Health scientists generally agree that disadvantaged neighbourhoods experience a greater burden of ill health and unhealthy lifestyles than other neighbouroods. In this issue’s regular column from colleagues at the substantial housing, health and regeneration research project, GoWell, Dr Jennifer McLean examines the evidence on whether neighbourhood amenities in disadvantaged areas amplify this problem.

Numerous theories have been advanced to help explain why ill health is more prevalent in our poorest communities. One theory suggests that people in deprived areas have more access to amenities that discourage healthy lifestyles. For example, are there more off licences in poorer areas? What about fast food outlets? Or maybe disadvantaged areas simply have less or poorer amenities across a whole range of services – leaving residents generally disadvantaged. We have assessed the evidence.

Alcohol outlets and poorer areas?

Studies from North America and New Zealand have found that alcohol outlets are indeed more common in deprived urban areas. Within Scotland, however, the pattern is less clear cut, with no systematic relationship between availability and deprivation. A Glasgow study found alcohol outlets were particularly prevalent in both the city’s affluent West End and deprived East End neighbourhoods, as well as in the city centre. While some of the city’s more deprived areas contained high concentrations of outlets, others contained very few.

Fast food outlets and poorer areas?

Observational studies have found independent associations between living in a low income or deprived area and the prevalence of obesity and the consumption of a poor diet. Evidence from Glasgow indicates that levels of reliance on fast-food outlets is twice as high in deprived areas as it is for the city as a whole.2 But in contrast, fast-food outlets do not appear to be more common in the city’s deprived areas.

Tobacco outlets and poorer areas?

International evidence has shown that the density of tobacco outlets is greater in deprived areas, and that a higher density of tobacco outlets is associated with higher rates of smoking. Again, we lack similar evidence for Scotland, although there is evidence from Glasgow that smoking is associated with living in a neighbourhood with a poorly rated physical environment and poor amenities.

General access to amenities

A recent study in Glasgow asked the question ‘Do poorer people have poorer access to local resources and facilities?’ An examination of the distribution of more than 40 types of facilities and resources in Glasgow city, found no consistent patterning by area deprivation.4 Instead, the authors suggest that the age, history, location, and residential/commercial mix of different areas are important.

In summary

A number of international studies have found links between area deprivation and the availability of amenities that might discourage healthy lifestyles. However, the very detailed analysis from Glasgow has found evidence that the assumed link between amenity distribution and poverty should not be taken for granted. It is complicated by a whole range of additional factors, and changing health behaviours in poor communities will undoubtedly involve more than just removing environmental barriers.

1 Ellaway et al. The socio-spatial distribution of alcohol outlets in Glasgow city. Health & Place (2010), 16:167-72

2 Macintyre et al. Out-of-home food outlets and area deprivation: case study in Glasgow, UK. International Journal of Behavioural Nutrition and Physical Activity (2005), 2:16

3 Ellaway & Macintyre. Are perceived neighbourhood problems associated with the likelihood of smoking? Journal of Epidemiology and Community Health (2009), 63:78-80

4 Macintyre et al. Do poorer people have poorer access to local resources and facilities? The distribution of local resources by area deprivation in Glasgow, Scotland. Social Science & Medicine (2008), 67:900-14