Striking beaches and fresh sea air may make coastal towns some of England’s most desirable places – but their attractiveness hides some of the country’s poorest health outcomes, which leave many residents “old before their time,” according to a report by the country’s chief medical officer, Prof Chris Whitty
Whitty has called for a national strategy to address the disproportionately high concentrations of chronic disease, mental illness and poor life expectancy in some of England’s most popular holiday destinations, including Blackpool, Hastings, Skegness, Clacton and Torbay.
Rates of mental illness, heart disease, and kidney disease are roughly 10% higher than the national average, even after deprivation and their relatively older population is taken into account. According to one director of public health cited in the report, in coastal areas “far shorter lives are spent in far poorer health”.
“Coastal areas are some the most beautiful, vibrant and historic places in the country. They also have some of the worst health outcomes with low life expectancy and high rates of many major diseases,” said Whitty.
He said Covid-19, which has had disproportionately negative effects on people with chronic health conditions, had reinforced the need to tackle concentrations of ill-health in certain communities. “It is important we do not lose sight of these enduring health challenges as we face the largest pandemic for a generation.”
Coastal towns had tended to be overlooked by policymakers because their high densities of deprivation and ill-health were obscured by being lumped with nearby affluent communities. Blackpool, he said, had more in common health-wise with Hastings 250 miles away, than with Preston just 18 miles inland.
Standards of NHS care were also poorer, including in cancer care, while services can be hit by major shortages of health and social care staff. There were 15% fewer postgraduate medical trainees, 15% fewer consultants and 7% fewer nurses per patient in coastal towns compared with the national average
Whitty urged investment in education, jobs, housing and transport, as well as action to tackle NHS staff shortages. “If we do not tackle the health problems of coastal communities vigorously and systematically there will be a long tail of preventable ill health, which will get worse as current populations age.”
Paradoxically, the report noted that notwithstanding their poor health, coastal areas were intrinsically healthier places to live compared with urban areas, with both physical and mental health benefits including better access to outdoor spaces for exercise and lower air pollution.
The predominantly older populations found in coastal towns, coupled with sub-par and hard-to-access health services, high levels of poverty, deprivation and poor housing had helped create a distinctive negative “coastal effect” on population health, the report said.
Clacton, in Essex, reported the second highest mental health need in the country, while in Morecambe Bay, patients were 20% more likely to have depression than the national average. Rates of self-harm among 10- to 24-year-olds were also higher in coastal communities compared with those further inland.
Health risk factors such as smoking and drinking were also higher in coastal communities: in Hartlepool and Blackpool for example, almost one in four women smoked in pregnancy compared with a national average of 10%. Blackpool had the highest rate of hospital admissions for alcohol-related harm in England.
“While the focus nationally over the summer may be directed towards visitors, with many opting to stay in one of the UK’s many beautiful coastal towns, it is important to remember that the coast is also home to millions of people and that the health and wellbeing of these populations has been long neglected and overlooked,” the report said.
The health and social care secretary, Sajid Javid, said: “I welcome this report from Prof Chris Whitty, which raises important points on inequalities that we must tackle to improve the health of coastal communities – and I will carefully consider these recommendations.
“Those living in coastal areas clearly face different sets of challenges to those inland but everybody, no matter where they live, should have similar opportunities in education, housing, employment and health.”
The Lancashire seaside resort is not only the UK’s most deprived local authority area. It is also notorious as the place where local GPs privately identified a chronic health condition afflicting residents combining emotional, social, financial and physical problems they called “Shit Life Syndrome”.
The chief medical officer for England’s report doesn’t mention this syndrome but notes Blackpool has some of the highest rates of health risk factors – poor diet, excess weight, alcohol and drug use, and smoking – in the country. The town is economically fragile, and the workforce highly dependent on low-paid, seasonal jobs.
A patch of the Devon coastline on England’s south-coast that includes the towns of Torquay, Paignton and Brixham, Torbay has higher rates of cardio-vascular disease, respiratory disease, and diabetes than the national average.
Its ageing housing stock – it has high numbers of former guest houses converted into relatively cheap houses of multiple occupation, and caravan parks – is identified as a key environmental factor in poor health outcomes in the area.
The north-east town has endured many of the health problems associated with the collapse of heavy industry and consequent high unemployment. Poverty is a driver of poor health, and Hartlepool has higher than average levels of children living in low‑income families.
Its poverty and poor health outcomes put the town at higher risk from the Covid- 19 pandemic, the report said. At its peak in January 2021, Hartlepool had a seven-day case rate of 889 per 100,000. The long term health impact of this, the report says, will be “significant”.
The West Country coastal area has a high proportion of residents living with chronic health problems: nearly a quarter of residents aged over 16 have a long-term condition; among those over the age of 65, nearly two-thirds have been diagnosed with a chronic health condition. The area also has shortages of health staff.
Improving the health of West Somerset’s coastal communities needs to take account of their unique characteristics, said Trudi Grant, Somerset county council’s director of public health. “We must recognise one size does not fit all and listen to their needs and wants.”
In common with many of England’s poorest areas, improvements in life expectancy have stalled in the city on the Humber estuary in Yorkshire. On average, residents spend more than a quarter of their lives in poor health (25% for men and 29% for women).
Covid-19, the contraction of Hull’s fishing industry, and the mechanisation of its ports have all hit the local economy hard, with a long term impact on health inequalities. “Far too many people living in these communities have far shorter lives spent in far poorer health,” said Julia Weldon, Hull city council’s director of public health.