Coastal communities tend to experience higher rates of deaths from major illness, drugs, and suicide and, in many places, shorter life expectancy than non-coastal places. Blackpool has the lowest life expectancy in the UK.
Health in coastal communities was the focus of the Chief Medical Officer’s report in 2021, coastal regeneration featured in the previous government’s Levelling Up agenda, and the topic is a growing area of academic interest. So far, though, this has failed to translate into any sustained national programme to support coastal areas.
Coastal areas have distinctive characteristics which make them both interesting and complex places to understand. Many are areas of natural beauty and possess unique local assets, such as fishing industries or strong tourism economies.
Simultaneously, though, there are often related challenges, such as poorer access to essential services, a lack of secure, good quality employment, and low levels of access to affordable and reliable public transport.
Coastal communities also tend to have older populations, which places additional pressure on health and social care services and can mean that the support offered is not appropriate for young people and families.
But across the country there are some promising local programmes in coastal communities which point to ways forward for better health, including partnerships with the UCL Institute of Health Equity (IHE).
Our 60+ ‘Marmot Places’ across the UK focus on the 8 Marmot Principles, the key social determinants of health, which support action to tackle health inequalities and strengthen health equity partnerships. By collaborating, local partners can begin to reduce unfair and avoidable differences in health.
Kent as the first Marmot Coastal Place
Kent County Council commissioned the IHE to support Kent in becoming the first Marmot Coastal Region. The programme was launched in Dover on Friday 13th March, where stakeholders from across the county came together to share data, evidence of effective practice, and to workshop solutions and pledge their commitment to advancing health equity.
Early insights generated by the IHE were presented by our Director, Professor Sir Michael Marmot. Sir Michael highlighted entrenched health inequalities between coastal and inland areas of Kent. This is most starkly illustrated by looking at gaps in life expectancy.
On average, women living in inland districts in Kent live over 1.2 years longer than their coastal neighbours, and this extends to over a year and a half for men.
The rate of deaths for under 75s, from causes considered preventable, is also much higher in Kent’s coastal (standing at 166 deaths per 100,000) than inland regions (115 deaths per 100,000). The proportion of early, avoidable deaths in Thanet is nearly double the rate of Sevenoaks.
These health inequalities perpetuate across generations and begin at the start of life: 2.8 per cent of babies born with low birthweight in coastal areas, compared with 2.4 per cent in inland areas.
Our analysis shows that inequalities in the social determinants of health, such as good early years development, educational attainment and income are likely driving these inequalities in health. Differences in employment prospects and levels of skills within Kent are particularly stark and, as such, are the first priorities of the programme.
Taking working-age economic inactivity rates as an example, Kent’s overall rate (21.3 per cent) is the same as the England average. However, this headline figure masks substantial inequalities within the county. Analysis shows that coastal regions have a higher level of inactivity (23.4 per cent) than inland areas (19 per cent).
This difference cannot simply be explained by coastal areas having an older population, as the rate only includes residents aged 16-64. Rather, this inequality is likely driven by differences in particular features between coastal and inland Kent.
Inland areas may enjoy better transport connections, more employment opportunities, and tend to have higher levels of educational attainment. On the latter, ‘attainment 8’ scores – a measure of competency across eight key subjects – were much lower in Kent’s coastal districts than inland. For children not eligible for free school meals, Tunbridge Wells has the highest average score in Kent, while Swale has the lowest. Among children who are eligible for free school meals, Swale also has the lowest average score, while Tonbridge and Malling has the highest.
Meanwhile, coastal economies are often reliant on tourism and associated seasonal and less secure work. Lower levels of development in the early years, lower levels of education, and poor quality employment and low pay are well-evidenced to be harmful to health and are likely drivers of worse health in coastal than inland areas in Kent.
Differences between coastal and inland communities in Kent are also reflected in benefit eligibility. Entitlement to Personal Independence Payments (PIP), a financial support to those aged 16-64 and living with a long-term health condition or disability, varies widely across Kent. In Tunbridge Wells, a relatively affluent, inland district, just 4 per cent of people require PIP, while in Thanet, a more deprived coastal district, the figure is more than double (9.1 per cent).
Defining and understanding ‘coastal’
One challenge in understanding the health of coastal communities, and a potential reason they have received limited support thus far, is that there is a lack of consensus on what actually defines a ‘coastal’ place. For some, it is proximity to the sea, others include estuaries, and some definitions extend further to communities that are connected to the coastal economy.
To understand local inequalities fully – and respond with effective policy solutions – analysis at smaller geographies, including Middle-Layer Super Output Areas (MSOAs) level or Lower Layer Super Output Areas (LSOAs) is essential. MSOAs typically contain 5,000 – 15,000 residents, while LSOAs contain 1,000 – 3,000.
Our preliminary data report begins to explore inequalities between coastal and inland Kent at this neighbourhood level. This work will be supplemented by the publication of a comprehensive coastal indicator dataset, co-produced by the IHE and Kent Public Health Observatory, to be released later in 2026.
Where data is available, this will examine a wide range of social determinants at MSOA and LSOA level, by level of deprivation, to understand the social, economic, and health outcomes experienced across Kent better.
This resource will help to ensure that local programmes are guided by data and evidence, and targeted to areas of greatest need. It will also be a critical tool in monitoring and evaluation, helping the system to understand whether interventions and action are successfully reducing health inequalities between coastal and inland areas in Kent and adapting accordingly.
As Sir Chris Whitty has highlighted, coastal communities are diverse and heterogenous in many ways, but they do face strikingly similar health challenges. The Marmot programme in Kent offers an opportunity both to understand and address these inequalities in Kent, while also generating lessons that could support healthier and fairer coastal communities across the UK.