Unpacking the coastal health gap: the tide is high and so are the disparities in healthy life expectancy in England and Wales

BACKGROUND: Coastal communities in England and Wales face unique challenges that may contribute to disparities in healthy life expectancy (HLE). METHODS: This study uses 2021 Census data and mortality records to estimate HLE at birth across 7264 Middle-Layer Super Output Areas (MSOAs) in England and Wales. HLE was calculated using the Sullivan method. Coastal MSOAs were identified using population-weighted centroids within 2 km of the UK coastline. Linear regression models assessed the association between coastal classification and HLE, adjusting for region, deprivation, educational attainment, and industry of employment. Interaction terms explored whether deprivation moderated coastal health disparities. RESULTS: Coastal MSOAs exhibited significantly lower HLE than inland MSOAs, particularly in the South East and East of England regions. After adjusting for socioeconomic factors, the coastal disadvantage was attenuated but remained significant in the most deprived areas of select regions. Area deprivation was a strong predictor of reduced HLE, with each decile increase associated with a 1.5-year reduction in HLE. CONCLUSIONS: The findings challenge the notion of a uniform coastal health penalty, highlighting the importance of regional context and deprivation in shaping health outcomes. Targeted public health interventions should prioritize deprived coastal communities through fairer resource allocation and decentralization of decision-making.