Coastal communities, the villages, towns, and cities of England’s coast, include many of the most beautiful, vibrant, and historically important places in the country. They also have some of the worst health and wellbeing outcomes in England, despite often exemplary action by local public health and civic leaders. The CMO Annual Report 2021 highlights the reality that coastal communities have a higher burden of disease across a wide range of physical and mental health conditions. [1] Life expectancy, cardiovascular and cancer incidence rates, and many mental health outcomes are worse in a high proportion of coastal communities. [2,3] There is however less access to primary and secondary healthcare in coastal communities than inland, despite their greater need, a problem the medical profession must address. [4]
The health needs and drivers of many coastal communities have more in common with one another, around the country, than with their nearest inland neighbours. A resort town like Blackpool has more in common with Hastings, Skegness, or Torbay than with Preston, 18 miles inland. Port towns also have many health issues in common.
Analysis undertaken for the CMO Report suggests that even after adjusting for well recognised factors such as age, smoking, and deprivation, there remains a “coastal excess” of disease. Life expectancy (LE), healthy life expectancy (HLE), and disability free life expectancy (DFLE) are all lower in coastal areas and the Standardised Mortality Ratios (SMRs) for a range of conditions, including preventable mortality, are significantly higher in coastal areas compared with non-coastal areas. [5]
Coastal communities, whilst clearly each having its own distinct characteristics, share similar drivers towards a clustering of poor health. These include the in-migration of older, retired citizens with increasing multimorbidity and the outmigration of younger populations in search of further education and employment opportunities. There is an oversupply of previous guest housing which has led to high concentrations of Houses of Multiple Occupation (HMOs), and in some areas caravan parks, which for different reasons lead to a concentration of deprivation and ill health near the coast. Deprivation is often highly concentrated on the coast. Rates of smoking, including in pregnancy, are high.
Many coastal communities were created around a single industry including previous versions of tourism, fishing, or port work that have since moved on, leading to employment that is often scarce, low paid, or seasonal. The result can be a cycle of deprivation. Diversifying their economies is an important long term goal, but the health challenges are present, and need to be addressed, now. [6]
Attracting and retaining both NHS and social care staff to these beautiful peripheral areas is surprisingly challenging. Health Education England’s analysis for the report found that despite coastal communities having an older and more deprived population, they have 14.6% fewer postgraduate medical trainees, 15% fewer consultants, and 7.4% fewer nurses per patient. The catchment areas for health services are also artificially foreshortened and transport to major NHS health centres is often limited.
There is a striking lack of data and evidence available on the health of coastal communities and much less research than their importance to ill health in the UK implies they should have. [7] This lack of research needs to be addressed by the academic community. Data are rarely published at a geographical level granular enough to capture coastal outcomes, with most data only available at local authority (LA) or Clinical Commissioning Group (CCG) level. As a result, deprivation and health outcomes at the coast are hidden by being lumped in with relatively affluent areas just inland.
Covid-19 has only exacerbated the problems of coastal communities, for example by its particular impact on tourism.
Given the similar characteristics and shared drivers of poor health in coastal communities, a national strategy to address the repeated problems, in addition to local and regional initiatives, is needed. If we do not tackle the poor health outcomes of coastal communities vigorously and systematically there will be a long tail of preventable ill health which will worsen as current populations age. Coastal communities face major public health challenges, which without action will only get worse, and the medical profession, researchers, public health and all areas of government have a responsibility to meet them.
Christopher Whitty is chief medical officer for England, chief scientific adviser at the Department of Health and Social Care, and Gresham professor of physic.
Bethan Loveless is a public health registrar, Department of Health and Social Care
Emily Whamond, office of the chief medical officer, Department of Health and Social Care
Twitter: @CMO-England
Competing interests: none declared.
References:
1. Whitty CJM, Loveless B. Health of Coastal Communities. Chief Medical Officer’s Annual Report 2021. Department of Health and Social Care, London, 2021
2. Campos C, Sikorski R, Anderson H. Economic, social and demographic trends in coastal areas. Health of Coastal Communities. PP. 141-177.
3. Public Health England (2020). Public Health Profiles: Local Health [Online. Accessed 12/01/2021]
(https://fingertips.phe.org.uk/profile/local-health). Crown copyright.
4. Matin T, Brooke A, Clayton T, Reid W. Medical Workforce. Health in Coastal Communities, pp 211-222.
5. Gibson A, Asthana S. Analysis of Coastal health outcomes. Health in Coastal Communities, pp 189-208.
6. House of Lords Select Committee on Regenerating Seaside Towns and Communities. The future of seaside towns. House of Lords 2019. https://publications.parliament.uk/pa/ld201719/ldselect/ldseaside/320/32004.htm#_idTextAnchor006
7. Sheena Asthana, Alex Gibson, Averting a public health crisis in England’s coastal communities: a call for
public health research and policy. Journal of Public Health, 2021; fdab130,
https://doi.org/10.1093/pubmed/fdab130