The most comprehensive review ever attempted of public health in London has revealed stark variations in health and service provision between health authorities.

A constant theme of the report by the Health of Londoners Project is the damage caused by the fragmentation of services in the capital. It recommends a pan-London approach to key issues, including contraception and abortion, HIV/AIDS, mental health, communicable diseases, transport and air pollution.

Bobbie Jacobson, director of public health for East London and the City HA, who chaired the committee that produced the report, said she hoped it would spark greater co-operation between HAs and other agencies. The authors also hope its ideas will be taken up by London's future mayor, the Greater London assembly and the single London regional office of the NHS Executive.

'Until now, no one has had a clear grip on the extent of the inequalities faced by the capital's people,' said Dr Jacobson.

However, she said pan-London approaches should not mean the dismantling of all local initiatives.

'We need a new way of working. The new Greater London assembly will need to work with the resources that are there already, while working across London at the same time.'

The chances of dying under the age of 65 are twice as great in some parts of the capital as in others, and infant mortality rates in areas of inner London are three times greater than in parts of outer London.

Stephen Farrow, public health director of Barnet HA and one of the report's editors, said the findings would give a 'corporate push' to an issue HAs knew needed action.

The Health of Londoners. A Public Health Report for London. King's Fund bookshop, 0171-307 2400. 16.95.