Townscapes: Health Inequalities in England

How equal are the health outcomes for towns in different parts of England? In the latest report from our ‘Townscapes’ series, we find large inequalities in many indicators of health between England’s poorest and wealthiest towns. And we explore too some of the implications of our findings for the challenges associated with the Coronavirus pandemic.

In this blog, researcher, Ben Goodair summarises some of the key findings of this new report authored with Professor Michael Kenny and Professor Theresa Marteau.

Populations in England’s poorest towns have on average 12 years fewer ‘good health’ in their lives than those in the country’s richest towns.

This is one of a number of striking differences in health outcomes between the most and least deprived towns in England. In our research we found that health inequalities between towns are far greater than the differences between towns and cities. For example, the average life expectancy of town-based populations is moving in a worse direction compared to those in cities in the last few years - but the average difference between the two is minimal.

In our townscapes project we are releasing a series of papers analysing the economic resilience and changing fortunes of British towns. Our latest report, authored with Professor Michael Kenny and Professor Theresa Marteau, focuses on England’s growing health inequalities. It reveals in stark terms the vast extent of divergence between the most affluent and deprived populations in England, on many different health indicators.

We find that the most deprived towns in England have higher rates of hospital admissions for alcohol-related causes and intentional self-harm, almost double the rates of child obesity, and a much higher incidence of lung cancer.

A comparison of two broadly similar towns - Sidmouth and Jaywick – illustrates this point very well. Both are amongst the oldest towns in England and both are also situated on the coast. However, Sidmouth has a relatively affluent population and Jaywick is one of the most deprived places in the country. Despite their geographic and demographic similarities, Sidmouth is one of the healthiest towns in England, and Jaywick one of the least healthy – in terms of indicators for child obesity, mental health, alcohol-related harm and life expectancies.

There is a strong geographical context to our findings as the healthiest towns in England are more often than not located in the South East. The least healthy towns, on the other hand, appear largely spread across former industrial parts of the North of England. There are important exceptions to this picture, however, as certain regions have hotspots for particular health outcomes - such as alcohol-related harm in the North West or child obesity in the West Midlands. Meanwhile, geographical outliers exist for all health measures, and there are poorly performing towns in every region we look at.

When analysing the environmental factors that may perpetuate these inequalities, we find significant divergences between the poorest and most affluent towns. The most deprived and least healthy towns are much less likely to have access to green space (commons/ municipal park or garden) in their urban centres. Considering the need for space in our communities in the current crisis, this finding is both pertinent and troubling. There is evidence of an increased appreciation among the public for green space since lockdown began.

The picture that our new report paints raises considerable challenges for policymakers in England. It points to the need to: build towns that serve their particular community’s needs whilst supporting healthy behaviours; do more to equalise the access to resources that enable better healthcare; and consider health considerations as central to the  ‘levelling up’ agenda.

The COVID-19 pandemic has been especially harmful to those already experiencing ill-health. The uneven geographic impact of the virus means that certain towns which have older-than-average populations, poor underlying health conditions or high levels of deprivation, such as Barrow-in-Furness, have been particularly badly hit. Unless interventions designed to address and mitigate poor health outcomes are implemented soon, there is every chance that the pandemic will significantly exacerbate current inequalities and have a much greater impact upon the lives and health of those who are most vulnerable, many of whom live in the most deprived communities.  

You can read our ‘Townscapes: England’s Health Inequalities' report here, and more from our ‘Townscapes project' here.