Alison While
The events in Afghanistan at the end of August have highlighted the importance of place, both geographically and temporally. Individuals belong to communities through their social ties, shared culture and location, which provides context for their everyday lives. Only the most hard-hearted would not be moved by the plight of Afghanistan and its citizens as they enter a new era of government and all that it will mean for the citizens of that country.
The importance of place in England is also emphasised by the latest Chief Medical Officer's (2021) annual report, where it is acknowledged that COVID-19 has reinforced local variations in health and certain geographies. In particular, some coastal communities, including coastal villages, towns and cities, despite being tourist destinations, have some of the worst health outcomes in England, with low life expectancy and high rates of long-term conditions. Coastal communities attract older people for their retirement, which increases health need, as they inevitably age and develop health conditions, and many guest houses have been repurposed as houses of multiple occupation as the tourist industry has changed over the years; they are now filled with people seeking low-cost housing and who are struggling economically. Not only has the tourist industry changed, but other sources of employment have also become scarce, such as fishing and port work, so unemployment is high, and much existing employment is seasonal. Compounding the challenge is the difficulty of attracting health and social care staff to the support services, which may be perceived as having fewer career opportunities and poor transport links. While each coastal community reflects its unique blend of history and culture as well as its geography, old resort towns and old fishing and trading ports may share common challenges that are distinct from the towns and cities located in their hinterlands. The 10 case studies (chapter 1) make interesting reading and suggest ways in which challenges may be tackled successfully, and chapter 6 outlines the benefits of coastal residence in terms of the natural environment and opportunities for nature-based social prescribing (UK Government, 2021).
Macintyre et al (2002) were the first to articulate ‘place effects’ on health, which they suggested were derived from compositional (characteristics of individuals), context (physical and social environment, including infrastructure) and collective (social and cultural features of communities) factors. Macintyre et al (2002) drew on their research in the west of Scotland to suggest what a healthy neighbourhood needs: good physical resources shared by all, such as a common source of good quality water and air; availability of healthy environments for home, work and play; services to support daily lives; socio-cultural features of a neighbourhood with community networks; and a desirable neighbourhood reputation, which reflects how residents feel about their area. In a more recent paper, Macintyre (2007) argued that individual and household deprivation may not always be amplified by place and that, while physical and social environmental changes may help promote healthier behaviours, location does not always disadvantage in terms of access to healthy food, recreation and health facilities, including pharmacies.
Both the CMO annual report (UK Government, 2021) and Macintyre (2007) cautioned against assumptions that communities are homogenous. Macintyre (2007) also asserted that residents' perceptions of the quality, accessibility and relevance of resources in their neighbourhood are more important than the presence or absence of resources per se. Additionally, she cautioned against diverting efforts away from individual determinants of diet and physical activity, with a focus solely on environmental factors to promote health; in other words, community nurses should continue their health-promotion efforts.
While each coastal community reflects its unique blend of history and culture as well as its geography, old resort towns and old fishing and trading ports may share common challenges that are distinct from the towns and cities located in their hinterlands.