Unequal high streets? A spatial analysis of inequalities in health-related amenities in England from 2014-2024

There are persistent inequalities in health-related behaviours in England which are stratified by region and deprivation. These are influenced by the interaction of people with places they live in, over and above individual risk factors. The amenities available on high streets is one such aspect of place but to date, its role in shaping health behaviours has been under examined. Our study presents a novel analysis into health-related amenities and change in availability between 2014 and 2024. We used geographic data analysis and statistical modelling of Ordnance Survey Points of Interest data to describe the association between health-related amenities, area level deprivation and region across England. We found that there were significant inequalities in amenity availability by deprivation over the past decade. The most deprived areas were more likely to gain a takeaway (OR1.56[1.28,1.91]), a bookmaker (OR2.14[1.64,2.79]), or a vape shop (OR2.11[1.68, 2.66] and more likely to lose a supermarket (OR1.95[1.62,2.35]) or a public toilet (OR1.34[1.12,1.62]), compared to the least deprived areas. These patterns were similar on a regional level - the North was more likely to gain a takeaway (OR1.65[1.44,1.90]), a bookmaker (OR1.40[1.18,1.66]), a pawnbroker (OR1.72[1.23,2.40]) or a vape shop (OR1.30[1.11,1.51]) compared to the South. Our findings indicate that the most deprived areas and regions are gaining potentially health-harming amenities and losing health-conducive ones. Through this analysis, we argue that amenities that facilitate health behaviours on high streets are influenced by political and economic drivers of health inequalities and therefore require political decisions to manage, rather than individual behaviour change.