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

The UK is home to stark and growing health inequalities. The COVID-19 pandemic has 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.  

Over 40% of the population in England live in cities with a directly elected mayor with a political mandate for regional system leadership. Mayoral combined authorities are in a unique position to take brave and bold action to shape and drive health inequalities policy at a regional level through their responsibilities for the underlying causes of ill health.

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 concluded in April 2022, having borne witness to the impacts of the COVID-19 pandemic and the rising awareness of health inequalities and opportunities presented to regional authorities and mayors in shaping regional action. 

The project aimed to accelerate this action by providing a means to reflect, share and learn how to approach the population health challenges consistent across cities and metro regions. 

To achieve this, the project aimed to: 

  • improve understanding of regional priorities, contexts, challenges and approaches to tackling health inequalities, identifying the levers of change, power and influence at our disposal 

  • engage all cities/combined authorities in seeking best practice and sharing knowledge 

  • create a mandate for action by identifying policy that works, shaping how health inequalities are framed and utilising the opportunities of devolution 

  • facilitate conversations, develop ideas, build relationships, collate evidence and link partners to build consensus on taking action

  • champion improvements to accelerate activity in tackling health inequalities through developing guidance, toolkits, networking, expertise and support.


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. 

The timing of this report makes it a significant document in providing a unique snapshot of policy and activity of regional authorities for health inequalities immediately prior to the COVID-19 pandemic.

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:  


For more information please contact:

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