Health and wellbeing swells on the seashore

We often equate the idea of being beside the seaside with rest and relaxation, recuperation and revitalisation, and new research shows that this belief in the beneficial effects of the coastline may be well-founded.

Data from the United Kingdom census of 2001 was used to examine the relationship between proximity to the sea and the health and wellbeing of the population. The 48 million respondents to the census were asked to rate their health in the preceding 12 months as ‘good’, ‘fairly good’ or ‘not good’, and it was this question combined with distance from the coast which formed the basis for the analysis.

The study was undertaken as part of the Blue Gym programme of research being carried out into aquatic environments and human health at the European Centre for Environment & Human Health, part of the Peninsula College of Medicine and Dentistry (PCMD).

I spoke to lead author Dr Ben Wheeler in order to learn more about what motivated the team to carry out the research, the implications of their findings, and how they may throw into relief certain health inequalities.

What were the motivations behind this research and did you expect to get the results you did?
We based the research on the association that has existed for hundreds of years between being by the sea or on the coast and healthiness. There is a lot of literature and so on from Victorian times about the idea of convalescing by the sea, for example. But very little research has been done to try to understand what is behind this association; whether being by the sea really does have health benefits and, if it does, why that may be.

Our study also fits into a whole world of research about people’s interactions with natural environments and how they might affect health and wellbeing. That area of research has been developing over the last 20 or 30 years, mostly focusing on greenspace and in particular on urban greenspace as a potential health resource. We wanted to tie those two things together with a study based on how close people live to the sea and whether proximity to the sea actually does seem to be associated with better health and wellbeing.

Did you find differences in health terms between living near greenspace and living near blue space?
We didn’t look directly at differences between the two. In the analysis that we did, when we looked at the effect of living near the sea we accounted for greenspace to effectively avoid any confounding effects, but it’s interesting to have them both in the same model.

Which other variables did you control for and why?
One of the key things we accounted for was age. Obviously the age distribution of local populations differs massively across the United Kingdom. Particularly because there are so many retirement communities by the sea, you do encounter very strong demographic variation along the coast. We accounted for that by using a standardised rate for the good health measures, taking age and sex out of the equation.

In the statistical models we included a number of components of the indices of deprivation. We looked at education, unemployment, income; a selection of socioeconomic variables to take them all out of the equation. Lastly, we separated the analysis by urban and rural. We thought there might be different factors at work in urban and rural settings and that did seem to be the case.

Do you believe that the differences you found can be accounted for more by the benefits of living near blue space than the absence of the negative effects of living further inland?
That would be our hypothesis; that living near the sea brings some sort of health benefits. Living inland is not necessarily a bad thing, but you see an improvement in health as you move towards the sea.

That is part of the reason we wanted to use this census data. The vast majority of research done using data from the 2001 census is focused on the people who tick the ‘not good’ box – people who rate their health as poor. We wanted to turn this on its head and look at the people who ticked the ‘good’ box.

Why do you think it might be that living near the sea confers health benefits?
A number of mechanisms have been proposed but, as we say, this kind of study cannot pick them all apart. One of the key points would seem to be the opportunity and motivation for physical activity. We know that physical activity is strongly linked with good health. The way we conceptualise it is that the nearer you are to the coast, the more frequently you’re likely to interact with it. We hypothesise that people who live in what we classify as the coastal band might access the coast almost every day or at least a couple of times a week, whereas people who live a little further away might only go every couple of weeks.

I think that the opportunity for relaxation and stress reduction might be significant too. Some of the psychological research that our group has been doing seems to indicate that this may well be the case and that people report positive effects on mood from being by the sea.

Has the study highlighted certain health inequalities or the potential to remedy some health inequalities?
That is one of the most interesting points about the study. It reflects quite closely a similar study that was done a few years ago on proximity to greenspace and how that interacts with socioeconomic deprivation and health. We find the strongest effect of the coast in the most deprived populations, so perhaps something about access to a good natural environment accords some degree of resilience to the harmful effects of socioeconomic deprivation. We see very little affect among the least deprived group separated out in the paper, and that may be because they have the resources to go on holiday more frequently or to get their physical activity in the gym. Perhaps for that more affluent group being near the coast does not matter so much.

What is the next step for your research? Are you planning follow-up studies?
This fits into a whole programme of research we have about access to aquatic environments, particularly the coast but also inland water, and how that might affect health. From my point of view, I’m especially interested in how we can take this a step further and look longitudinally, with datasets that follow people across time. One of the key limitations of this study is that it’s a snapshot. It only measures where people lived on the day that they filled out the census form, so it will be important to follow populations over time in order to figure out the effects of migration here.

We know that there is a ‘healthy migrant’ effect, where people who are more healthy and wealthy are more likely to have the capacity to move towards the coast or other desirable environments. We can’t account for this in a snapshot study, but with long-term, longitudinal analyses we can begin to take it into account.

What are the potential implications of this research?
Not everyone can live near the sea, but if we find that there is a really beneficial effect here we can begin to understand the mechanisms behind it. Then it may be possible to transfer these mechanisms to other settings – whether inland or in virtual environments – to harvest the benefits of living by the sea.

However, we also need to recognise the potentially negative effects of coastal living with extreme weather events and other impacts of climate change, for example. Also, we wouldn’t want to encourage the unsustainable exploitation of the coast purely so that we can reap health benefits.