Andy Alaszewski with Liz Meerabeau, Jill Stewart, Ann Palmer and Linda Jenkins Does Coastal Deprivation Affect People

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Andy Alaszewski with Liz Meerabeau, Jill Stewart,
Ann Palmer and Linda JenkinsDoes Coastal
Deprivation Affect Peoples Health? What Effects
of Social, Health and Cultural Factors and
Economic Transitions have on Need and Demand for
Public Services and the Challenges Faced by
Coastal Towns

• Comparison of Sante/Public Health Conference,
  Darwn College Conference Suite 26th March 2007

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introduction

• aims
• awareness of coastal deprivation
• evidence from the Interreg/cosph study
• implications for health and social care

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aims

• Context- Interreg programme designed to transfer
  knowledge and skills across boundaries- cosph
  programme focusing on inequalities and
  deprivation and effect they have on health- one
  of the common features of Nord Pas de Calais and
  Kent and East Sussex is that they both have
  substantial coast lines- while there are
  concentrations of deprivation inland, especially
  in ex-mining areas, clear evidence of
  deprivation and increased morbidity and mortality
  in coastal areas
• Aims of paper- to identify coastal deprivation
  and its links to inequalities- consider the
  underpinning dynamics

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coastal deprivation in policy discourse

• late development- lagged behind urban and rural
  deprivation- in the UK Office of Deputy Prime
  Minister identified it as an issue around 2003
  and the Select Committee report was not issued
  until March 2007
• Coastal versus other forms of deprivation- urban
  deprivation is linked to the concentration of
  vulnerable populations in inner city areas and
  public housing, migration and exclusion form
  other areas- rural deprivation is linked to the
  dispersion, vulnerable groups become hidden in
  rural areas, access and transport issues-
  coastal deprivation, ribbon with beads of varying
  sizes, rural areas with coastal towns, i.e. both
  dispersion and concentration, cut off from other
  areas, with access and transport issues, combined
  with migration and concentration of vulnerable
  populations

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history plays an important role

• Dominant industries - the beads developed around
  dominant industries, fishing, ports, naval
  dockyards and leisure
• Legacy of this past investment at various
  levels i. transport often well developed rail
  but poor road ii. physical fabric of towns,
  redundant docks, some substantial houses, much
  artisan housing iii. socio-demographic often
  predominantly manual labour working in
  manual/toxic industries iv. socio-cultural Some
  aspects easy to recognise, the thrills and
  spills of the seaside, some more difficult,
  e.g. fishing industry in Hull associated with
  high but irregular income, ?link to risk taking,
  future valuation
• Social implications i. Isolation/exclusion due
  to poor transport ii. Physical decline of
  fabric, Large houses used to house transient
  individuals iii. Legacy of ill health from
  former industries, problem of retraining for
  new, high levels of unemployment iv. Attraction
  of vulnerable populations in some cases with high
  risk behaviours, older people and younger people
  escaping social problems. ?high service users
  

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cosph Using Townsend Scores to compare
deprivation across SE England and N France

• More concentrated deprivation in northern France
• Coastal deprivation
• Central belt of deprivation through the mining
  regions of France

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cosph Men 1996-2002 - All Cause Mortality, SMRs
(all ages)
Using Local Linear Empirical Bayes Smoother SMR
Nord-Pas-de-Calais South-East England regions
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cosph Men premature mortality (0-64 years)
1996-2002 All causes
The mortality in Nord Pas-de-Calais is higher
than in Southeast of England. In France, some
areas show very high rates of mortality (areas
with old mining industry, areas around Dunkerque)
Using Local Linear Empirical Bayes Smoother SMR
Nord-Pas-de-Calais south-east english regions
100
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cosph Women, mortality 1996-2002 - SMR all cause
and all age
Using Local Linear Empirical Bayes Smoother SMR
Nord-Pas-de-Calais south-east english
regions 100
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cosph Women, 1996-2002 Premature Mortality
(0-64 years), all causes
Smoothed using the Local Linear Empirical Bayes
Smoother SMR Nord-Pas-de-Calais South-East
English regions 100
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cosph Deprivation at the coast?

