Understanding what works to reduce health inequalities

9 December 2014

A new study by researchers at the Scottish Public Health Observatory (ScotPHO) has, for the first time, shown the extent to which regulatory and tax interventions which redistribute income are more effective at reducing health inequalities than interventions focussed on individual health behaviours.

The study 'Informing investment to reduce health inequalities in Scotland' developed an interactive tool to model the impact of 11 interventions over a period of 20 years on health and health inequalities ranging from changes to income and employment to investment in smoking cessation, alcohol brief interventions and weight management services.

Results showed that interventions have markedly different effects on health and health inequalities. The most effective interventions were regulatory and tax options which redistribute income. Interventions focussed on individuals changing their own behaviours, were much less likely to impact on inequalities, even when targeted at those in the most deprived communities.

Dr. Gerry McCartney, Head of the Public Health Observatory (PHO) at NHS Health Scotland, said:

"Reducing health inequalities has been identified as a priority issue for the Scottish Government. Our results show that many interventions may improve population health, although they won't necessarily help to reduce health inequalities.

"Whilst regulatory and tax options may not seem to be directly health related, they will save lives, and ultimately save the NHS precious money and resources. Interventions that redistribute income, such as increasing the standard rate of income tax or implementation of a living wage are among the most effective interventions for reducing inequalities and improving health. These results are consistent with previous evidence that interventions that tackle inequalities in the socio-economic environment and regulatory interventions are more likely to reduce health inequalities. In contrast, interventions focused on the individual were less effective, but could be useful in mitigating against increases in health inequalities in some areas.

"Uniquely we are now able to quantify and compare the impact on health and inequalities across a range of interventions. Future research in this area will consider an even broader range of interventions and outcomes."

Jamie Hepburn, Minister for Sport, Health Improvement and Mental Health, said:

“This Government is clear that health inequalities cannot be solved with health solutions alone. They are rooted in poverty and income inequality. In the face of the UK Government's welfare cuts, we are using all the powers at our disposal, and working with all of our partners to tackle poverty and inequality and help people into work.

"We're absolutely committed to increasing the number of people receiving the Living Wage. This report concludes that the living wage can play a significant part in reducing health inequalities. As part of the Programme for Government, we will provide funding to more than double the number of organisations that are signed up to the Living Wage Accreditation Scheme.

"These measures and others, coupled with decisive and targeted action on alcohol, smoking, active living and mental health, all play their part in tackling health inequalities and delivering a more just society."

ENDS

Notes to editors

  1. The full report and modelling tools ‘Informing investment to reduce health inequalities in Scotland’ are available to download from the ScotPHO website.
  2. This report should be cited as: Scottish Public Health Observatory. Informing investment to reduce inequalities: a commentary. Edinburgh; ScotPHO, 2014.
  3. The report concluded:
    • the introduction of a 'living wage' generated the largest beneficial impact on health, and led to a modest reduction in health inequalities;
    • increases to benefits had modest beneficial impacts on health and health inequalities;
    • income tax increases had a negative impact on population health but reduced inequalities, while council tax increases worsened both health and health inequalities (as the model looked only at the taxation increases and not the potential for redistribution or changes to expenditure that this might facilitate).
    • increases in active travel (defined as a modal shift from driving to walking/cycling for those commuting to work) had minimally positive effects on population health via increased physical activity 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 socially targeted, while smoking cessation and counterweight weight reduction programmes had only minimal impacts on health and health inequalities even when socially targeted.
  4. Health inequalities are the unfair and systematic differences in health outcomes between social groups. They are largely a consequence of the inequalities in the determinants of health – in particular of those in income, resources and power across the population and between groups.  
  5. Evidence suggests that inequalities declined across Great Britain from the 1920s until the 1970s, the period in which the welfare state was established and societal inequalities were reduced. However, since the late 1970s, inequalities in health have increased as a consequence of the rises in income inequality and the reductions in social solidarity. Inequalities in mortality are larger in Scotland than the rest of western and central Europe on many measures (and are continuing to rise in relative terms).
  6. Tackling health inequalities is important for the health and economy of the whole population. Health-improving structural changes to the environment, legislations, fiscal policies, income support, accessibility of public services and intensive support for disadvantage population groups are all likely to be effective in reducing health inequalities. Initiatives might include: narrowing the extreme income inequality that the population experiences; payment of at least a living wage to those in work, and ensuring welfare benefits provide sufficient income for healthy living; extending the Scottish Housing Quality Standard from social housing to private rented accommodation to ensure such housing meets tolerable standards for ventilation, facilities, insulation, energy efficiency and safety. In contrast, information-based campaigns, written materials, information campaigns reliant on people opting-in and messages designed for the whole population, whilst still important for the individual are least likely to reduce health inequalities.
  7. The Scottish Public Health Observatory (ScotPHO) collaboration is co-led by NHS Health Scotland and ISD Scotland, and includes the Glasgow Centre for Population Health, National Records of Scotland and Health Protection Scotland.
  8. ScotPHO provides a clear picture of the health of the Scottish population and the factors that affect it. They contribute to improved collection and use of routine data on health, risk factors, behaviours and wider health determinants.
  9. NHS Health Scotland is a national Health Board working with and through the public, third and private sector to reduce health inequalities and improve health. At NHS Health Scotland we:
    1. link experts from across Scotland to tackle the biggest issues in achieving the right to good health,
    2. compile world class evidence and research to further Scotland’s understanding of health inequalities,
    3. influence policy makers at all levels to design targeted interventions to help build a fairer healthier Scotland.

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Contact

Kerry Teakle
Senior Corporate Communications Manager
0131 314 5324, 07769 931458, kerry.teakle@nhs.net

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