Townscapes: England’s health inequalities



Benjamin Goodair, Research Assistant, Bennett Institute for Public Policy
Professor Michael Kenny, Director, Bennett Institute for Public Policy
Professor Dame Theresa Marteau, Director, Behaviour and Health Research Unit


May 2020

About this report

This is the fourth in a series of papers analysing the fortunes of towns across Britain. The analysis draws upon data relating to public service provision, economic outcomes and demographic changes.

This report examines the health inequalities between English towns.

Key Findings

  • Health outcomes in towns are, compared with cities, moving in a worse direction in the last few years – the previous pattern of rising life expectancy has stalled or gone into reverse in many English towns.
  • But we should be much more aware of the markedly different health experiences and outcomes between towns; on some measures inequalities between them are much greater than the average difference between towns and cities.
  • The most deprived set of towns is much worse off than the least deprived on a number of key measures such as life expectancy, child obesity rates and the prevalence of lung cancer.
  • The built environment of towns, including their provision of green spaces and the kinds of retail options they provide, including fast food outlets, are closely linked to their inhabitants’ health outcomes.
  • GPs play a key role within local health provision; yet there are some notable divergences between a town’s level of need and the medications prescribed for its residents.
  • The COVID-19 crisis is having a major impact upon England’s towns. Access to green space, which is crucial to the mental and physical health of a population, especially during lockdown, is very unevenly distributed within them. There is an overriding need for policies to address the large and widening gaps in the health and economic fortunes of many towns, and these should be integral to the ‘levelling up’ and economic recovery agendas.

About Townscapes

The declining economic fortunes of many towns, and the chasm that divides the experiences and outlooks of many of their inhabitants from the metropolitan centres where wealth and power have become concentrated, are issues of growing interest in political life and public policy.

In the UK, the preponderance of support for Brexit among town-dwellers, and the countervailing values of many young urbanites, has sparked a deep debate about how and why towns are locked out of the circuits of growth in the modern economy, and how the inequalities associated with economic geography can be more effectively tackled.

Our Townscapes project offers a deeper analysis of how towns are faring across the regions of Britain and elsewhere. It aims to step away from the generalisations and dogmas that infuse much of the contemporary policy debate and offer instead a more finely grained picture of how different towns relate to their wider regions and nations, as well as to their nearest cities. It showcases the merits of a more granular and regionally rooted perspective for our understanding of geographical inequalities and the kinds of policy needed to address them.


  • About the author

    Professor Michael Kenny, Co-Director, Bennett Institute for Public Policy

    Professor Kenny directs the Institute’s place and public policy programme.   Learn more

    Mike Kenny
  • About the author

    Professor Dame Theresa Marteau, Director of the Behaviour and Health Research Unit at the University of Cambridge

    Professor Dame Theresa Marteau is Director of the Behaviour and Health Research Unit at the University of Cambridge. She is also Director of Studies for Psychological and Behavioural Sciences at Christ’s College. Her research focuses on the development and evaluation of interventions to change behaviour (principally diet, physical activity, ...   Learn more

    Theresa Marteau