• 8 of 13 Focus Groups explicitly commented on
  coastal areas, and all but 1expressed surprise
  that these areas were generally deprived
• I was surprised that the low life expectancy
  are mainly on coastal areas - that was my first
  thoughts I would have thought that in the
  coastal environment where food is supposed to be
  that much better, sea breezes and all this should
  constitute a better lifestyle and from a health
  point of view, but it doesnt seem to (Focus
  Group 2)
• where people used to go to get better. (Focus
  Group 2)
• Yeah, on the coast which surprises me ...
  Because I would think the fresh healthy sea air
  you know. (Focus Group 4)
• Fresh air, lovely fresh air. (Focus Group 7) 

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copsh Recognition of social problems?

•  
• It's not good living within sea air! It's
  because of the bed and breakfast classes, because
  it's a migrant population. Well, in Ramsgate, it
  always struck me that a lot of the mothers who
  came into school were slightly depressed, they
  were down, and they didnt (Focus Group 12).
• The red areas seem to be mostly urban areas and
  it should be remembered that there are a lot of
  people in areas like Margate and Dover who are on
  state benefit, who are immigrants, but apart from
  that, most of Kent seems to be a healthy place to
  live. (Focus Group 12).
• Well I am looking down at the Folkestone area
  and I used to live down in Dover so I know down
  there pretty well and I wouldnt have thought
  that that was a particularly deprived area,
  although I must admit since we lived there, there
  have been a lot more asylum seekers and people
  like that, that affect the health of the area
  maybe. (Focus Group 1)

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cosph concentration of vulnerable/dangerous
people

• Well because you get young pregnant girls, you
  get ones who have been in trouble and inner
  cities have dumped them on the coast to manage by
  themselves. They get involved in drug taking
  with various unsavoury people. And also, as far
  as I understand it, a lot of people with mental
  health problems - they are dumped on the coast to
  look after themselves. (Focus Group 9)
• And also, a lot of particularly in the Thanet
  area I think, isnt it the case that well the
  London area ships down their teenagers and things
  like that, who very often are depressed as well
  and they probably live rough after a while. It's
  got a lot to do with it And the unemployment in
  those little red areas in Thanet (Focus Group
  12).

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cosph importance of history

• Prompt What do you mean by apathy in the area?
• and my grandparents came on holiday down here,
  so every year we came down to Margate, Ramsgate
  or down by the Lido or somewhere to meet, so the
  whole family, cousins etc all met, and the area
  was totally different then ... Well it was
  humming, it was buzzing - I mean this is looking
  at the early 50s into maybe until just about the
  beginning of the 60s, and then tourism came in
  and foreign holidays and a better guarantee of
  sunshine. Coaches stopped coming down for
  day-trippers so the area (Focus Group 5) in
  the 70s it broke down, because there were so many
  hotels and the hoteliers didnt have anybody
  staying, so they were going towards
  bankruptcy.But people dont come to England for
  their holiday now, they jump on a plane to go to
  Spain orYes, it has completely changed the
  area .. (All the old resorts) have all lost the
  holiday trade. (Focus Group 5)

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Implication for health and social care

• demand- higher (an issue for further empirical
  study)- manual industrial working population
  related to high level of occupation related
  illness, e.g. asbestosis from naval dockyard,
  social problems, i.e. no accident that first of
  modern child abuse scandals, Maria Collwell took
  place in Brighton- migration adds
  vulnerable/dangerous population, Bridlington
  study small area of boarding houses with
  concentration of high users of health and social
  care
• supply- outward migration of younger upwardly
  mobile individuals- difficulty or attracting and
  retaining skilled professionals in health and
  social care- usually poorly developed health and
  social care facilities
• investment- investment in transport especially
  roads has made some seaside more accessible, e.g.
  A299 to Thanet, M23/A23 to Brighton- investment
  in higher education increasing supply of medical
  professionals, who tend to stay near where they
  are trained- capital investment

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