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RCP responds to Chief Medical Officer’ annual report 2021: health in coastal communities

Professor Chris Whitty has published his second annual report. It highlights the health disparities in coastal communities compared to their inland neighbours.

The chief medical officer’s second annual report is an analysis of health in coastal communities, which “have some of the worst health outcomes in England, with low life expectancy and high rates of many major diseases. For example, Blackpool, one of the country’s favourite holiday destinations, has the worst life expectancy in the UK despite remarkable efforts by local health and civic leaders.” Yet coastal communities “have been long overlooked with limited research on their health and wellbeing… As a result, deprivation and ill health at the coast is hidden by relative affluence just inland which is lumped together.”

The CMO’s key recommendations, aimed at government, policy makers, and healthcare and public health professionals are:

  • Given the health and wellbeing challenges of coastal communities have more in common with one another than inland neighbours, there should be a national strategy to improve the health and wellbeing of coastal communities. This must be cross-government as many of the key drivers and levers such as housing, environment, education, employment, economic drivers and transport are wider than health.
  • The current mismatch between health and social care worker deployment and disease prevalence in coastal areas needs to be addressed. This requires action by HEE and NHSE/I.
  • The paucity of granular data and actionable research into the health needs of coastal communities is striking. Improving this will assist the formulation of policies to improve the health of coastal communities. Local authorities, ONS and NHSE/I need to make access to more granular data available. Research funders, including NIHR and UKRI, need to provide incentives for research aimed specifically at improving coastal community health.

RCP president Andrew Goddard said: “The RCP thanks the chief medical officer for his report and the focus on health inequality between coastal and inland areas. Once a thriving part of our country and its economy, since the advent of low cost foreign travel they have been left to languish.

“This is demonstrated by the ‘relatively little research focusing on health and care in coastal communities’ highlighted by the report. As the RCP has said, targeted funding is crucial to encouraging and supporting more research activity in rural areas, which are often the areas with highest disease burden but lowest research activity.

“Making sure there are enough of the right doctors, nurses, other clinicians, public health and social care professionals in these areas is crucial. Primarily, they are needed to prevent ill health and deliver care, but without the right people there is simply no time for research. We found that 40% of doctors in rural hospitals not involved in research would like to be: 12% more than among their counterparts in cities.

“The report found that coastal communities have 15% fewer consultants and 7.4% fewer nurses per patient than the national average. It should not have to be the responsibility of the chief medical officer to point out a mismatch between the health and care people need and the NHS staff available to deliver it. The government should have an ongoing understanding of the situation, which is why it is important that the health and care bill introduces a legal duty to ensure transparency and accountability on NHS workforce planning.

“This is also further evidence that we need to train more doctors. If the NHS and HEE are to address the ‘mismatch between health and social care worker deployment and disease prevalence in coastal areas’, they are going to have to move staff from somewhere or recruit more people, and we know there are no parts of the country with too many doctors, nurses and others.

“Finally, we support the CMO’s call for a national strategy to improve the health and wellbeing of coastal communities. But, as the convenor of the Inequalities in Health Alliance, we think it would be even more efficient to develop a strategy for the whole of the country. The focus for action and funding would of course be areas of highest need, with the changes required on issues such as housing and employment relevant for communities both on the coast and inland."