Are the candidates for London mayor ignoring health as an issue? As the election - and HSJ's own mayoral debate - approaches, Mark Gould finds out

From the top floor of the huge crystal crash helmet planned to house the Greater London Assembly, London's mayor will be able to gaze on the health problems of the capital.

Looking east across the river to Tower Hamlets, the poorest borough in the UK, levels of tuberculosis among Bengali, Somali and now Eastern European migrants are reaching Victorian proportions.

The growing refugee population there, and in Hackney and Newham, means that GPs are being forced to close their lists in the face of 200 new registrations per week.

Below the mayoral feet, in Southwark - the site of the GLA headquarters - the fourth poorest borough in the UK is at the centre of an epidemic of HIV and sexually transmitted diseases. Across the city, mortality rates are twice the national average for middle-aged men and for young women.

A new survey by financial information company Experian reveals that five of the poorest 13 UK local authorities are in the capital - this at a time when London is supposedly booming.

But new privately financed hospitals and health centres are promised to replace crumbling London brickwork.

In the west, Royal Brompton and Harefield hospitals are moving to the St Mary's trust site to create a new European cardiac centre of excellence in Paddington Basin.

In north and central London, Whittington Hospital, University College London Hospitals and Royal Free Hampstead trusts are debating which services should go where. In the City of London the saga of Bart's - the hospital controversially 'saved' from closure and intended to become a cancer and cardiac centre - continues.

Doctors at its sister hospital the Royal London - a mile and a half away in Tower Hamlets - say that Bart's is 'dangerously isolated'.

So what powers will the mayor have?

They will hold a notional£3. 7bn budget, devolved to the boroughs. They will run transport, police and fire services and oversee the environment, planning, regeneration, development, culture and public health. The NHS, including the London Ambulance Service trust, will remain free-standing.

The London boroughs and NHS Executive regional office have prepared a London health strategy to reduce health inequalities, provide information and work in partnership.

They want to ensure that mayoral policies attempt to tackle the asthma, cigarettes and pollution that kill their residents faster than the rest of the country.

The statute setting up the GLA says it must consider the 'effects' of its policies on health and should 'promote improvements' to the health of Londoners. Much of the mayor and Assembly's job specification talks about enabling, providing, supporting and developing close relations with health authorities and trusts.

So this is not a muscular body with powers to hire and fire, open blocked beds or slash waiting lists. All of which may account for the paucity of debate around health policy.

Geoff Martin, Unison's London regional convenor, has issued a challenge to all candidates to attend a hustings where the public can hear full details of their policies. 'To date there has been no focus on health. We want a mayor that can stick up for the NHS and lobby in the right places. '

The mayor will also have to face a phenomenon dubbed the 'Evening Standard factor'. The public will expect them to threaten, thunder and bash heads when asked to comment on a health issue by the newspaper.

Hilary Samson-Barry, head of health development at London regional office, loath to be critical of the mayor's health remit, claims the mayor 'can make a difference in people's health'.

She says the mayor will help to improve health 'in its broadest sense' by dealing with issues such as transport and pollution.

Liberal Democrat hopeful Susan Kramer's message is peppered with words like holistic, collaboration and integration.

Ms Kramer wants to introduce a yearly audit of London hospital beds to ensure the government is 'keeping its promises'.

She also wants to re-evaluate London weighting for healthcare workers, to catch up with the real rise in the cost of living in the capital over the past few years.

Low-cost affordable housing for health staff is also high on her list. As health secretary, Labour candidate Frank Dobson created the Londonwide NHS region which will work with the GLA.

Ask Mr Dobson's team about health issues and the first thing they will tell you is that he saved Bart's. Those words may come to haunt them, given the level of opposition to the hospital in Tower Hamlets. Detailed Dobson policy statements will only emerge in April.

But what about the Evening Standard factor? 'The mayor has a role where he can and will speak out when that is required'.

In keeping with New Labour custom, Mayor Dobson would appoint a public health czar as an advisor. And he is on record as saying he wants affordable housing for public sector workers.

Conservative Stephen Norris wants to 'take the politics out of health' and involve patients in shaping health services.

He supports a watchdog service to monitor bad practice and provide information to patients in London's hospitals as 'a sophisticated supplement to the government's league tables'.

'I will be an ally of all good. . . doctors and nurses when the government politicians attempt to make them scapegoats, 'he says.

Independent candidate Ken Livingstone's tiny press office was unable to provide any details of specific policy.

But a speech in response to the government white paper setting out plans for the Assembly might startle a few NHS managers.

'It is clear that the GLA should eventually become the regional health authority for London, with the boroughs taking responsibility for the provision of services at district level. '

Green Party candidate Darren Johnson wants to donate 100 million apples each year to London schools and designate fruit-only break times as part of a healthy eating strategy. He is also opposed to plans to fluoridate drinking water.

HSJ 's mayoral debate, Thursday 6 April, 10am-12. 30pm, central London. Free tickets from Jane Warmbold, 020-7874 0231.

London by numbers

Population : 7 million plus 670,000 commuters. 25 million tourist visits a year.

People : more than 37 different nationalities 'significantly' represented. One Londoner in every five is from an ethnic minority community.

Poverty : one-third of secondary school pupils are eligible for free lunches.

Extremes: a person's chance of dying before their 65th birthday is almost twice as high in the most deprived parts of the city as in the wealthier.

Disease: the death rate from tuberculosis is more than 80 per cent above the national average.

NHS: annual budget over£5bn GPs: 4,232 family doctors Hospitals: 58 acute, community and mental health trusts Health authorities: 16, with four health action zones Medical schools: Five

The clash

University College London Hospitals trust staff nurse and Unison firebrand Candy Udwin is standing on the London Socialist Alliance ticket for the same Camden Assembly seat as official Labour candidate Helen Gordon - UCLH trust personnel director. Ms Gordon has been awarded£500 towards her campaign by Unison's head office.