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People have always gone to the coast for the restorative effects of sea air, But these days, there is a more complex story to be told about the health of those who live beside the seaside. Once-thriving communities with strong economies and magnificent architecture are becoming deprived and decrepit, and lumbered with large, crumbling properties. The inward migration of older people and those on benefits, combined with the outward migration of younger people looking for better-paid jobs means the demographics have become skewed towards those who lean hardest on health services. Add in the seasonal nature of the seaside economy, plus the proliferation of houses in multiple occupation which are often poorly maintained, and we have the basic recipe for an unhealthy community.This is one picture of our coastal towns. But there is another view. Some towns are thriving, and have found new ways to survive. Visit Blackpool in the summer and you will find a thriving tourist destination which attracts up to 10 million visitors a year, worth more than £540m annually. Look deeper, and the reality is more complex. Despite its tourists, the town is ranked 24th most deprived out of 354 local authority areas. Whichever we look at it, economic mapping reveals a ring of social deprivation around the English coast, and some coastal places are among the most deprived areas in the country. The Government's index of multiple deprivation shows traditional seaside resorts all have pockets of deprivation to rival the worst inner-city areas. Health inequalities in coastal areas warrant as much attention as anywhere. And there are some common factors in coastal towns, which combine in such a way as to cause this severe deprivation. The Department of Health claims health inequalities are the result of a ‘complex and wide-ranging network of factors'. Its says: ‘People who experience material disadvantage, poor housing, lower educational attainment, insecure employment or homelessness are among those more likely to suffer poorer health outcomes and an earlier death compared with the rest of the population.' All these factors, commonly associated with inner-city areas, are familiar problems in coastal towns. Poor housing, insecure employment and homelessness come up time and again when discussing the decline of the seaside resort. A lot of people on benefits and homeless people seem to have drifted into some seaside towns, so they've got the same problems as inner cities – a lot of depression and emotional upset. Many people at the seaside live in caravans or other temporary dwellings for large parts of the year. They are prone to damp, which can lead to respiratory diseases. East Riding Council and primary care trust conducted a survey of caravan residents around the town of Withernsea, where there is a 2,600-caravan strong population. They found considerably worse health among the caravan population compared with the general population, with falls and wheezing of particular concern. Levels of long-term limiting illness, obesity and smoking were also higher. One of the most prominent features of any British seaside resort is the number of elderly people who choose to make their homes by the sea. Sometimes infirm, these are people who often lack the support networks offered by friends and family. Add in a ‘churning population' – people coming and going for seasonal work, asylum-seekers settled locally because of the sheer number of large properties suitable for multiple occupancy, and young runaways attracted by the ‘bright lights syndrome', with the inherent child-protection issues – and the list becomes a heady brew of social problems. This bright lights syndrome is also responsible for health problems associated with a fast-living, heavy-drinking and sexually-active culture. Cases of liver cirrhosis are being seen in young people employed as bar and club staff, and a particular concern is the higher-than-expected incidence of HIV/Aids. But what has led to the degeneration of these towns, which were once the playgrounds of the English on holiday? Traditional coastal industries, such as ship-building and fishing, have declined along with tourism, which peaked in the 1970s but has dropped off as people take advantage of cheap flights abroad. Coastal towns often find it hard to attract new businesses because of the limited geographical area from which to pull staff and customers, and often poor transport infrastructure, making it hard to move goods and services. The Department for Communities and Local Government is looking at the economic future of coastal towns. A select committee report published last year said: ‘The economies of coastal towns cannot… rely on tourism alone to be economically successful. There is a role for economic diversification strategies to provide opportunities for local people to work in a range of industries.' Some towns have bucked the trend, having identified their unique selling points and are attracting tourists. Whitstable in Kent is famed for its oysters, while Newquay in Cornwall has a reputation as Britain's surfing capital. In Southend-on-Sea, the 2004 discovery of the remains of a seventh century Anglo-Saxon king's burial chamber led the council to its unique selling point. Adult services director of the council, Simon Leftley, recognises all the familiar problems of coastal towns. He is targeting smoking and obesity, and looking at ways of diversifying the economy: ‘We're contributing to regeneration and the growth of different employment opportunities to increase the average wage. We're particularly trying to drive the cultural industries, and thinking about skills and employment around the airport and the new university.' Local authorities now have a duty to tackle health inequalities in partnership with health service providers, and are assessed on how well they do this. There is, of course, another factor affecting the health of those living in coastal areas, which is nothing to do with social deprivation – climate change, and the increased risk of flooding. In their book England's seaside resorts, published by English Heritage, Allan Brodie and Gary Winter argue it's not all doom and gloom for our coastal towns, they are just changing and have been doing so for 300 years. The challenge now is to find what to change into. In the meantime, acknowledging that some of these towns have health needs as severe as anywhere in the country is a good basis from which to start tackling them. Liam Hughes is the IDeA national adviser for the healthy communities programme funded by the Department of Health. The IDeA conference, Turning the tide? will be at Southend-on-Sea on 20 May

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HEALTH

Deprivation by the dunes

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