Ghost Towns: The Decline of the High Street and Health Inequalities
What were we trying to do?
We wanted to find out how high streets had declined in England between 2014 and 2024. We looked at the amenities that were and weren’t available, and whether there were variations in amenities based on location and deprivation level.
Why was this important?
We believed that a decline in high streets, with an associated increase in unhealthy amenities - such as takeaways and vape shops - could have increased inequalities and the pre-existing North-South health divide.
Improving knowledge in this area provides the government with the opportunity to produce policies that help to reverse this decline, focusing on working with local communities to restore our high streets.
How did we do it?
We gathered data about 16 key amenities in towns across England between 2014 and 2024. We looked at whether there were relationships between where the amenities were located and:
- the level of deprivation
- whether it was classed as urban or rural
- the region
- whether it was a coastal or inland area
The 16 key amenities we searched for were broken down into 3 main groups, as follows:
Health promoting:
- Pharmacies
- Public Toilets
- Supermarkets
Health reducing:
- All takeaway services (fast food and fish and chip shops)
- Alcohol only outlets (shops that primarily sell alcohol, including off-licenses)
- Bookmakers
- Vape Shops
Third spaces and retail:
- Amusement Parks and Arcades
- Pawnbrokers
- Libraries
- Pubs, bars, and inns
- Charity shops
- Department stores
- Post Offices
- Banks and Building Societies
- Shopping Centres and Retail Parks
Findings
National
- Between 2014 and 2024, the number of vape shops increased by almost 1200% in England.
- Pharmacy availability has decreased by 20% in the most deprived parts of England.
- Takeaways have risen by 24% in England and 30% in the most deprived areas.
- There are 40% fewer banks and building societies on England’s high streets, with 57% fewer in rural areas.
- There are 25 times more pawnbrokers in England’s most deprived areas.
- Deprived areas have over 3 times more bookmakers than the least deprived.
- Public toilet provision has decreased by 38% in the most deprived areas, which disproportionately affects women, young children and the elderly.
North of England
- Takeaways have increased more in all 3 northern regions than the 24% national average: 35% in the North East, 33% in the North West, and 29% in Yorkshire and the Humber.
- In the North, there are 12.8 unhealthy takeaway outlets per 10,000 people. This is higher than the national average of 10.2 per 10,000, and much higher than the 8.9 per 10,000 in the South.
- Public toilets have reduced by 32% in the North in the last decade, but only 19% in the South and 23% overall.
- There are twice as many vape shops in the North compared to the South.
- In 2024, there were 3 times more pawnbrokers in the North than in the South.
- Northern regions saw a greater decrease in supermarkets than southern regions: 23% in Yorkshire and the Humber, 14% in the North East and North West, compared to a 5% decline in the South.
Recommendations
A number of recommendations came out of the findings, including:
- Increase local authority regulation of unhealthy amenities, such as takeaways, off licenses, vape shops and bookmakers – especially in deprived areas, coastal towns, and areas in the North.
- Increase and incentivise health-promoting amenities and “third places” – which are places away from home and the workplace, such as pubs, community centres and libraries, on our high streets.
Read the report ‘Ghost Towns: The decline of the high street and health inequalities’ for the full findings and recommendations.
Who did we work with?
- Northern Health Science Alliance
- NIHR ARC North East and North Cumbria
- NIHR Newcastle Patient Safety Research Collaboration
Resources
Funding information
This report is a joint piece of work between the Northern Health Science Alliance, NIHR Applied Research Collaborations North East and North Cumbria [reference NIHR200173] and Greater Manchester [reference NIHR200174] and the NIHR Newcastle Patient Safety Research Collaboration [reference NIHR204291]. The project was also funded by the Wellcome Trust [221266/Z/20/Z].
More information
Senior Programme Lead
Mike Spence
Michael.spence@manchester.ac.uk