Chief Medical Officer Annual Report 2021

• Chief Medical Officer’s 2021 Annual Report highlights the substantially higher burden of physical and mental health conditions in coastal communities

• The health challenges of coastal towns are serious and today’s report shows there is more in common between them than their nearest inland neighbours

• Key recommendations include proposals for a cross-government strategy, greater coastal deployment of healthcare staff and improved data collection

England’s Chief Medical Officer (CMO), Professor Chris Whitty has recommended a cross-government national strategy to improve the health and wellbeing of coastal communities, as part of his 2021 Annual Report.

The report highlights that, despite the significant efforts of local leaders, coastal communities continue to have a high burden of health challenges across a range of physical and mental health conditions, often with lower life expectancy and higher rates of many major diseases.

The CMO developed the report, Health in Coastal Communities, over the last year and is recommending a cross-government national strategy be developed to improve the health of coastal communities.

He worked alongside Directors of Public Health in coastal regions who looked at case studies within large port cities and local authorities covering smaller seaside towns. The case studies provide an overview of the demographic structure of the population and their health and wellbeing outcomes, along with both the strengths and challenges facing their communities.

Major points from the report include:

• Older, retired citizens – who have more and increasing health problems – often settle in coastal regions but without the same access to healthcare as urban inland areas. In smaller seaside towns, 31% of the resident population was aged 65 years or over in 2019, compared to just 22% in smaller non-coastal towns.

• Difficulties in attracting NHS and social care staff to peripheral areas is a common issue. The report found coastal communities have 14.6% fewer postgraduate medical trainees, 15% fewer consultants and 7.4% fewer nurses per patient than the national average despite higher healthcare needs.

• An oversupply of guest housing has led to Houses of Multiple Occupation (HMOs) which lead to concentrations of deprivation and ill health. Directors of Public Health and local government leaders raise concerns about the challenges of poor quality, but cheap HMOs, encouraging the migration of vulnerable people from elsewhere in the UK, often with multiple and complex health needs, into coastal towns.

• The sea is a benefit but also a barrier: attracting NHS and social care staff to peripheral areas is harder, catchment areas for health services are artificially foreshortened and transport is often limited, in turn limiting job opportunities. The least wealthy often have the worst health outcomes.

Another important theme was that the underlying factors in coastal communities with poor health outcomes share more similarities with other coastal areas than their nearest inland neighbours. For example, in terms of health characteristics, a resort town like Blackpool has more in common with Hastings, Skegness or Torbay than with Preston, just 18 miles inland.

The report highlights the paradox that coastal areas are generally intrinsically healthier than their inland counterparts due to the physical and mental health benefits to living near the coast, including better access to outdoor spaces for exercise, social contact and lower air pollution.

The CMO makes three key recommendations:

1. There should be a cross-government national strategy to improve the health and wellbeing of coastal communities, incorporating key drivers such as housing, environment, education, employment and transport.

2. The current mismatch between health and social care worker deployment and disease in coastal areas needs to be addressed. This should be actioned by Health Education England (HEE) and NHS England and Improvement (NHSE/I).

3. There needs to be a substantial improvement on the lack of granular data and actionable research into the health needs of coastal communities and research funders need to provide incentives for research aimed specifically at improving coastal community health.

Chief Medical Officer, Professor Chris Whitty, said:

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.

These communities have often been overlooked by governments and the ill-health hidden because their outcomes are merged with wealthier inland areas. A national strategy informed by local leaders and experts will help reduce inequalities and preventable ill health.

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.

Responding to the report, Health and Social Care Secretary, Sajid Javid, said:

I welcome this report from Professor 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.

We are committed to levelling up across the nation and the new Office for Health Promotion – launching in the Autumn – will drive and support the whole of government to go further in improving people’s health.

Julia Weldon, Director of Public Health, Hull County Council said:

Our coastal communities and Port Cities are amazing, have a huge part to play in terms of the health and wealth of our nation and yet have some of the worst health and wellbeing outcomes in England.

It is time to recognise and address the unjust and unnecessary burden of multiple health inequalities that means far too many people living in these communities have far shorter lives spent in far poorer health. We will only achieve this through targeted and sustained focus on Building Back Fairer.

Dr Arif Rajpura, Director of Public Health, Blackpool Council said:

Blackpool, like many other seaside towns has its strengths as well as it’s challenges. The town is a major centre for tourism in England with 18 million visitors annually. Housing, especially poor quality private rented, is a significant contributor to poor health in the town. Tackling the failed private sector housing, especially the large number of houses of multiple occupation (HMOs) will be key to tackling health inequalities in coastal towns.

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