Is coastal living healthy living?

Coastal living is perceived to be health promoting, offering residents reduced exposure to environmental health risks, such as air and noise pollution. Access to the coast should also encourage higher levels of physical activity such as walking and swimming. Exposure to coastal environments is also thought to improve ‘restoration’ or the alleviation of psycho-physiological stress. The coast, it seems, is a therapeutic landscape.

Available health data tell us a different story. Updating the analysis we did for the 2021 Chief Medical Officer’s Annual Report, we find that coastal areas in England continue to have some of worst health outcomes underpinned by significant health inequalities.

We examined standardised mortality and life-expectancy data available at MSOA-level (MSOAs typically contain between 3 and 5 LSOAs and cover populations of between 5,000 and 15,000 people). We found that MSOA-level life expectancy, healthy life expectancy and disability-free life expectancy were all lower in coastal areas for both males and females. The differences were small, but statistically significant. Across all categories of standardised mortality, rates were higher in coastal MSOAs i.e. where more than 50% of their population live in coastal LSOAs within 5 km of the coast. The average standardised mortality rate for preventable mortality (<75 years old) was much higher (114.5 as opposed to 101.1).

Looking at morbidity data from the GP Quality and Outcome Framework (QOF) Disease Register data for 2019–23, we found significantly higher rates of cardiovascular disease (CVD) in coastal LSOAs than in non-coastal LSOAs in 2019-23. For coronary heart disease, coastal prevalence was 18.8 per cent higher than the national average. The ‘coastal excess’ for other cardiovascular conditions was 10.1 per cent (hypertension), 18.5 per cent (stroke/ transient ischaemic attack), 21.8 per cent (heart failure) and 23.9 per cent (peripheral arterial disease).

As CVD is subject to profound age and socio-economic gradients, the coastal excess of CVD partly reflects the fact that coastal populations tend to be older and more deprived than non-coastal populations. According to the 2021 Census, 22.0% of people living in coastal LSOAs in England are aged 65+, compared with 17.5% in non-coastal LSOAs. In addition, 14.2% of coastal residents are living in one of the 10% most deprived LSOAs in the country; compared with 9.1% of non-coastal residents.

However, our analysis has found that age and deprivation do not fully account for the findings. Once age, deprivation and indeed ethnicity are controlled for, the coastal excess in the prevalence of CVD and, indeed, other conditions such as chronic kidney disease, cancer, asthma, epilepsy, chronic obstructive pulmonary disease, depression and mental health holds. Only obesity and asthma appear to be less prevalent than expected in coastal areas.

We do not fully understand why there is an excess of morbidity and mortality on the coast, although several key risk factors may be playing a part. There are more smokers along the coast; 15.9% of adults are registered as ‘current smokers’ in coastal LSOAs compared with 14.6% in non-coastal LSOAs. Children and young people on the coast also have the highest rates of smoking, particularly compared with their counterparts in London. Hospital admissions due to drug and alcohol misuse among under 18-year-olds between 2019/20 and 2023/24 were significantly higher in coastal than non-coastal areas and particularly London. Local authorities with predominantly coastal populations also have the highest age-standardised mortality rates for deaths from drug misuse.

Inequalities in housing may be contributing to inequalities in coastal health. Problems of housing affordability, poor access to social housing and higher rates of second homes, holiday homes and short-term holiday lettings in coastal areas undermine the ability of coastal residents to rent or purchase property. Tenure insecurity, unaffordability and poor housing quality have been linked to the concept of housing precariousness which, through reduced security and increased stress, has implications for poor health. More research is needed to understand the potential role of housing tenure in explaining coastal health outcomes.

The socio-cultural context of some coastal areas also affects health and wellbeing. Coastal communities exhibit many of the characteristics of left-behind places and face economic challenges including poor pay and low-skilled seasonal work, low educational attainment, the outmigration of more highly educated young people and skilled workers and poor connectivity. These dynamics affect seaside towns, fishing communities, industrial and commercial ports alike. The loss of jobs that people associated with a sense of identity, efficacy and belonging – such as shipbuilding – has given rise to a belief that success can only be achieved by leaving or, for those left behind, a poverty of aspiration.

Looking at health outcomes provides a useful summary measure of the variations in cumulative dis/advantage experienced by different population groups. We are unsure why, precisely, coastal living is associated with an additional contextual risk to health; one potential causal pathway may be a sense of collective disempowerment — of being ‘left behind’.

In previous decades public policy has focused disproportionately on metropolitan growth. The opportunity cost of such an approach has continued the socio-economic decline on the periphery, increasing feelings of discontentment and powerlessness. As a nation, we cannot continue to ‘coast along’ with policy attention focused mostly on deprivation and inequality in inner cities.