Coastal Population Health, Sustainability and Resilience: Health Provision and Patterns

Despite the National Health Service’s founding principles of comprehensive, free, and equitable care, coastal populations in the United Kingdom face long-term structural neglect. England’s Chief Medical Officer reports in 2021 and 2023 highlight persistent “coastal excess” of disease and severe health inequalities spanning urban-coastal and rural-coastal settings. Coastal health access is threatened by the intersection of the climate crisis and urbanisation, while sparse data renders these populations largely invisible within policy and practice. More recently, "coastal" is increasingly recognised as a unique public health geography, demanding a broadening of the urban-rural debate through a coastal lens for understanding urbanisation, equity, and climate resilience. Adopting Joanna Briggs Institute methodology and adhering to PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines, this scoping review examines how coastal health provision has evolved over time and why disparities persist. Preliminary findings reveal an evidence base dominated by non-experimental research and discussion articles, with no longitudinal studies. Coastal health is rarely a distinct category, with evidence framed around rural/remote and island-based contexts over direct coastal terminology. A fundamental structural gap exists in the absence of a standardised "coastal" definition, with only a few studies using a government spatial classification. Key coastal health disparities may stem from socio-economic deprivation, geographic isolation, ageing populations, mental health concerns, seasonal economy, climate crisis, and digital exclusion. Primary barriers include geographic isolation, transport difficulties, funding constraints, and workforce recruitment and retention. This work aims to inform policies advancing equitable, climate-resilient health systems and reducing coastal health inequities.

Key messages

• Integrating historical, policy, & experiential narratives, this research exposes drivers of coastal health inequalities and yields valuable evidence translating into policies to achieve health equity.

• Delivering UK-wide evidence, this research responds to health inequities compounded by the intersection of urbanisation and climate crisis, advancing equitable and climate-resilient health systems.