Research articleEquitable Access to Exercise Facilities
Introduction
Aphysically active lifestyle is associated with a range of beneficial health outcomes,1 and reducing the number of people engaging in low levels of physical activity would lead to significant reductions in premature morbidity and mortality rates.2 In England, leisure-time physical activity levels are low and are lowest in adults from lower socioeconomic positions.3 It has been observed that in areas of deprivation, the availability of local exercise facilities that may assist people to live physically active lifestyles is poorer than more affluent areas.4 In the U.S., a population study reported that high–socioeconomic status (SES) areas were more likely to have at least one physical activity facility than low-SES areas. Furthermore, the number of physical activity facilities in an area was associated with levels of physical activity.5 Also, a study in a midwestern U.S. city found that low-SES areas had fewer free-for-use facilities compared to high-SES areas.6 However, there are exceptions. In a relatively wealthy Australian city, access to recreational facilities was higher in lower-SES areas compared with higher-SES areas.7 Apart from one U.S. study, existing ecologic studies of the availability of physical activity facilities according to area socioeconomic position or deprivation are restricted to single geographic areas or regions.8, 9 In this study, national-level data were used to examine the relationship between neighborhood deprivation and the density of physical activity facilities in England.
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Methods
An educational research license was taken out with a commercial company (Leisure Database Company, London, UK) that supplied a database of physical activity facilities. The company carries out an annual telephone survey of all operational sports/recreational facilities in England that have public access. Cross-checks to ensure the robustness of the data are conducted with leisure management contractors and private health club operators as well as comparisons with published directories such as
Results
Table 1 shows the type of physical activity facility by sector. There were slightly more public than private facilities with a greater variety in type of provision in the public sector facilities, and private facilities comprised mainly gyms and swimming pools.
When all facilities were considered, there was a statistically significant negative relationship (p<0.001) between quintile of area deprivation and the density of physical activity facilities (Table 2). A graphic example of this
Discussion
This geographic study has revealed that the availability of physical activity facilities is associated with area deprivation. The absolute difference in the density of facilities between the least- and most-deprived areas is equivalent to four facilities per 100,000. In Kent (Figure 1), the most-deprived neighborhoods currently share just six facilities, whereas if the density of facilities were equivalent to the least-deprived quintile in the population, they would have 10. Perhaps more
Conclusion
The study has shown that the availability of physical activity facilities declines with the level of deprivation. Areas in most need of facilities to assist people to live physically active lifestyles have fewer resources. If the government is to meet its targets for improving levels of physical activity and reducing inequalities,17 it may need to consider the way in which market forces might be creating an inequitable distribution of facility provision in England.
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