In this latest blog from Councillor Dr Wendy Taylor, she highlights how neighbourhood health can close the gap in outcomes by bringing care closer to communities and ensuring geography no longer dictates people’s chances of living well.
Greater distance from health services is consistently associated with poorer health outcomes in England. The evidence spans emergency care, long term conditions, screening, prevention and the wider determinants of health. Geography continues to shape people’s chances of living well. Neighbourhood health offers a practical way to close these gaps by bringing care closer to where people live and by aligning the NHS with the strengths of local government.
A major systematic review of studies across high income countries found that most research identified a distance decay effect, where people living further from the services they need experience worse outcomes. Seventy-seven per cent of the studies reviewed showed that greater distance was linked with poorer survival, longer hospital stays or lower attendance at follow up appointments. This pattern is highly relevant to England, where rural and coastal communities often face longer travel times, limited transport and fewer local services.
Emergency care provides some of the clearest evidence. National analysis shows that the longer a patient spends in an emergency department, the higher their risk of death within 30 days of discharge. Compared with two hours in A and E, the odds of post discharge death rise steadily, reaching more than double after twelve hours. These findings highlight how delay, whether caused by distance, transport barriers or system pressure, can directly affect survival.
The Chief Medical Officer’s analysis of coastal communities highlights that between 10.3 and 10.4 million people live in coastal areas, representing around 18.5 per cent of the population. These communities have an older age profile, with around 21 per cent of residents aged 65 or over compared with 18 per cent in non-coastal areas. They also face higher burdens of preventable disease, persistent workforce shortages and limited transport options. These structural factors mean that people often live further from the services they need, and this distance compounds existing disadvantage.
Councils understand how distance interacts with ageing, deprivation, seasonal employment and poor housing. They see the consequences in missed appointments, late presentation and preventable illness. This insight is essential for neighbourhood health because the model depends on understanding place, strengthening local assets and designing services around the lived geography of communities.
The CMO’s work on cities adds another dimension. It shows that health inequalities follow clear geographic patterns shaped by housing, transport, air quality, access to green space and the availability of local services. Even where services are physically close, they may not be accessible or trusted.
England’s wider evidence base reinforces these findings. National guidance highlights that variation in access, transport and local infrastructure contributes to avoidable differences in outcomes across communities. Studies of urgent and emergency care reconfiguration show that increased travel times can worsen outcomes for time critical conditions, particularly where alternative services are limited or transport is poor. Research on screening and prevention shows that uptake is lower in communities with poorer access to primary care, fewer local services and weaker community infrastructure. This leads to later diagnosis and poorer survival for conditions such as cancer and cardiovascular disease.
Neighbourhood health provides a practical way to reduce these risks by designing care around the lived geography of communities and by working with the strengths of local government. Proximity supports survival because bringing urgent advice, rapid assessment and community-based interventions closer to home reduces delays and improves the chances of early treatment.
Local variation requires local solutions because rural, urban and coastal communities face different access challenges. Neighbourhood models allow services to be shaped around these patterns. Stronger community infrastructure improves outcomes because trusted local teams help people seek help earlier, maintain continuity and manage conditions before they escalate.
Neighbourhood health reframes access as a local asset. It strengthens prevention, builds trust and ensures that geography no longer dictates people’s chances of living a healthy life. Most importantly, it aligns the NHS with the everyday work of councils, whose decisions on transport, housing, planning and community infrastructure shape the real distance between people and the care they need.
Cllr Dr Wendy Taylor MBE
Chair, LGA Health and Wellbeing Committee