Professor Chris Whitty, Chief Medical Officer for England – Written evidence (RST0005)
Whilst coastal communities include some of England’s most beautiful, vibrant, and historically important places, many are areas of significant deprivation, have older populations and suffer from problems of being peripheral. They therefore continue to have some of the worst health outcomes in the country. The COVID-19 pandemic disproportionately impacted areas of relative deprivation, something which happens in almost all major epidemics and pandemics anywhere in the world. Although the full impact of the pandemic is not yet clear, it is likely that there will have been some worsening in health outcomes and services in coastal areas. It is therefore important that coastal areas are not left behind as health services recover. Many coastal towns rely either on domestic tourism (for which COVID-19 had both negative and positive impacts) or port towns which were affected by travel changes.
Several parts of government and the health system have taken the issue of coastal health and inequalities seriously. For example, Health Education England (HEE) are delivering several new initiatives to attract, train and retain clinical staff in rural and coastal areas, including in four pilot ICBs along the East Coast with the highest indices of multiple deprivation and lowest workforce per head of population. The HEE Addressing Health Inequalities: Distribution of Medical Specialty Training Programme aims to ensure equitable distribution of HEE-funded specialty training posts aligned to population need, expected to increase the medical workforce in many rural and coastal locations, and five new medical schools have opened in historically hard-to-recruit rural and coastal locations in Tyne and Wear, West Lancashire, Essex, Lincolnshire and Kent. The Office for National Statistics has, among much other work, led the development of the cross Government Statistical Service Subnational Data Strategy to improve data available at lower levels of geography across the statistical system. Organisations named in the 2021 report recommendations would be best placed to provide detailed updates on work undertaken.
A lot is also done locally, by local government colleagues as well as extremely impressive charity organisations. For example, in March this year I visited Bexhill-on-Sea to hear from colleagues working for Rother District Council. Public health was core to Rother District Council’s local plan which focuses on using their natural resources to benefit health and developing age-friendly communities to enable residents to live well locally.
The size of the challenge is however substantial, and more needs to be done. Tackling health inequalities in coastal communities is a long-term issue requiring sustained and collaborative action. My view remains that there should be a national strategy for coastal town health across all the relevant departments.
As above the key recommendation I made in the 2021 report was for a cross-government national strategy to improve the health and wellbeing of coastal communities. This is a route to coordinated and strategic actions rather than piecemeal actions.
As outlined in the report, the specific health challenges of coastal communities often have much more in common with one another than their nearest inland neighbours. Whilst a large amount of innovative work is being done locally and there is significant engagement across government and the health system, a national strategy would allow for a best practice approach to tackle issues in a way that work for the coast as a whole rather than viewing each community as having separate set of problems.
Many of the challenges faced by coastal communities are amenable to strong, targeted, long-term action. Demographic trends tell us that ageing populations and the associated challenges in coastal areas will only increase. This is therefore an issue which requires action to prevent it getting worse.
Improving the prevention, diagnosis, and treatment of the conditions included in the Major Conditions Strategy (cancers, cardiovascular disease, chronic respiratory disease, dementia, mental ill health, and musculoskeletal disorders) will be important to improve ill health across the population. It is however aimed at a different, although equally important, goal. It will not in my view be sufficient to address significant health disparities in coastal communities which are driven by many factors, including higher levels of obesity, smoking and drug and alcohol use, significant health and social care workforce recruitment and retention challenges and a mismatch between availability of, and need for healthcare and social care staff, and complex socio-economic issues such as low and seasonal employment and educational attainment.
6 April 2023