Tom Lloyd Goodwin, Tallulah Eyres, Luca Tiratelli, David Buck, Gwyneth Ataderie

In a programme of joint working launched at the start of 2024, the Centre for Local Economic Strategies (CLES), The King’s Fund and the Health Foundation have joined forces to explore the effectiveness of devolution in narrowing health inequalities in England.1 Despite some variations in devolution settlements, all English mayoral combined authorities have powers and resources in areas of policy t. [...] In terms of the specific relationship between mayoral combined authorities and ICSs, the NHS has a significant role to play as an anchor institution and can use its capacity – particularly as an employer and purchaser of goods and services – to address health inequalities. [...] And across the board, the combined authority is committed to a health in all policies approach to act on health inequalities across the wider determinants of health in relation to transport, housing, skills, energy and the environment. [...] Rather than being able to take the time to develop skills levels in the local population, for example, the rush for growth can encourage greater reliance on pulling in labour from other areas to plug any skills gaps.12 Consequently, the opportunity to use employment to improve the fortunes of existing local communities and narrow health inequalities is risked. [...] In addition to the work of local councils – through their economic development and wider functions21 – the advent of mayoral combined authorities and their new powers and resources enriches the picture.