Health outcomes reflect the combined effects of social, economic and environmental conditions, as well as access to the health and care system. There are significant health inequalities across London both between and within boroughs; these are defined as “avoidable, unfair and systematic” differences in outcomes between different groups of people1 . Some of the wider determinants of health, otherwise known as the ‘causes of the causes’, are considered in other chapters. This chapter focuses on physical and mental health outcomes in London and access to health and care services.
Mental and physical health
This section provides a selection of indicators about the physical and mental health of Londoners, including: life expectancy; the infant mortality rate; prevalence of obesity and smoking; and two measures of well-being.
In London, life expectancy at birth in 2023-25 for males stood at 80.7 years, and for females it was 84.9 years, a slight increase on the previous period of 2022-24 (80.5 and 84.7 years, respectively). This increase continued to raise life expectancy to levels higher than those before the pandemic.
Life expectancy in London is higher than that for England which was 79.7 years for males and 83.5 for females in 2023-25. This has been the case for males since 2005-07 and for females since 2001-03.
However, there is significant variation in life expectancy by local authority in London. In 2023-25, life expectancy for males ranged from 78.2 in Barking and Dagenham and Hackney to 83.3 in Kensington and Chelsea. For females it ranged from 82.2 in Barking and Dagenham to 87.2 in Richmond upon Thames. Barking and Dagenham was the only borough for which life expectancy was significantly below the national average for both males and females.
Healthy life expectancy (HLE) is an estimate of lifetime spent in “Very good” or “Good” health based on how individuals perceive it, and a key summary measure of population health.
HLE is higher in London than the national average for both males and females. However, HLE fell in London from 63.9 to 62.9 for males and from 64.0 to 62.9 for females between 2021-23 and 2022-24. The values also fell for England for both males (61.5 to 60.9 years) and females (61.9 to 61.3 years).
There are persistent and significant variations in HLE between and within boroughs, with a gap of more than 10 years lived in good health between the boroughs with the best and worst values. Values of this indicator range from 58.3 years in Haringey and Lewisham to 69.3 years in Richmond upon Thames for males, and from 57.5 years in Greenwich to 70.3 years in Richmond upon Thames for females.
The infant mortality rate (IMR) in 2022-24 was lower for London (3.3 per 1000 live births) than the England average (4.2 per 1000 live births). There was a downward trend in the IMR in London over several decades, but from 2014-16 it levelled off and even slightly increased. However, since 2019-21 when the value was 3.5 per 1000 live births, the IMR in London appears to have resumed its downward trend. In contrast, the IMR in England increased from 3.9 per 1000 live births in 2020-22 to 4.2 in 2022-24.
There is substantial variation in the IMR across London boroughs, reflecting inequalities associated with deprivation that are also evident at the national level. For the same period 2022-24, the IMR was 6.5 in the 10% most deprived areas in England (based on the Index of Multiple Deprivation) compared to 2.9 in the least deprived. There are also inequalities of IMR by ethnicity, irrespective of deprivation.2
Low birth weight among infants is an outcome of factors including maternal malnutrition, maternal ill-health and poor healthcare in pregnancy. The overall London values are higher than the national average as shown in the chart above.
In 2024, 3.5% of babies born at term in London had a low birthweight, which is greater than all other regions in England and higher than the England average which is 3.0%. Unlike England, which shows a relatively stable rate, this represents part of a continuing worsening trend since 2017.
The proportion of low birthweight babies varies greatly by borough. In 2024, it ranged from 2.2% in Wandsworth to 5.2% in Redbridge.
Choropleth map of boroughs.
Across London in 2023/24, more than half (57.8%) of adults were overweight or obese. The rate has gradually increased from 55.0% in 2015/16, but has been consistently lower than the national rate (64.5% in England in 2023/24). The map above shows that the highest rates tend to be concentrated in Outer London boroughs, with Barking and Dagenham having the highest percentage (69.3%) and Islington the lowest (42.6%).
In 2024, smoking prevalence among adults (18+) in London was 10.2%, similar to the level in England of 10.4%. The proportion of adults smoking has decreased over the years, down from 17.2% a decade before in 2014. Smoking prevalence in 2024 ranged from 6.1% in Merton to 19.0% in Haringey. The prevalence was significantly higher for males (12.8%) than females (7.6%).
