Using spatial equity analysis in the process evaluation of environmental interventions to tackle obesity: the healthy towns programme in England

INTRODUCTION: Process evaluations of environmental public health interventions tend not to consider issues of spatial equity in programme delivery. However, an intervention is unlikely to be effective if it is not accessible to those in need. Methods are required to enable these considerations to be integrated into evaluations. Using the Healthy Towns programme in England, we demonstrate the potential of spatial equity analysis in the evaluation of environmental interventions for diet and physical activity, examining whether the programme was delivered to those in greatest need. METHODS: Locations of new physical infrastructure, such as cycle lanes, gyms and allotments, were mapped using a geographic information system. A targeting ratio was computed to indicate how well-located the infrastructure was in relation to those at whom it was specifically aimed, as detailed in the relevant project documentation, as well as to generally disadvantaged populations defined in terms of UK Census data on deprivation, age and ethnicity. Differences in targeting were examined using Kruskal-Wallis and t-tests. RESULTS: The 183 separate intervention components identified were generally well located, with estimated targeting ratios above unity for all population groups of need, except for black and ethnic minorities and children aged 5–19 years. There was no evidence that clustering of population groups influenced targeting, or that trade-offs existed when components were specifically targeted at more than one group. CONCLUSIONS: The analysis of spatial equity is a valuable initial stage in assessing the provision of environmental interventions. The Healthy Towns programme can be described as well targeted in that interventions were for the most part located near populations of need.