Duncan Stephenson, Director of External Affairs & Marketing at RSPH

Duncan Stephenson, Director of External Affairs & Marketing at RSPH, reflects on the impact of the Health on the High Street campaign and how there is still work to be done to ensure that our high streets support the public's health.

In the spring of 2015, the residents of the northern city of Preston could have been forgiven for choking on their breakfast when they saw in the news that their high street was named by RSPH as the UK’s unhealthiest.

To recap, our Health on the High Street campaign was developed to highlight the impact of the retail environment on the health and wellbeing of local communities. We sought to define the healthiness of different types of businesses, and better understand the relationship between the healthiness of different retailers and population health and wellbeing.

As part of this campaign, we developed a Richter Scale of Health to measure the healthiness of different retailers and scored businesses on the extent to which they promoted healthy choices, improved the mental wellbeing of their customers, supported community cohesion, and promoted access to health services. We examined a number of different business types through the lens of this Richter Scale.

Fast food takeaways, payday lenders, bookmakers and tanning salons scored poorly and were identified as the unhealthiest business types. The healthier businesses included pharmacists, leisure facilities, cultural venues and even pubs (while they do sell alcohol, they are licensed premises and do support community cohesion to a certain extent).

We published a league table composed of the healthiest 70 UK towns and cities based on the prevalence of healthy versus unhealthy businesses. Our report did not set out to name and shame, but rather to shine a spotlight on the damage being done to the health and wellbeing of local communities from the proliferation and clustering of retail outlets which are widely regarded by both experts and the population at large as being damaging to the public’s health. It is accepted that living in close proximity to a high density of unhealthy businesses is linked to higher levels of obesity, alcohol harm and smoking rates.

We also sought to raise awareness of what policy makers, businesses and communities could do to make their high streets more health promoting. Since we published our report almost three years ago, the nation’s high streets continue to change. Famous names including British Home Stores closed in 2016 and, according to figures from the Local Data Company, the annual churn rate of businesses closing down on high streets is around 10%.

Only this month, Toys R Us and Maplin became the latest retail casualties in a war that is being waged on many fronts. Following a revaluation of property prices last year, businesses are now paying higher rates (taxes), and this, coupled with the competition from online retailers, means that the high street itself is facing an existential crisis.

The changes, which have taken place since our report was published, are mixed when it comes to the healthiness of a high street:

  • A number of payday loan shops have closed as a result of action taken by the Financial Conduct Authority to reduce the interest payday lenders can apply to customers
  • While the number of betting shops have declined by about 5%, the menace from Fixed Odds Betting Terminals (FOBTs) continues. FOBTs which are described as the crack cocaine of gambling and currently destroying lives and the reputation of the rest of the gambling industry may also be finally dealt with as the calls to reduce the maximum stake to £2 may finally see the threat posed from these removed
  • Fast food takeaways are one of the few business types to continue to expand, with 4,000 more being added to the UK’s high streets since 2014. Of concern is that most continue to be in the poorest and more deprived areas
  • The number of community pharmacies has remained broadly the same, although an increasing number are now classed as Healthy Living Pharmacies which signals that they are doing more to support local community health and wellbeing
  • There have also been new developments on the high street. With two vape shops opening every day, they have grown at an exponential rate, reflecting the increased popularity of e-cigarettes. While research is underway to assess the relative risks and benefits of e-cigarettes their presence is just another example of how the high street is evolving – in this case potentially positively impacting community health

Given these changes, we will be repeating Health on the High Street in the UK this year with support from the US-based Robert Wood Johnson Foundation (RWJF) Global Ideas Fund at CAF America.

As part of this project, we will also be working with the University of California, Los Angeles (UCLA) to explore adapting the Health on the High Street model and methodology for the US’s “Main Streets.”  We will be taking some of the lessons we learned from the UK project to help shape and adapt it for the US.

While the geography of the UK and US may be different, it is clear that place matters when it comes to the public’s health. We hope that this project will increase awareness and support policy makers and the business community in their quest to make both High Streets and Main Streets more health promoting. 

Please note: the views expressed here do not necessarily reflect the views of CAF America or the Robert Wood Johnson Foundation.