Inequalities in local funding cuts to environmental and regulatory service expenditure in England from 2009 to 2020

Background: Local authorities have been subject to substantial reductions in funding, placing strain on local services. Environmental and Regulatory (ER) services provide essential functions including infectious disease prevention and control via Food Safety and Animal and Public Health Infectious Disease Control services (APHIDC). This study investigates inequalities in local funding cuts to these services. Methods: We used a generalised estimating equation model to estimate the annual percent change of ER service expenditure between 2009/10 and 2020/21 in addition to Food Safety and APHIDC expenditure change overall, and as a share of total ER expenditure. Models analysed trends by deprivation level, local authority structure and population density. Results: Areas of higher deprivation had the largest reduction in expenditure, with ER and Food Safety and APHIDC cuts of 2% and of 23% respectively, compared to a 1% and 8% reduction in the least deprived areas. The share of ER expenditure spent on Food Safety and APHIDC decreased by 13% in the most deprived authorities compared to 6% in the least deprived areas. Environmental and Regulatory services saw the largest cuts in unitary authorities, declining by 2%. London boroughs had the greatest reductions in Food Safety and APHIDC expenditure, decreasing by 10%. Both ER and Food Safety and APHIDC expenditure decreased with increasing population density. Conclusion: The unequal distribution of cuts shows the need for increased and equitable investment into these services to enable resilience to emerging infectious disease threats, and to prevent widening of health inequalities. ### Competing Interest Statement DH is currently in receipt of research grant support from the Food Standards Agency. MAG, IB, BB, HEC, XZ, KF, LM, RG, MC declare no relevant competing interests. ### Funding Statement This study is funded by the National Institute for Health and Care Research (NIHR) Health Protection Research Unit in Gastrointestinal Infections, a partnership between the UK Health Security Agency, the University of Liverpool and the University of Warwick (Grant Reference Number PB-PG-NIHR-200910). BB was funded the NIHR Policy Research Programme (RESTORE; Award ID, NIHR202484) and the NIHR Applied Research Collaboration Northwest Coast (NWC ARC; Award ID: NIHR200182). HECs participation in this research is funded by NIHR through HPRU-GI. DH is funded by a National Institute for Health Research (NIHR) Post-doctoral Fellowship (PDF-2018-11-ST2-006). The views expressed are those of the author(s) and not necessarily those of the NIHR or the Department of Health and Social Care. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes The data sets used in for analysis are available at https://pldr.org/, https://www.ons.gov.uk/ and https://www.gov.uk/