Health in a global city is local: how diversity and deprivation affect health

In March, I was privileged to be invited to a where Guy’s and St Thomas’ Charity announced its new focus. The Charity has a theme that focuses on tackling the health challenges in urban, diverse, and deprived areas.

We heard about how Louisville, Kentucky, was transforming the health of a city that has similar patterns of poverty and diversity as Lambeth and Southwark, the home of Guy’s and St Thomas’ NHS Foundation Trust and Charity. We also learned that history is imprinted in places. The geography of Louisville’s current health inequalities can be traced back to the decision made in 1919 to segregate this city. It was a vivid reminder of what I knew intellectually from my own and others’ work: the importance of history in neighborhoods. It also reminded me that, closer to home in east London, much of the current prevalence of diabetes can be mapped to Booth’s map of Victorian London.

We also learned how individuals experience health in different ways. The effects of living in a diverse inner city, but often deprived, can manifest themselves in unpredictable, complex, and sometimes unpredictable. We were given a taste of the research that was commissioned by Charity to understand better how health in Lambeth & Southwark is experienced today. Fang’s story, a Chinese university student, opened my eyes. Fang is not registered with a GP and uses Chinese medicine at home, which she believes is more than Western medicine. She also uses online communities for her health. Fang, a Chinese student, is completely healthy and does not use our health system.

The research report contains many other people’s experiences. Isobel is one example. She has a chronic condition that makes her tired easily. She believes living in the center of a large city allows her to travel and live a more fulfilling life than she would if she lived somewhere else. Teresa moved to Lambeth from Brixton and has since lost her social network and support system, which we know are very important for our health. Tessy lives in Southwark and is also featured in the report. She is a single mother with limited time and struggles to motivate herself. She cooks her food in the oven instead of frying it to be healthy. But when her kids refuse to eat, she gives up. She is a local woman who only makes one or two trips to Oxford Street per year for shopping.

It shows that every experience is unique and that living in inner-city areas, which are often deprived, can be both challenging and supportive for health. The report indicates that the affairs of the people in it are all unique. They have limited time to plan or think about their health the way services expect.

This experience will be used by the Charity to implement its new strategy. It will focus on reducing the incidence and impact on residents of multi-morbidity. This is about understanding the interactions between deprivation and living in an inner city, as well as diversity, and how they impact health and health decisions. This is a tall order, but there are many people interested in it, including community-centered health as well as approaches to health that focus on the local population.

There is a lot that the Charity can learn and contribute on the research front. How can this knowledge be applied to adapt the health system to this new reality? This Charity is in a good position to do so, given its relationship with Guy’s and St Thomas’ NHS Foundation Trust, whose chief executive is also the lead for the South-East London Sustainability and Transformation Plan (STP). South-East London, other STPs, and place-based planning in urban, deprived, and diverse places across the country will begin to be implemented. They would do well to understand better, reflect upon, and respond to Fang, Isobel, Teresa, Tessy, and others like them. Then and only then will we be able to tell if they were transformative.

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