Researchers from UCL have found that midlife multimorbidity in England and Wales is linked to neighborhood deprivation and selective migration rather than coastal living itself. A study published in BMJ Public Health reveals that people moving out of coastal areas before age 42 typically have better health than those who stay or move in.
Living by the sea is often romanticized as a health tonic, but the reality for many in England and Wales is a concentration of chronic illness. New research suggests that the perceived health gap between coastal and inland populations isn’t caused by the salt air or the shoreline, but by who is left behind in these communities.
The study, led by Professor Stephen Jivraj of UCL Epidemiology & Health Care, analyzed data from two major birth cohorts: the 1958 National Child Development Study (NCDS) and the 1970 British Cohort Study (BCS). By tracking 13,691 people from the NCDS and 14,683 from the BCS from birth through midlife, researchers aimed to see if growing up or living on the coast predicted multimorbidity—the presence of two or more chronic conditions.
The Impact of Selective Migration on Coastal Health
The most striking finding isn’t where people live, but how they move. The researchers identified a pattern of selective migration
that effectively sifts the healthiest individuals out of coastal towns, leaving a more vulnerable population behind.
Data shows that people who move away from coastal areas between the ages of 16 and 42 are significantly less likely to report multimorbidity in midlife than those who migrate into these areas.
- NCDS (Age 55): The predicted probability of multimorbidity between in-migrants and out-migrants differs by 10 percentage points.
- BCS (Age 46): The difference in predicted probability between these two groups is 5 percentage points.
According to the BMJ Public Health report, this process makes the composition of coastal areas unhealthier over time. This isn’t a phenomenon limited to these specific birth cohorts; graduates in the 2010s who left coastal areas for university were less likely to return than those who left inland areas.
Neighborhood Deprivation vs. Geographic Location
While there is a raw correlation between coastal living and poorer health, that link vanishes when socioeconomic factors are applied. In the NCDS sample, living in a coastal area by age 42 was associated with 22% higher odds of multimorbidity at age 55 before adjustment. However, that association was attenuated once the researchers accounted for neighborhood deprivation.
The study found that those who remain in coastal areas often live in more deprived neighborhoods during both adolescence and midlife compared to those who stay inland. Furthermore, people moving to the coast often transition from less deprived childhood neighborhoods to more deprived adult environments. Conversely, those leaving the coast typically move from high-deprivation areas to lower-deprivation ones.
This creates a compounding effect where deprived coastal regions become concentrated hubs for multimorbid populations. The researchers tracked nine specific conditions to determine these outcomes, including asthma, diabetes, cancer, heart problems, and depression.
Economic Decline and the Physical Barrier of the Sea
The disparity is not just a matter of statistics but of structural economic failure. The decline of traditional coastal industries, such as fishing and tourism, has stripped these areas of employment opportunities, which in turn fuels the migration of healthier, younger residents.
“Some evidence suggests that living closer to the coast has protective health effects – such as less pollution and the chance to reduce stress by exploring beautiful, scenic walks. However, the decline of traditional industries, such as tourism and fishing coupled with limited employment opportunities for residents, has led to a concentration of health inequalities in many coastal communities across England and Wales.”
Professor Stephen Jivraj, Corresponding Author, via UCL News
Beyond economics, the geography itself acts as a hurdle. Professor Jivraj noted that the physical barrier of the sea can limit access to education and employment, a challenge not shared by those living inland.
Policy Implications for Coastal Communities
Because the health burden is tied to deprivation and economic stagnation rather than the coast itself, the researchers argue that general health initiatives are insufficient. They are calling for cross-cutting interventions that combine public health resources with economic development to break the cycle of decline.
“This suggests coastal regions may need targeted policies and resources to address growing health inequalities.”
Professor Stephen Jivraj, Corresponding Author, via UCL News
The study, funded by the Economic and Social Research Council and conducted with the University of Essex Centre for Coastal Communities, acknowledges some limitations. The researchers used the Office for National Statistics definition of Built Up Areas, which may lead to some misclassification of what constitutes a coastal area. Additionally, the study did not differentiate between types of coastal settlements, such as industrial ports versus holiday villages.
What remains uncertain is the “chicken or egg” nature of this decline: whether coastal areas declined economically, causing people to move away, or whether the departure of the population caused the economic decline.
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