In this interview with Dr Mylene Riva, co-author of the recent study ‘Coalfield health effects: Variation in health across former coalfield areas in England‘, we looked at some aspects of the research  in detail, including how some communities have fared better than others despite living in harsh socioeconomic conditions, perhaps demonstrating resilience.

What are the health patterns that you found within coal mining communities?

What we observed among coalfield communities in England is quite interesting from a public health and public policy perspective.  Most research to date has focused on health differences between coalfield communities and other communities in England.  In our study we went further and we also looked at variability in health between different coal mining communities.  We observed that people living in former coalfield communities were about 27% more likely to report having a limiting long-term illness compared to people living in other communities across England.  This ‘coalfield effect’ was evident when we considered the age, sex and socioeconomic status of respondents and the levels of deprivation, social cohesion and the urban-rural location of the communities.

When we focussed on health variation among former coalfield communities only, we observed that the probabilities of reporting limiting long-term illness and less than good health varied across communities, suggesting that some coalfield communities were enjoying better health status than others.  This variation was largely explained, but not completely, by the type of people living in the communities, including their age, sex and socioeconomic status.  In addition, we observed that people living in the most deprived coalfields were more likely to report poorer health outcomes than people living in better off coalfields and that people living in most rural coalfields were more likely to report less than good health.

An important point to note is that we examined association between living in a former coalfield community and health indicators at one point in time.  We’re not talking about causality, we’re not saying that living in the coalfield predicts developing limiting long-term illness over time.  We’re saying that in 2006-08, which are the years for which we analysed data, people living in coalfield communities are more likely to report having a limiting long-term illness compared to people living in other types of communities.

What is the ‘coalfield effect’?

Coal field communities are characterised by heavy de-industrialisation from the 1970s-80s onwards with the closure of the coal pits.  Between 1984 and 1997, 170,000 people lost their jobs in coal mining, representing about 25% of the total male employment in the English coalfield areas as a whole.  Coal pit closures left communities with immediate problems of environmental degradation, economic disadvantage, social deprivation and poor health outcomes, which have been exacerbated in the longer term by physical isolation, poor road access and inadequate infrastructures.  Some of these problems have endured over the years, and more so in some communities.

How are the health effects from living in coalfields distributed?

The health effects are distributed both socially and spatially.  As observed in other communities in England, people in lower socioeconomic positions are more likely to report poorer health status than people in higher socioeconomic positions.  There are also health inequalities by gender.  This shows that some residents of coalfield communities enjoy better health than others.  As a whole, coalfield communities are characterised by higher levels of deprivation compared to other communities across England; some of them are among the most deprived areas of England.  Even so, when considering the socioeconomic conditions of the population, poor health is not characteristic of all coalfield communities.

Some coalfield communities are not really different from the national picture while others are actually doing better.  Nonetheless, many of them are still lagging behind. This variability in health between coalfield communities in England is what is meant by the spatial distribution of the health effects.  In addition, it seems that living in coalfield areas is associated with some health problems, e.g. limiting long-term illness, but not with other health indicators.  In our study, there was variation among different coalfield communities in reporting less than good self-rated health, but not when coalfield communities as a whole were compared to other communities across England.  For common mental health problems, there was no coalfield effect meaning that the mental health of the population was not influenced by residing in a coalfield or not.

Where did the data for this study come from?

Data from this project came from several sources.  First, the identification of coalfield communities came from previous work commissioned by the Improvement and Development Agency from whom we were asked to produce a report on health inequalities in ex-coalfield and industrial communities.  We worked with a sample of 354 Local Authority Districts, of which 55 were classified as former coalfield communities.  Second, we used various sources of data to measure the local conditions of the communities. We used the overall Index of Multiple Deprivation 2007 to measure socioeconomic deprivations levels.

The social context was measured using an index of social fragmentation, which combined four different variables from the census. The urban-rural location was defined using Defra’s classification of Local Authority Districts.  Finally, this information was linked to individual and health data from the Health Survey for England.  Data were pooled for the years 2004 to 2006.  Overall, we were working with a sample of about 26,100 people, among whom about 4,750 live in one of the 55 coalfield communities.

What findings should government and the public pay more attention to?

I think we should focus more on positive findings, on positive health outcomes for example, instead of always focusing on poor health and more negative findings about what is not working well.  Unfortunately, some of the communities are still lagging behind, be they coalfield or more deprived communities located elsewhere, and we can’t hide that fact.   But I think a lot can be learnt from success stories and exchange between communities, for example in relation to regeneration schemes that have worked well and the conditions fostering that success.  Also, there seems to be a change in UK government with a new focus on well-being, what it means, how we measure it, how we foster it at the individual and community levels, etc.  Focussing on individuals’ and communities’ well-being is likely to contribute to ongoing efforts to reducing health inequalities across the country.

What do good health outcomes in coalfield communities have to do with resilience?

Probably a lot actually.  I think that community resilience, well-being and health go hand in hand, so maybe the communities that were able to bounce back more rapidly from the coalpit closure in the 1980s were more resilient, had more local resources to overcome the adverse economic and social conditions. Resilience to me is another way of thinking about health and well being.  I would be tempted to venture into saying that coalfield communities where health outcomes are better, given the harsh economic situations that they’ve been through (and taking into account that the impact of coalpit closure will have been less in some communities than in others), were more resilient or more able to adapt to the changing local conditions. But we don’t know this from our study; it would certainly make for interesting future research.  In 2009, the definition of health was re-visited in an editorial of The Lancet, a leading scientific journal in public health, by referring to the work of French physician Georges Canguilhem in the 1940s where he defined health as ‘the ability to adapt to one’s environment’; this to me is not that different from resilience.