and early intervention. Healthy life expectancy there has moved against the direction seen in much of the country, where progress has stalled or gone backwards.The lesson is not that one model can simply be transplanted elsewhere. It is that action on the causes of ill health works best when local leaders have the powers, resources and relationships to act.The Government's next phase of devolution is an opportunity to put that principle into practice. Its new devolution settlement already recognises a role for strategic authorities in improving health and reducing health inequalities. The white paper promised for this autumn should ensure local leaders have the powers and resources to make that ambition meaningful.People will judge these reforms by whether their lives improve: whether their homes make them ill, whether their work provides security, whether their children can grow up healthy and whether they have a genuine say in what happens where they live.That means treating health not as a discrete NHS responsibility, but as an outcome shaped by housing, transport, employment, skills and regeneration. Devolution cannot simply transfer responsibility downwards while leaving the levers that determine people's health fragmented across Whitehall.The same thinking should underpin neighbourhood health. Done properly, it can connect clinical care with practical support on debt, housing, employment and other pressures that shape whether people stay well. The Government's commitment to include debt advice in Neighbourhood Health Centres is a good example of what this can look like.The opportunity is to join these reforms up: devolved power that allows places to act on the causes of poor health, and neighbourhood services organised around the realities of people's lives. Prevention then becomes something government does with places and communities, rather than something the NHS is expected to deliver alone.People will judge these reforms by whether their lives improve: whether their homes make them ill, whether their work provides security, whether their children can grow up healthy and whether they have a genuine say in what happens where they live.No 10 North may help narrow the perceived distance between central government and the places it serves. But the deeper test of the Government's approach to place is not whether power travels further from Whitehall.It is whether power reaches people who currently have too little of it — including those living on Whitehall's doorstep.If the ambition is growth in every postcode, improving health has to be part of what that growth means. And if neighbourhood health is to live up to its name, it must tackle inequalities not only between places, but within them.Mark Heffernan, Director of Policy, Influence and Communications, Impact on Urban Health

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NEIGHBOURHOOD HEALTH

Neighbourhood health must tackle the inequalities on Whitehall's doorstep

By Mark Heffernan | 28 September 2026

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