Why don’t British cities have greater health powers?
Elliot Bidgood, 20 August 2013
Conservative London Mayor Boris Johnson is somewhat known for big ideas, from accepted ones like the Barclays Bikes to more blue-sky ones like the ‘Boris Island’ airport. In an interview on Thursday with the Health Service Journal, the mayor spoke about primary care, public health in the capital (“I want Londoners to live longer, for them to be healthier, for justice in the outcomes”) and the ever-sensitive subject of hospital reconfigurations, on which he said he’d “been pretty consistent” about supporting them when health professionals recommended them (though HSJ did question this claim, as he opposed one such measure in 2008).
Perhaps the most interesting revelation, however, was Johnson’s argument that “The mayoralty has responsibility to tackle health inequalities but it doesn’t have many of the levers that it could have. The mayoralty should have a bigger role in healthcare.”
Also last week, a BBC feature asked who was more powerful out of Johnson and New York City Mayor Michael Bloomberg, both of whom lead international cities with populations of 8.3 million. On health in particular, Bloomberg is the undoubted winner.
Bloomberg is well-known for launching citywide public health initiatives that UK local government officials can only dream of having the power to enact – he has banned public smoking and trans-fats in restaurants and came close to banning supersize sugary drinks. Of course not all might agree with such initiatives (I briefly addressed such topics in February) and the centre must always ensure common national entitlements, social solidarity and strategic oversight in health, hence Bloomberg’s early support for President Obama’s on-going efforts to reform the US’s thoroughly broken national healthcare model. But nevertheless, Bloomberg’s ability to tackle his city’s specific health problems as he best judges shows the merits of localism, direct accountability and democratically-driven flexibility.
And it’s far from just public health powers that Bloomberg has. In the piece he wrote supporting Obama’s reforms, Bloomberg praised his city’s own municipal healthcare system (consisting of 11 hospitals and 70 community clinics and run as a public-interest corporation, it is the largest such system in the US).
“New York City has supported our award-winning public hospital system which serves more than 450,000 uninsured patients; invested in the nation’s largest primary care electronic health record network linking more than 1,100 doctors with real-time, prevention-focused electronic health records; connected thousands of residents with public health insurance”
I’d also add that this preference for local autonomy is not merely the product of some all-American anti-government fixation – Sweden, Finland, Spain and Germany put it at the core of their highly effective national health systems and Herbert Morrison fought (unsuccessfully) to preserve it within the NHS in 1946.
So yes, it would be wise to grant Mayor Johnson and his fellow local government officials across the county greater control over health affairs in their areas. The results can only be good.
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