Pharmacist-Led Discharge Care to Reduce Postdischarge Health Care Utilization: A Randomized Clinical Trial.

Health outcomes are influenced by the interaction of people with the places they live in, over and above individual risk factors (). Places are primarily constructed through the composition (demographics) of their residents, the context (built environment, infrastructure) and vertical drivers (macro social, economic and political decisions) (; ). There are persistent health inequalities in England which are stratified by region and deprivation. Health is generally worse in the Northern regions and in deprived and “left behind” areas (, p. 2; ). The primary drivers of such health inequalities are structural factors - the social, economic and political decisions leading to the uneven distribution of wealth and resources, rather than individual behaviours or characteristics (). Such structural factors can also affect the retail environment of places, and subsequently the amenities available on high streets. The availability of health-related amenities on the high street (the services and shops available) can provide opportunities for health promoting or health reducing behaviours. Specific amenities, such as takeaways, gambling outlets, and alcohol only outlets, represent ‘environmental risk factors’ for unhealthy behaviours and subsequent poor health outcomes (; ; ). On the other hand, amenities such as supermarkets, pharmacies, and public toilets can influence health for the better (; ). The decision to undertake specific health behaviours is often automatic rather than conscious and linked to the socio-economic conditions of a place and the availability of amenities (; ). Previous research has studied one or two types of amenities, and usually in one time point or location (for examples, see: ; ; ). There has been less focus on the availability of multiple types of outlets, the change in availability over time and the association with socio-economic deprivation and geographical region in England. To our knowledge, no studies have explored trends over time in changes to the availability of health-related amenities across all of England or studied the distribution of amenities by geographic region. Our study presents a novel analysis into health-related amenities on the high street and their change in availability over the past decade. We use the most up to date yearly data from the Ordnance Survey Points of Interest database which has seldom been used in health research. Through linking amenity availability to deprivation, region and change over time, we argue that health-related amenities on the high streets are driven by similar social, political and economic vertical drivers of health inequalities and not only by individual demand of such amenities.