The UK’s Chief Medical Officer’s 2021 Annual Report on ‘Health in UK Coastal Communities’ has raised concerns about personal health
The UK’s Chief Medical Officer’s 2021 Annual Report on ‘Health in Coastal Communities’ has raised concerns about personal health.
- a higher burden of heart disease, diabetes, cancer, mental health and COPD in coastal areas,
- age and deprivation are two causes of this but health service standards, indicators and emergency admissions may also play a part,
- life expectancy is significantly lower in coastal areas,
- lower participation in Higher Education, as well as higher rates of hospital admissions for young people with ‘health-risking behaviour’, show the effects of socio-psychological and economic dislocation in coastal communities.
Their findings also point to the lack of available data for small areas on or beyond the coastal fringe.
Coastal communities appear to include a disproportionately high burden of ill health, and this is demonstrated in the mapping of Coronary Heart Disease (CHD). Between 2014-2019, nearly 60,000 more people were on CHD registers in coastal areas (mapped by Lower Layer Super Output Areas or LSOAs) – or 17.8%.
Conditions including hypertension, stroke and transient ischemic attack (TIA), heart failure and peripheral arterial disease (PAD) show similar differences in prevalence between inland and coastal communities.
Age and deprivation go some way to explain this – both factors are associated with increased risk of diseases, higher prevalence of CHD and other cardiovascular diseases. Coastal residents are more likely to be older and live in a more deprived area. However, Professor Asthana and Dr Gibson found that these factors do not fully account for the difference – rates are still higher in deprived coastal areas compared to similarly deprived inland areas. Similarly, they also found that the ‘coastal effect’ is associated with ill-health that cannot be wholly explained by demography or ethnicity.
Mortality rates categorised by Middle Layer Super Output Area (MSOA) demonstrate that deaths from all causes are, on average, 8.8% higher in coastal areas. Standardised mortality rates (SMRs) are higher in coastal areas for cancer, circulatory disease, stroke, respiratory disease and ‘preventable disease’ – a category that is defined as ‘causes where all or most deaths could potentially be prevented by public health interventions in the broadest sense’.
It is recognised that this could also be influenced by a greater proportion of people smoking in coastal areas, as well as higher rates of obesity and more ‘health-risking behaviours’ of coastal residents.
Professor Asthana and Dr Gibson’s research found lower recorded recommended treatment rates in coastal areas, in comparison to non-coastal areas. For example, 39.9% of Type 1 diabetes patients in coastal areas received at least eight of the recommended care processes for the condition, compared to 40.8% in non-coastal areas. This represents a marginally lower, but still significant difference.
Similarly, cancer conversion rates – the percentage of urgent suspected cancer referrals which result in a diagnosis of cancer – is 8.4% in coastal areas, compared to 7.4% in non-coastal areas. This difference could be a reflection of late presentations by older, more deprived populations but may also be because they face greater barriers to secondary treatment. Between 2015-2019 there were, on average, 2,127 patients per full-time equivalent (FTE) GP in coastal areas, compared to 2,079 in non-coastal areas. This is despite the fact coastal populations are older and more deprived.
It is concluded that there is a substantial health service deficit in coastal communities that is leading to a small, but significant ‘coastal effect’ of ill-health.
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