Can we adapt fairly? Systematic review of health equity implications of climate change in coastal communities in the UK

Abstract As climate change becomes more apparent, it is important to evaluate the equity implications of adaptation interventions and policy measures. Many coastal populations experience high levels of social deprivation, which can be compounded by environmental factors. Coastal hazards, such as erosion and flooding can cause short and long term impacts on physical and mental health. To systematically review the published evidence on the differential impacts of coastal change on health inequalities and review the implications of adaptation responses for health inequality. We systemically reviewed the evidence for the UK only on a) inequalities in coastal flood impact or risk, and b) effectiveness and equity implications of current measures to manage the climate risks to an acceptable level of impact. Interventions included: plans and guidance, insurance, and infrastructure, including natural flood management. We found 8 papers quantifying differentials in current and future impacts of coastal flood risk and 6 papers assessing equity implications of adaptation measures. Coastal flood risk is unevenly distributed. Those owning their own home were more likely to experience flood impacts including increased stress and displacement. There is good evidence that policies for household insurance and property level protection measures have the potential to increase inequalities; other measures (community engagement; planning; defences) may reduce health inequalities, depending on implementation and local context. Adaptation to coastal change requires a range of approaches in the short and longer term, which potentially exacerbate current inequalities. Adaptation responses that rely on individual behaviour change, such as relocation, purchasing insurance, or retrofitting dwellings, may exacerbate inequalities within coastal communities. Climate change challenges organisations to deliver national and local policy responses ensuring that adaptation is effective and equitable.