In 2022-24, the prevalence of smoking in London for working-age adults (those aged 18-64) in routine and manual occupations was 16.9%, higher than the rate among all working-age adults (10.6%)3 . Data from the GP Patient Survey (GPPS) in 2024-25 show that smoking prevalence in London was higher in adults with a long-term mental health condition at 26.2%, compared to 14.6% in the general adult population.4
Turning to mental health, the ONS examines personal well-being using several indicators5 . The charts above examine two of them: self-reported levels of anxiety and life satisfaction. Anxiety levels increased slightly between 2021-22 and 2022-23, from 3.28 to 3.34 in London and from 3.13 to 3.24 in England. Similarly, life satisfaction fell slightly from 2021-22 to 2022-23, from 7.46 to 7.35 in London and 7.55 to 7.44 in England. Both measures have been relatively stable since the series began in 2011, but life satisfaction fell and anxiety increased slightly during the pandemic.
The health and care system
This section provides indicators about the health and care system including how rates of premature death from cardiovascular disease and cancer compare between London and England, take-up of childhood vaccinations, and perceptions of the health and care system.
Cardiovascular diseases (CVD) and cancer are leading causes of death in London6 and major causes of death in those under 75, which are considered premature. There have been large improvements over the last 20 years as treatments and lifestyles have improved, but there is a continued focus on improving outcomes in these areas through prevention and treatment.
In 2002-04, the under-75 mortality rate from CVD in London was 137.0 per 100,000 and in 2022-24 this had reduced to 73.6 per 100,000, noticeably lower than the rate for England (76.5 per 100,000) in the same period. However, the rates have plateaued over the last six years.
There are large differences in CVD rates by gender: in London in 2022-24, the rate for males was 107.6 and for females was 42.8. The rate also greatly varies by London borough, ranging from 43.5 in Richmond upon Thames to 113.1 in Barking and Dagenham. At the England level, the rates are strongly correlated with levels of deprivation, with the rate over two times higher in the most deprived IMD decile (109.6) compared to the least deprived decile (54.5).
The rate of premature mortality from cancer has consistently decreased over the last twenty years for both London and England, with a lower rate in London compared to England, and the gap in rates between the two is widening. In 2022-24 the under-75 mortality rate in London was 107.9 per 100,000, significantly lower than the England average (120.3). The rate in London was higher for males (121.6) than females (95.9), and varied by London borough, ranging from 81.6 in Harrow to 142.1 in Barking and Dagenham.
Two doses of the Measles, Mumps and Rubella (MMR) vaccine prevent 99% of measles and rubella, and 88% of mumps infections. However, London’s MMR vaccine uptake is lower than England’s and has been on a downward trend since 2015/167 . The coverage of full vaccination with MMR (2 doses at age 5) in London was 69.6% in 2024/25, compared to 83.7% for England and well below the WHO target of 95% for herd immunity.
Other vaccines with relatively low uptake rates in London include the Hib/MenC at age 5 (since 2015/16) and DTap-IPV-Hib-HepB at age 5 (since 2017/18). It is important to note that coverage varies across London boroughs. Variation in uptake and coverage between different communities can often reflect wider health inequalities, lack of access to NHS services, as well as trust and confidence issues. Coverage of both MMR vaccines varied markedly in 2024/25, from 56.3% in Kensington and Chelsea to 79.8% in Sutton for two MMR doses by age 5, with all boroughs in London below the 95% target.
The public’s satisfaction with the health and care system gives a sense of whether Londoners believe they have a system that supports them when they need it. While the focus here is on publicly provided healthcare via the NHS and social services provided by local authorities, there are other providers including voluntary organisations and independent providers that are part of the system.
Public satisfaction with the NHS, reported in the Health Survey for England, reveals lower rates of satisfaction in London than in England, at 52% compared to 58% for 2022 (the most recent data point). Both these values fell sharply from the previous year in 2021, when the values were 65% for London and 69% for England.
The NHS Personal Social Services Adult Social Care Survey tracks service users’ satisfaction with social care. As seen with satisfaction with the NHS, satisfaction with social care is lower in London than in England, at 86% for London and 89% for England in 2024/25. Satisfaction varies among boroughs in London, varying from 77% in Ealing to 92% in Richmond upon Thames.8