Health, wellbeing and regeneration in coastal resorts

Below is the background information to accompany the health, wellbeing and regeneration chapter of the Coastal Communities Alliance (CCA) 'Coastal Regeneration Handbook'.

The chapter and the specific references made to it can be found in the publication below.

Coastal Communities Alliance Coastal Regeneration Handbook – Coastal Communities Alliance website.

Introduction

An email survey was conducted as part of the Healthy Communities programme’s input to the Coastal Communities Alliance 'Coastal Regeneration Handbook', which was launched on 28 January 2010. The survey was briefly referred to in the final text analysis. The full survey analysis can be found below.

Health, Wellbeing and Regeneration in Coastal Resorts (PDF, 13 pages, 113KB) – full survey analysis

The survey was sent to all directors of public health (DsPH) with the help of the Association of Directors of Public Health (ADPH). It was conducted by Ben Cave Associates on behalf of the IDeA. Work by the Healthy Communities programme on coastal health issues forms part of the programme’s thematic workstrand.

Survey

The survey aimed to develop an outline of public health issues in coastal resorts to help inform the Healthy Communities contribution to the handbook. The email survey also informed DsPH with coastal resorts in their area, about the 'Coastal Regeneration Handbook' and began to identify a group of DsPH with a particular interest in issues concerning coastal resorts.

Methodology

A rapid survey methodology was used in recognition of the fact that the 'Coastal Regeneration Handbook' has been published electronically and will be updated periodically.

The survey focused on regeneration and the social determinants of health in relation to coastal and particularly seaside resorts: it didn’t explore health protection issues such as the quality of bathing water. The key public health issues contained in the survey were established through a rapid review of relevant literature and discussions with those leading the handbook’s production. These issues can be found in Table 4 – see full survey analysis. The survey was structured so that respondents could answer with reference to the size of the coastal resorts.

Results

Unfortunately the response rate was relatively low – nine out of a sample of 47 coastal primary care trusts (PCTs). We believe the swine flu outbreak played a part in this.

The survey was a mix of open and closed questions. The first part of the survey asked about the size of the coastal resorts and whether populations in coastal resorts face any particular challenges. Table 1 shows that responses to the survey cover approximately 19 coastal resorts, that the best-represented group is for populations of 20,000-49,999, and the second most represented group is smaller resorts with populations of 0-9,999. Respondents were encouraged to answer for each of the resorts in their area.

Discussion

The survey was a pragmatic exercise to develop a picture of issues faced by coastal resorts. It does not provide a comprehensive, or representative, picture of public health in coastal resorts. Its shortcomings include: the speed with which it was designed and issued; the short response time; the absence of piloting; the small sample size; and minimal explanation and guidance. It was issued in June 2009 when PCTs were addressing the swine flu epidemic. The results are indicative of the kind of public health issues facing coastal areas but should not be taken as conclusive. One of the clearest results from our survey is the importance of the in-migration of older people to coastal resorts. In their study of the seaside economy Beatty and Fothergill look at why people move to the coast.

The Seaside Economy. The final report of the seaside town project. 2003 – Beatty, C. and Fothergill, S. on the Sheffield Hallam University website.

They concentrate on seaside towns with populations over 8,000. While examining the working age population, they report substantial net in-migration to seaside towns among both men and women from age 35 up to state pension age (1971-1991). Ages 35 to 65 were divided into three groups and each group had similar numbers of in-migrants. This increases the representation of older people. In interviews with recent migrants they found that many people move to the coast because they want to live there. Work-related reasons for moving were cited less often. Beatty and Fothergill suggest this may owe something to a stock of suitable housing. Evidence from the case study in Mablethorpe – see 'Coastal Regeneration Handbook' –  a smaller resort than those considered by Beatty and Fothergill, suggests that people also move to the seaside because it is good to be by the sea: good for general wellbeing.

Respondents to our survey did not note positive aspects of living by the coast as a public health issue. Mental health was noted as an issue in the responses to the open questions. For example, regeneration was indirectly linked to improved perceptions of wellbeing and improvements to the physical environment were linked to improved mental health and community cohesion. Neighbourhood identity is important and change can be stressful. The health impact assessment (HIA) of the Herne Bay Area Action Plan (AAP) expressed concern that development could create tension between opponents and supporters of change –  see 'Coastal Regeneration Handbook'. The importance of social support for those at risk of isolation or suffering from mental health concerns is demonstrated in the houses in multiple occupation (HMOs) case study in the main handbook document.

Populations that are older, deprived and or hard-to-reach place heavier demands on health services. Beatty and Fothergill found that the older population were more likely to be out of work and, if childcare is not counted, that ill-health or injury was the single most important cause of job loss for both men and women. The patient list at the Mablethorpe Health Centre has three times the national average for conditions such as obesity, hypertension, coronary heart disease and diabetes – see 'Coastal Regeneration Handbook'. Caravan park residents in Withernsea – see 'Coastal Regeneration Handbook' – were found to have poor health yet low levels of GP usage. Hard-to-reach groups use primary care less, they tend to present late and with more serious conditions and they tend to use A&E services more often. Emergency plans need to take special account of an older population.

A coastal resort was defined as having one or more of the following features:

• tourism as the dominant industry;
• a specialist tourist infrastructure – promenades, piers, parks and so on
• housing stock that includes houses in multiple occupation (HMOs) and caravan sites.

While this captures some of the features of a coastal resort it is not clear that it will be useful as a definition. The survey results include responses about ongoing work in two port towns – the results were not excluded as these towns may not have tourism as the dominant industry but they both report results for HMOs. Can a park be defined as specialist tourist infrastructure?

The size and characteristics of settlements on the coast vary considerably: there are small rural towns and villages, traditional ‘seaside resorts’, and sites of industrial activity. Many witnesses to the Communities and Local Government Select Committee Inquiry into Coastal Towns commented on the risks inherent in any generalisation about coastal towns, given their differing social and economic profiles.

Communities and Local Government Committee. 'Coastal Towns: Second report of session 2006-2007’. HC 351. 2007 House of Commons – United Kingdom Parliament website.

The IDeA was happy to the support the 'Coastal Regeneration Handbook' and hopes that the local health and wellbeing community will continue to discuss the health inequality challenges at the coast and share experiences via the Healthy Communities Community of Practice (CoP).

Join the Healthy Communities CoP

Page published January 2010.