Rethinking Personal Responsibility in Health

We are quick to frame health as a matter of personal responsibility, whether it be eating better, moving more, or making healthier choices. But for many people living in England’s cities, recent evidence has demonstrated that those choices are majorly shaped—or in some cases made impossible—by the environments around them.

More often than not the impact of our local surroundings on our health is overlooked. Public health strategies can be guilty of generalising or applying broad solutions across communities and populations, assuming a one size fits all, but the reality of health is far more complex and circumstantial. For many communities across the UK, the relationship between health and place is distinct and structural, emphasising the requirement to understand the specific realities of our neighbourhoods and urban environments.

Food Deserts: A Structural Barrier to Health

Food deserts—areas where residents have limited access to affordable and nutritious food—serve as a clear example of how local environments determine health outcomes long before clinical decisions come into play. They trap communities in cycles of poor diet and food-related illness. Recent national findings report that over a million people in the UK live in “food deserts” and in many cases can be labelled “food swamps”, with high numbers of fast-food outlets that drive high consumptions of UPFs, exacerbating the risk of conditions such as diabetes and obesity³.

The Urban Food Environment and Widening Inequality

These concerns are reinforced within the latest annual report from the country’s Chief Medical Officer, who highlights that the food environment in numerous English cities is entrenching health inequalities and pushes both children and adults towards shorter and unhealthier lives¹. The impact is stark, with the poorest 10% of the population eating 42% less fruit and vegetables than recommended, compared to 13% less among the richest².

The landscape of these neighbourhoods is dominated by small convenience stores and fast-food outlets, with minimal larger supermarkets or affordable healthy food options. But even in cases where healthier food is physically available, it doesn’t mean it’s a choice that is accessible to those living there. For the most deprived fifth of the population, eating the government-recommended healthy diet would consume on average half of their disposable income, while the least deprived fifth would only need to spend 11%¹.

Who is Most Affected? The Hidden Barriers within Food Deserts

This disparity is even more severe for those who are especially vulnerable living in a food desert, for example the poor, elderly, disabled, or those without access to a car. In many cases, reaching a large supermarket requires travel they cannot easily manage, and the additional financial burden of transport becomes yet another barrier to accessing healthy food.

These conditions emphasise the need to look beyond the choices of the individual and instead recognise the structural barriers such as cost, accessibility, and the urban retail environment that is failing them.

Why Education Alone Isn’t Enough

Recognising that food-related diseases are shaped more by limited access and affordability than by individual choices makes it clear that breaking this cycle requires more than education. It demands systemic intervention grounded in spatial understanding of how environments shape health.

Deprived areas often are the places to become food deserts due to the structural disadvantage that makes them unappealing for large supermarkets or healthier food outlets. When residents cannot afford the kinds of food these retailers sell, it is not economically viable for businesses to operate there. This locks communities into a cycle whereby poor access continues to reinforce poor health outcomes.

What Geomapping Reveals about Food Deserts

Food deserts don’t form in isolation or emerge by chance. They are fundamentally spatial problems. They are consistent with patterns of deprivation, limited transport access, high urban density, and retail inequalities. Traditional datasets often examine these factors in isolation, obscuring how they interact in real-life contexts. However, geomapping overlaps them spatially, revealing patterns that would otherwise remain hidden.

By visualising and analysing data spatially, analysts, public health teams and policy makers can:

• Identify neighbourhoods with limited supermarket access or where supermarkets are sparsely distributed relative to population.
• Compare the availability of health food across regions down to neighbourhood level.
• Map the density of fast-food outlets or convenience stores in relation to residential areas and schools.
• Overlay data on diet-related illnesses, such as obesity prevalence with environmental and socio-economic factors.
• Highlight communities where structural barriers and social determinants combine to create a high risk for food insecurity and poor health outcomes.

These insights from geomapping are indispensable as they bring to light not only what the specific issue is but where is it happening, facilitating targeted and successful interventions. For example, incentivising supermarkets in certain underserved areas, regulating fast-food density or subsidising health food in high-risk areas.

The US has experimented with ‘supermarket solutions’ that provide grants to attract large retailers into deprived areas³. It is an approach that highlights the power of geospatial intelligence as the success of targeted interventions relies on knowing precisely where the barriers exist and who is being underserved.

The Future of GLP-1s: When Biology Meets Environment

As powerful GLP-1 therapies reshape obesity care, emphasis is being placed on how success looks within certain postcodes, rather than just on the drug’s efficacy.

While GLP-1s reliably reduce appetite and food noise, there is evidence demonstrating that the success of this drug is far more complex. Many people on these treatments struggle to meet basic protein and micronutrient needs which may lead to losing lean mass if the correct nutritional and movement support isn’t in place.

In areas with strong food access and local activity infrastructure, these risks can be mitigated. However, in deprived regions and areas classified as ‘food deserts’, that supportive environment does not exist and leads to people eating less but not better. So, yes although these individuals may lose weight, they might also experience muscle loss, reduced strength, or worsening frailty. This is known among clinicians as sarcopenic obesity—becoming lighter on the scales but weaker overall.

In addition to this, access to GLP-1s is already uneven. Geography, income, and ethnicity are emerging as powerful predictors of who receives treatment. As these drugs scale, these disparities risk widening unless we understand and address the environmental realities that surround the patients.

This is exactly where geomapping becomes crucial. Combining prescribing patterns with adelo’s spatial “social index” and activity data it becomes evident where GLP-1 patients are losing weight in environments that support healthy habits as well as where weight loss is occurring in areas that lack access to affordable healthy options and safe movement spaces. Place stops being background context and becomes a measurable variable which can be used to explain why outcomes are different across neighbourhoods even when the medication is the same.

For pharma, payers, and policy makers, this unlocks a new strategy where interventions are designed and tailored not just to a patient group, but to the local context around them. This could look like pairing GLP-1s with increased protein access or food delivery in areas where accessibility is scarce. Fundamentally, this facilitates a new type of real-world evidence whereby GLP-1s, paired with the right environmental support, can narrow outcome gaps between deprived and affluent areas, rather than unintentionally widening them.

The Role of adelo: Making Spatial Health Intelligence Actionable

At adelo, we already work with spatial health data, combining SDOH, disease prevalence, and geospatial analytics, to help teams within the healthcare and pharmaceutical industry understand health risk down to the neighbourhood level. Our database of 8.5 billion health data points enables a comprehensive analysis of the overlap of patterns that aren’t visible in traditional public health data.

Spatial intelligence does not solve food deserts and food insecurity on its own; however, the value lies in exposing patterns and giving teams the visibility to act, with data-driven evidence.

Why Food Deserts Highlight the Importance of Geospatial Intelligence

Food deserts are a concrete example of how place shapes health outcomes. They demonstrate why spatial data must be part of every serious health strategy, from public health planning and policy to pharmaceutical launches and programmes.

If we can’t see where need lies, we can’t meaningfully address it. Geomapping empowers organisations to move beyond assumptions and into data-driven evidence. Looking at not only who is affected but where and why. This is what sparks genuine positive change.