Developing an openly accessible multi-dimensional small area index of ‘Access to Healthy Assets and Hazards’ for Great Britain, 2016
Mark A. Green; Konstantinos Daras; Alec Davies; Ben Barr; Alex Singleton (2018). Health & Place, 54, 11-19. DOI: 10.1016/j.healthplace.2018.08.019
Abstract
Health geographers have been long concerned with understanding how the accessibility of individuals to certain environmental features may influence health and wellbeing. Such insights are increasingly being adopted by policy makers for designing healthy neighbourhoods. To support and inform decision making, there is a need for small area national level data. This paper details the creation of a suite of open access health indicators, including a novel multidimensional index summarising 14 health-related features of neighbourhoods for Great Britain. We find no association of our overall index with physical health measures, but a significant association to mental wellbeing.
Extended Summary
This research aimed to develop an openly accessible multidimensional index measuring neighbourhood access to health-related environmental features across Great Britain. The study created the Access to Healthy Assets and Hazards (AHAH) index, combining 14 indicators across three domains: retail environment (access to fast food outlets, gambling facilities, pubs, off-licences, and tobacconists), health services (proximity to GP practices, hospitals, pharmacies, dentists, and leisure facilities), and physical environment (air quality and green space access). Data were collected for 2016 from multiple sources including the Local Data Company for retail outlets, NHS Digital for health services, OpenStreetMap for green spaces, and DEFRA for air pollution estimates. The methodology adapted the Index of Multiple Deprivation approach, standardising indicators and applying exponential transformations to create domain scores and an overall index for Lower Super Output Areas in England and Wales, and Data Zones in Scotland. The research revealed distinct urban-rural inequalities, with remote rural regions and inner-city areas identified as having the poorest health-related environmental features. Inner London areas performed worst due to high pollution levels and density of potentially harmful retail outlets, whilst suburban areas around cities performed best. Ecological analyses found little association between AHAH and area-level health measures or deprivation indices. However, individual-level analyses using Understanding Society survey data (n=40,000) demonstrated significant associations between AHAH and mental wellbeing measures, including SF12 mental health scores and General Health Questionnaire measures. The retail domain showed consistent associations with poorer mental wellbeing, whilst the physical environment domain correlated with both physical and mental health outcomes in expected directions. Surprisingly, the health services domain showed associations opposite to expectations, possibly reflecting compositional effects where individuals living further from services tend to have higher socioeconomic status. The research addresses critical data accessibility barriers that previously limited geographical health research to small regions, providing the first comprehensive national-level open-access dataset of health-related environmental features for Great Britain. This work supports evidence-based policy making for healthy neighbourhood design and has been incorporated into Public Health England’s Fingertips system, demonstrating its practical utility for targeting interventions and understanding geographical determinants of health and wellbeing.
Key Findings
- Created first comprehensive open-access multidimensional index of health-related environmental features for Great Britain covering 14 indicators
- Found significant associations between neighbourhood environmental quality and individual mental wellbeing but not physical health measures
- Identified distinct urban-rural health inequalities with inner-city and remote rural areas having poorest environmental features
- Demonstrated retail environment accessibility consistently associated with poorer mental wellbeing across multiple measures
- Provided nationally extensive dataset addressing previous data accessibility barriers that limited geographical health research
Citation
@article{green2018developing,
author = {Mark A. Green; Konstantinos Daras; Alec Davies; Ben Barr; Alex Singleton},
title = {Developing an openly accessible multi-dimensional small area index of ‘Access to Healthy Assets and Hazards’ for Great Britain, 2016},
journal = {Health \& Place},
year = {2018},
volume = {54},
pages = {11-19},
doi = {10.1016/j.healthplace.2018.08.019}
}