Can we adapt fairly? Scoping review of health equity implications of flood risk in coastal communities.

Background: As climate change progresses, it is critical to assess the equity of health impacts, adaptation interventions and policies. Climate change can contribute to coastal hazards like flooding resulting in loss of life, property and land, leading to potential long-term physical or mental health impacts. Additionally, some UK coastal populations often face social deprivation and limited healthcare access, which can be worsened by environmental changes. Methods: We conducted a scoping review of UK evidence on (a) inequalities in coastal flood risk and (b) the equity of measures to manage climate-related flood risks. Interventions included plans, flood insurance and infrastructure, including natural flood management. Following the screening of 19 329 references, we included 11 papers in the final review. Results: Four studies examined the differentials in current and future coastal flood impacts, and seven assessed the equity of adaptation measures. Coastal flood risk is unevenly distributed across the UK. Policies and practices like household insurance and property resilience measures may increase inequalities, while community engagement, planning and structural solutions can reduce disparities, depending on local context and implementation. Conclusions: Adaptation to UK coastal flood risk requires both short-term and long-term strategies. Approaches relying on individual behaviour or household income may worsen health inequalities. Further evaluations and better evidence are needed to improve flood planning and incident management. Climate change presents a challenge for organisations to deliver national and local policy responses ensuring that adaptation is effective and equitable in the immediate and longer term.