Levelling up: a north-south or a peripheral problem?

Coastal communities have received little attention in the public health literature, perhaps because our mental maps tend to perceive socio-economic deprivation and associated health inequalities with the inner city.

Mapping a range of key health indicators at small area level, this paper demonstrates a distinctly core-periphery pattern in disease prevalence, with coastal communities experiencing a high burden of ill health across almost all conditions included in the Quality and Outcomes Framework dataset. It shows particularly poor outcomes for children and young people, where rates of participation in higher education are poor along the coastal fringe, while rates of hospitalisation for self-harm, alcohol and substance use are high, reflecting a profound shift in the distribution of children living in poverty since the 1990s. There are, moreover, indications of a contextual effect over and above that of population composition.

These findings raise the question of whether it is time to stop conceptualising social disadvantage and health inequalities in north-south terms and recognise that these are problems of the periphery.

The research presented in this paper forms part of a chapter published in the 2021 Chief Medical Officer’s Report on Coastal Health by Professor Sheena Asthana, Director of the Plymouth Institute of Health and Care Research.