Health, wellbeing and regeneration in coastal resorts
Enjoyment of the highest attainable standard of health is one of the fundamental rights of every human being without distinction of race, religion, political belief, economic or social condition.2
Coastal town needs tend to be intense ... The isolation of coastal towns reinforces limited outlooks and poverty of ambition.3
Much of what affects our health lies outside the domain of the health sector. Local authorities are responsible for the maintenance and creation of healthy environments for everyone. They occupy a vital role in our democracy, providing governance, coordination and strategic leadership. Public health explicitly recognises the role played by the state in preventing disease, prolonging life and promoting health. Public health professionals reach outside the usual National Health Service structures and work in partnership with different agencies. This chapter aspires to be the start of a dialogue between coastal public health professionals, regeneration practitioners and spatial planners in coastal resorts.
Local neighbourhood renewal and other regeneration initiatives are in a particularly good position to address health inequalities because they have responsibility for dealing with the wider determinants that have impact on people’s physical and mental health.4
In this chapter, the terms ‘health and wellbeing’, ‘coastal resort’, ‘inequality’ and ‘regeneration’ are defined with reference to coastal communities. It looks at examples of good practice, and draws on the results of a survey of coastal health issues conducted with directors of public health in primary care trusts having coastline in their area.5 Above all, we invite readers to use this chapter as a basis for local discussion on an agenda for coastal public health, and to contribute further examples on health and wellbeing in coastal resorts to support the work of the Coastal Communities Alliance.
Health and wellbeing are central to most people’s understanding of, and relationship with, the coast. The coast is seen as being good for your health: a review of coastal towns found that one of the most important reasons for moving to the coast was simply that respondents wanted to live there.6
Spatial planners, regeneration practitioners and public health professionals in coastal resorts have similar strategic agendas in terms of creating sustainable environments, improving people’s life experiences and addressing social exclusion. These are reflected in the range of issues that respondents to our survey cited as affecting the health of coastal communities: joint top were alcohol and in-migration of older people, followed by houses in multiple occupation (HMOs) and opportunities for younger people. Note that these issues are outside NHS control. Table 11-1 highlights the shared relevance of these issues to public health and regeneration professionals.
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Coastal resorts have been noted for in-migration of older people, many arriving with no family support and some with pre-existing health conditions (see case study 2). Housing is an issue as in-migrants may live in poor accommodation such as caravan parks (case study 3) or HMOs, creating a population hidden from primary care and other services (case study 5). Some coastal resorts have a preponderance of second homes which reduce the housing stock available to permanent residents. Smaller coastal resorts can be geographically isolated, making access to services, to education and to employment difficult (case study 2). Coastal populations tend to be more deprived than their counterparts living inland: 21 of the 88 most deprived authorities are in coastal areas.8 Looked-after children from urban areas are moved to seaside towns for care. Opportunities for young people are limited: employment opportunities centre on tourism, they are thus seasonal and tend to be low-paid. Tourists also create particular public health issues: they may indulge in risky behaviour ranging from too much sun to excess alcohol or unprotected sex. The emphasis on entertainment and the night-time economy does not always benefit residents of coastal resorts (case studies 4 and 5).
Public health has a broad remit and we would expect priorities for action to vary between areas and resorts. A recent independent review lists public health priorities in England as: cardiovascular disease and cancer; obesity; risk-taking behaviours in younger adults (alcohol, drugs, violence); mental ill-health throughout life; and the threats to wellbeing in older people.9 Minimising, and adapting to, climate change is also a critical issue for public health.10 Our case studies show how some coastal resorts have identified and then sought to address public health priorities, and how local government plays a central role in this work.
Coastal resorts are defined as having one or more of the following features:11
- tourism as the dominant industry;
- a specialist tourist infrastructure (promenades, piers, parks etc.);
- housing stock that includes HMOs and caravan sites.
Regeneration has been defined as the broad process of reversing physical, economic and social decline in an area where market forces will not do this without intervention.12 In seaside resorts this means a focus on the specific shared challenges for coastal public policy and regeneration, such as:13
In 1946 the World Health Organization defined health as being not just the absence of sickness but the attainment of a complete state of mental and physical wellbeing. This broad definition continues to be relevant and challenging. Figure 11-1 shows how healthy public policy looks beyond health services, which help people once they are ill, and emphasises factors that maintain health. When we realise that core functions of local and regional government such as employment, transport, access to green spaces, social support, education and housing are all components of a healthy community,15 we recognise the importance of regeneration and public policy in improving and protecting health and wellbeing. Mental health, which ranges from anxiety to more severe conditions, is very much a part of this picture and was a recurring theme in our survey responses. Poor mental health is believed to cost the economy £77 billion a year and the cost in terms of GDP is expected to double to over 10 per cent by 2026. The indirect costs of poor mental health include poor educational attainment, unemployment and increased crime and antisocial behaviour. 16
- decline of the traditional tourist industry;14
- failure to diversify from traditional tourism;
- traditional building stock that is highly suitable for single-resident occupancy dwellings.
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Reducing inequalities in health and improving the health of the most deprived people in society is a main driver for public health policy.19 A look at the national picture shows that inequalities have persisted even though average measures have improved. For example, if we compare life expectancy between the ‘routine and manual’ groups and the population as a whole we see that, for men in the period 2005–7, the gap between these social groups was 4 per cent wider than it was in 1995–7; for women this gap was 11 per cent wider.20 The case studies repeatedly show that populations in coastal resorts are older and more likely to be materially deprived than their counterparts inland. Since 1997, nationally there has been a 2.2 per cent increase in the number of people claiming incapacity benefit, special disability allowance or income support for disability, compared with a 12.3 per cent rise in the number of claimants in coastal towns.21
Community health profiles provide data on a local authority basis on a number of health outcomes and indicators of deprivation.22 These are a good introduction to local health concerns and help to highlight where health is poorest. Pooling this information with relevant economic and regeneration indicators creates a richer understanding of life in a coastal resort. This gives us part of the picture, but one of the problems with using routine data is that many indicators are not readily available below local authority level and so issues in smaller coastal resorts can be masked by the rest of the area.23 This can mean that the needs of small coastal resorts get overlooked. The case studies show how NHS organisations have commissioned studies and Health Impact Assessments to investigate specific concerns of small areas in coastal resorts.
Whitehead offers a useful typology of policies and interventions through which health inequalities can be reduced.24 Table 11-2 shows how our case studies can be grouped under Whitehead’s typologies and illustrate the variety of issues faced by coastal communities and the ways in which local authorities can influence health. There are six case studies presented in this chapter and two on the IDeA website.25
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