Home > Informing investment to reduce inequalities.

McAuley, Andrew and Denny, Cheryl and Taulbut, Martin and Mitchell, Rory and Fischbacher, Colin and Graham, Barbara and Grant, Ian and O'Hagan, Paul and McAlister, David and McCartney, Gerry [PLOS One] . (2016) Informing investment to reduce inequalities. Public Library of Science. PLoS ONE, 11 (8) e01592. 10.1371/journal.pone.0159256

URL: http://journals.plos.org/plosone/article?id=10.137...

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.


Item Type:Evidence resource
Publication Type:Review
Drug Type:Alcohol, Tobacco
Intervention Type:AOD disorder harm reduction
Source:PLOS One
Date:3 August 2016
Pages:e01592
Publisher:Public Library of Science
Volume:11
Number:8
EndNote:View
Subjects:B Substances > Alcohol
B Substances > Tobacco (cigarette smoking) > Tobacco smoke (cigarette law / policy)
J Health care, prevention and rehabilitation > Health care delivery
J Health care, prevention and rehabilitation > Health care economics
L Social psychology and related concepts > Inclusion and exclusion
MA-ML Social science, culture and community > Social position > Social equality and inequality
MP-MR Policy, planning, economics, work and social services > Economic policy
MP-MR Policy, planning, economics, work and social services > Economic aspects of substance use (cost / pricing)
VA Geographic area > Europe > United Kingdom

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