Dataset Information

Informing Investment to Reduce Inequalities: A Modelling Approach.

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.

SUBMITTER: McAuley A

PROVIDER: S-EPMC4972318 | biostudies-literature | 2016

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Informing Investment to Reduce Inequalities: A Modelling Approach.

McAuley Andrew A Denny Cheryl C Taulbut Martin M Mitchell Rory R Fischbacher Colin C Graham Barbara B Grant Ian I O'Hagan Paul P McAllister David D McCartney Gerry G

PloS one 20160803 8

<h4>Background</h4>Reducing health inequalities is an important policy objective but there is limited quantitative information about the impact of specific interventions.<h4>Objectives</h4>To provide estimates of the impact of a range of interventions on health and health inequalities.<h4>Materials and methods</h4>Literature reviews were conducted to identify the best evidence linking interventions to mortality and hospital admissions. We examined interventions across the determinants of health: ...[more]

PMID: 27486857

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Project description:ObjectivesTo determine health and equity benefits and cost effectiveness of policies to reduce or eliminate trans fatty acids from processed foods, compared with consumption remaining at most recent levels in England.DesignEpidemiological modelling study.SettingData from National Diet and Nutrition Survey, Low Income Diet and Nutrition Survey, Office of National Statistics, and health economic data from other published studiesParticipantsAdults aged ≥25, stratified by fifths of socioeconomic circumstance.InterventionsTotal ban on trans fatty acids in processed foods; improved labelling of trans fatty acids; bans on trans fatty acids in restaurants and takeaways.Main outcome measuresDeaths from coronary heart disease prevented or postponed; life years gained; quality adjusted life years gained. Policy costs to government and industry; policy savings from reductions in direct healthcare, informal care, and productivity loss.ResultsA total ban on trans fatty acids in processed foods might prevent or postpone about 7200 deaths (2.6%) from coronary heart disease from 2015-20 and reduce inequality in mortality from coronary heart disease by about 3000 deaths (15%). Policies to improve labelling or simply remove trans fatty acids from restaurants/fast food could save between 1800 (0.7%) and 3500 (1.3%) deaths from coronary heart disease and reduce inequalities by 600 (3%) to 1500 (7%) deaths, thus making them at best half as effective. A total ban would have the greatest net cost savings of about £265m (€361m, $415m) excluding reformulation costs, or £64m if substantial reformulation costs are incurred outside the normal cycle.ConclusionsA regulatory policy to eliminate trans fatty acids from processed foods in England would be the most effective and equitable policy option. Intermediate policies would also be beneficial. Simply continuing to rely on industry to voluntary reformulate products, however, could have negative health and economic outcomes.

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Dataset Information

Informing Investment to Reduce Inequalities: A Modelling Approach.

Background

Objectives

Materials and methods

Results

Conclusions

Publications

Informing Investment to Reduce Inequalities: A Modelling Approach.

Similar Datasets

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