Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities.

Economics Health Status Disparities Humans Social Determinants of Health / economics Systematic Reviews as Topic
Economic policy Economy Health inequalities Macroeconomy Population health Public health Regulation Social determinants of health

Journal

BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562

Informations de publication

Date de publication:
17 Dec 2019
Historique:
received: 19 08 2019
accepted: 04 11 2019
entrez: 18 12 2019
pubmed: 18 12 2019
medline: 5 3 2020
Statut: epublish

Résumé

The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions. Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented. The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations. The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review. Protocol for umbrella review prospectively registered with PROSPERO CRD42017068357.

Sections du résumé

BACKGROUND BACKGROUND
The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions.
METHODS METHODS
Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented.
RESULTS RESULTS
The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations.
CONCLUSIONS CONCLUSIONS
The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review.
TRIAL REGISTRATION BACKGROUND
Protocol for umbrella review prospectively registered with PROSPERO CRD42017068357.

Identifiants

DOI: 10.1186/s12889-019-7895-6 PMID: 31842835 PMC: PMC6915896
pubmed: 31842835
doi: 10.1186/s12889-019-7895-6
pii: 10.1186/s12889-019-7895-6
pmc: PMC6915896
doi:

Types de publication

Journal Article Review

Langues

eng

Sous-ensembles de citation

IM

Pagination

1678

Subventions

Organisme : Norwegian Research Council
ID : 288638
Organisme : National Institute for Health Research
ID : NIHR CLAHRC NWC
Organisme : National Institute for Health Research
ID : ACF-2015-21-024
Organisme : Wellcome Trust
ID : 215654/Z/19/Z
Pays : United Kingdom
Organisme : Wellcome Trust
ID : 106554/Z/14/Z
Pays : United Kingdom
Organisme : Medical Research Council
ID : MR/K02325X/1
Pays : United Kingdom
Organisme : Fuse - funded by British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council and the National Institute for Health Research, under the auspices of the UK Clinical Research Collaboration
ID : [MR/K02325X/1]

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Auteurs

Yannish Naik (Y)

Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF, UK. yannishnaik@nhs.net.
University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK. yannishnaik@nhs.net.
ORCID: 0000-0001-7719-9984

Peter Baker (P)

Global Health and Development Group, School of Public Health, Imperial College London, St Mary's Campus, Norfolk Place, London, W2 1PG, UK.

Sharif A Ismail (SA)

Department of Global Health and Development, London School of Hygiene and Tropical Medicine, 15-17 Tavistock Place, London, WC1H 9SH, UK.
Department of Primary Care and Public Health, Imperial College London, Reynolds Building, St Dunstans Road, London, W6 8RP, UK.

Taavi Tillmann (T)

Centre for Global Non-Communicable Diseases, Institute for Global Health, University College London, 30 Guilford Street, London, WC1N 1EH, UK.

Kristin Bash (K)

School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.

Darryl Quantz (D)

NW School of Public Health, Health Education England North West, First Floor Regatta Place, Brunswick Business Park, Summers Road, Liverpool, L3 4BL, UK.

Frances Hillier-Brown (F)

Department of Sport and Exercise Sciences, Durham University, 42 Old Elvet, Durham, DH1 3HN, UK.

Wikum Jayatunga (W)

Institute of Health Informatics, University College London, 222 Euston Road, London, NW1 2DA, UK.

Gill Kelly (G)

Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF, UK.

Michelle Black (M)

School of Health and Related Research (ScHARR), The University of Sheffield, Regent Court, 30 Regent Street, Sheffield, S1 4DA, UK.

Anya Gopfert (A)

Junior Doctor and National Medical Director's Fellow, London, UK.

Peter Roderick (P)

Leeds Teaching Hospitals NHS Trust, Beckett St, Leeds, LS9 7TF, UK.

Ben Barr (B)

University of Liverpool Department of Public Health and Policy, 3rd Floor, Whelan Building, Brownlow Hill, Liverpool, L69 3GB, UK.

Clare Bambra (C)

Faculty of Medical Sciences, Newcastle University, Sir James Spence Building, Royal Victoria Infirmary, Newcastle upon Tyne, NE1 4LP, UK.

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Classifications MeSH

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