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Informing Investment to Reduce Inequalities: A Modelling Approach

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  • Andrew McAuley
  • Cheryl Denny
  • Martin Taulbut
  • Rory Mitchell
  • Colin Fischbacher
  • Barbara Graham
  • Ian Grant
  • Paul O’Hagan
  • David McAllister
  • Gerry McCartney

Abstract

Background: Reducing health inequalities is an important policy objective but there is limited quantitative information about the impact of specific interventions. Objectives: To provide estimates of the impact of a range of interventions on health and health inequalities. Materials and Methods: Literature reviews were conducted to identify the best evidence linking interventions to mortality and hospital admissions. We examined interventions across the determinants of health: a ‘living wage’; changes to benefits, taxation and employment; active travel; tobacco taxation; smoking cessation, alcohol brief interventions, and weight management services. A model was developed to estimate mortality and years of life lost (YLL) in intervention and comparison populations over a 20-year time period following interventions delivered only in the first year. We estimated changes in inequalities using the relative index of inequality (RII). Results: Introduction of a ‘living wage’ generated the largest beneficial health impact, with modest reductions in health inequalities. Benefits increases had modest positive impacts on health and health inequalities. Income tax increases had negative impacts on population health but reduced inequalities, while council tax increases worsened both health and health inequalities. Active travel increases had minimally positive effects on population health but widened health inequalities. Increases in employment reduced inequalities only when targeted to the most deprived groups. Tobacco taxation had modestly positive impacts on health but little impact on health inequalities. Alcohol brief interventions had modestly positive impacts on health and health inequalities only when strongly socially targeted, while smoking cessation and weight-reduction programmes had minimal impacts on health and health inequalities even when socially targeted. Conclusions: Interventions have markedly different effects on mortality, hospitalisations and inequalities. The most effective (and likely cost-effective) interventions for reducing inequalities were regulatory and tax options. Interventions focused on individual agency were much less likely to impact on inequalities, even when targeted at the most deprived communities.

Suggested Citation

  • Andrew McAuley & Cheryl Denny & Martin Taulbut & Rory Mitchell & Colin Fischbacher & Barbara Graham & Ian Grant & Paul O’Hagan & David McAllister & Gerry McCartney, 2016. "Informing Investment to Reduce Inequalities: A Modelling Approach," PLOS ONE, Public Library of Science, vol. 11(8), pages 1-20, August.
  • Handle: RePEc:plo:pone00:0159256
    DOI: 10.1371/journal.pone.0159256
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    References listed on IDEAS

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    1. Andrew J. Mirelman & Miqdad Asaria & Bryony Dawkins & Susan Griffin & Richard Cookson & Peter Berman, 2020. "Fairer Decisions, Better Health for All: Health Equity and Cost-Effectiveness Analysis," World Scientific Book Chapters, in: Paul Revill & Marc Suhrcke & Rodrigo Moreno-Serra & Mark Sculpher (ed.), Global Health Economics Shaping Health Policy in Low- and Middle-Income Countries, chapter 4, pages 99-132, World Scientific Publishing Co. Pte. Ltd..
    2. Hwa-Kyung Lim & Young-Ho Khang, 2019. "Quantifying the impact of reducing socioeconomic inequalities in modifiable risk factors on mortality and mortality inequalities in South Korea," International Journal of Public Health, Springer;Swiss School of Public Health (SSPH+), vol. 64(4), pages 585-594, May.
    3. Richardson, Elizabeth & Fenton, Lynda & Parkinson, Jane & Pulford, Andrew & Taulbut, Martin & McCartney, Gerry & Robinson, Mark, 2020. "The effect of income-based policies on mortality inequalities in Scotland: a modelling study," EUROMOD Working Papers EM3/20, EUROMOD at the Institute for Social and Economic Research.
    4. Susan Griffin & James Love-Koh & Becky Pennington & Lesley Owen, 2019. "Evaluation of Intervention Impact on Health Inequality for Resource Allocation," Medical Decision Making, , vol. 39(3), pages 171-182, April.
    5. Mark A. Green & Matthew Hobbs & Ding Ding & Michael Widener & John Murray & Lindsey Reece & Alex Singleton, 2021. "The Association between Fast Food Outlets and Overweight in Adolescents Is Confounded by Neighbourhood Deprivation: A Longitudinal Analysis of the Millennium Cohort Study," IJERPH, MDPI, vol. 18(24), pages 1-15, December.

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