A mayor for London.

In May last year Londoners elected a mayor by direct vote for the first time. The mayor and the London Assembly, together forming the Greater London Authority (GLA), have an electorate of seven million people and command resources of almost 6 billion euros. Four appointed committees—the police authority, the fire and emergency planning authority, TraYc for London and the London Development Agency—oversee major services for the capital. But the Greater London Authority also has a " duty to promote the health of Londoners and to take into account the eVect of its policies on health. " 1 The United Kingdom has decentralisation of power more in theory than in practice. While cities, and their rural counterparts, counties, have been responsible for local taxes and services since the 19th century, in recent years central government has increased pressure to achieve national " standards " for education, housing and welfare services across the country. The National Health Service, created in 1948 and funded from central taxes, has decen-tralised management authorities (regularly changing in structure), but these are appointed by central government and never controlled by locally elected politicians. New parliaments for Scotland and Wales, elected in 1999, have changed the balance of power. To match these, the government developed eight regional oYces in England—still directly controlled by Westminster—for several of the main ministries, including health. However, this year, as a pre-election gesture of " cutting bureaucracy " , the minister of health has decided to close the regional health oYces and reduce the number of local health authorities from 100 to 30 (and probably five in London). Health authorities are not elected, nor will they match any other devolved government body: observers of the long game predict their demise at the hands of a future minister. The department of health's public health strategy for England, Saving lives: our healthier nation 2 focuses on reducing accidents, cancer, coronary heart disease and mental illness through prevention and improved health care. At the same time, 26 deprived areas, including three in London, have been selected as Health Action Zones and given extra funds for joint work with local authorities on the determinants of health. 3 Given these existing public health objectives at national and local level, what extra can a London mayor do? Transport is a political issue because the mayor (and public sentiment) opposes the government's neo-conservative policy of privatisating London Underground. 4 (London's …