In 2022, the Health Foundation launched a programme of support to the ten Mayoral Combined Authorities to develop their knowledge of, and policy approaches to, addressing health inequalities. As part of this project, Shared Intelligence was commissioned to support the co-design of the programme of support, including developing a specification for a learning partner to be embedded within the combined authorities.

The first stage of our research was to conduct a desk review to map what activity was already taking place at a combined authority level to address health inequalities, and how this had changed over the course of the Health Foundation’s previous Cities Health Inequalities Project. The desk research was supplemented by interviews with public health teams within the combined authorities, as well as with their partners. We then wrote our findings into a ‘pen portrait’ for each authority, exploring what action had been taken, and to what extent health inequalities were embedded in the authority’s workstreams.

A number of themes were identified from our desk research and interviews. For example, a number of combined authorities had committed to working with employers to develop healthier workplaces. Other work on the wider determinants of health included working with partners in housing and transport to put health at the centre of policymaking.

However, a number of challenges were also identified. For example, our interviews uncovered a varying level of buy-in to the health inequalities agenda between combined authorities. Furthermore, some felt that while health inequalities now commonly feature in strategies, there is a need to move towards more implementation.

A key part of our approach to this project was a co-design workshop held with representatives from the Health Foundation, the combined authorities, and their partners. Here, we presented the findings from our research before discussing potential approaches to the programme and exploring what the role of the learning partner could be.

Key themes to the discussion included the need for the support programme to be flexible to fit local need, to encourage ambition outside what combined authorities are already doing, and for a solid knowledge-sharing mechanism to be implemented.

In terms of the learning partner, the group discussed the need to balance academic rigour with a more practical approach. While an academically rigorous approach may uncover more nuances in terms of dealing with health inequalities, there is a need to ensure that the lessons learnt are implementable.

Following this workshop, Shared Intelligence, the Health Foundation and West Midlands Combined Authority collaborated on the development of the support programme and a detailed learning partner specification.

More information on the project can be found on The Health Foundation website.

If you would like to learn more about this project, please contact Lisa McCance at

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