Mental health impact of cuts to local government spending on cultural, environmental and planning services in England: a longitudinal ecological study.
Austerity
Culture
Environmental health
Health inequality
Local government
Mental health
Planning
Journal
BMC public health
ISSN: 1471-2458
Titre abrégé: BMC Public Health
Pays: England
ID NLM: 100968562
Informations de publication
Date de publication:
28 07 2023
28 07 2023
Historique:
received:
01
06
2023
accepted:
18
07
2023
medline:
31
7
2023
pubmed:
28
7
2023
entrez:
27
7
2023
Statut:
epublish
Résumé
Over the past decade, there have been significant and unequal cuts to local authority (LA) budgets, across England. Cultural, environmental and planning (CEP) budgets have been cut by 17% between 2011 and 2019. This funding supports services such as parks, leisure centres, community development and libraries, all of which have potential to influence population mental health. We therefore investigated whether cuts to CEP services have affected mental health outcomes and the extent to which they have contributed to mental health inequalities between areas. Using fixed effects regression applied to longitudinal LA-level panel data in England, we assessed whether trends in CEP spend were associated with trends in mental health outcomes, between 2011 and 2019. The exposure was CEP spend and the primary outcome was the LA-average Small Area Mental Health Index (SAMHI). Additionally, we considered subcategories of CEP spend as secondary exposures, and antidepressant prescription rate and self-reported anxiety levels as secondary outcomes, both aggregated to LA-level. We adjusted all models for confounders and conducted subgroup analysis to examine differential mental health effects of spending cuts based on the level of area deprivation. The average decrease in CEP spend of 15% over the period was associated with a 0.036 (95% CI: 0.005, 0.067) increase in SAMHI score, indicating worsening mental health. Amongst subcategories of CEP spending, cuts to planning and development services impacted mental health trends the most, with a 15% reduction in spend associated with a 0.018 (95% CI: 0.005, 0.031) increase in the SAMHI score. The association between cuts in CEP and deteriorating mental health was greater in more affluent areas. Cuts to spending on cultural, environmental, planning and development services were associated with worsening population mental health in England. Impacts were driven by cuts to planning and development services in particular. Reinvesting in these services may contribute to improved public mental health.
Sections du résumé
BACKGROUND
Over the past decade, there have been significant and unequal cuts to local authority (LA) budgets, across England. Cultural, environmental and planning (CEP) budgets have been cut by 17% between 2011 and 2019. This funding supports services such as parks, leisure centres, community development and libraries, all of which have potential to influence population mental health. We therefore investigated whether cuts to CEP services have affected mental health outcomes and the extent to which they have contributed to mental health inequalities between areas.
METHODS
Using fixed effects regression applied to longitudinal LA-level panel data in England, we assessed whether trends in CEP spend were associated with trends in mental health outcomes, between 2011 and 2019. The exposure was CEP spend and the primary outcome was the LA-average Small Area Mental Health Index (SAMHI). Additionally, we considered subcategories of CEP spend as secondary exposures, and antidepressant prescription rate and self-reported anxiety levels as secondary outcomes, both aggregated to LA-level. We adjusted all models for confounders and conducted subgroup analysis to examine differential mental health effects of spending cuts based on the level of area deprivation.
RESULTS
The average decrease in CEP spend of 15% over the period was associated with a 0.036 (95% CI: 0.005, 0.067) increase in SAMHI score, indicating worsening mental health. Amongst subcategories of CEP spending, cuts to planning and development services impacted mental health trends the most, with a 15% reduction in spend associated with a 0.018 (95% CI: 0.005, 0.031) increase in the SAMHI score. The association between cuts in CEP and deteriorating mental health was greater in more affluent areas.
CONCLUSION
Cuts to spending on cultural, environmental, planning and development services were associated with worsening population mental health in England. Impacts were driven by cuts to planning and development services in particular. Reinvesting in these services may contribute to improved public mental health.
Identifiants
pubmed: 37501117
doi: 10.1186/s12889-023-16340-0
pii: 10.1186/s12889-023-16340-0
pmc: PMC10375661
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1441Subventions
Organisme : Medical Research Council
ID : MR/P008577/1
Pays : United Kingdom
Organisme : Department of Health
Pays : United Kingdom
Informations de copyright
© 2023. The Author(s).
Références
J Affect Disord. 2020 Mar 15;265:475-485
pubmed: 32090775
Maturitas. 2019 Nov;129:76-84
pubmed: 31547918
Am J Public Health. 2003 Sep;93(9):1546-51
pubmed: 12948978
Health Place. 2023 Mar;80:102999
pubmed: 36924674
Soc Psychiatry Psychiatr Epidemiol. 2018 Feb;53(2):107-119
pubmed: 29234826
Pharmacoepidemiol Drug Saf. 2000 Jan;9(1):55-8
pubmed: 19025803
Lancet Public Health. 2021 Sep;6(9):e641-e647
pubmed: 34265265
Lancet Public Health. 2020 Mar;5(3):e157-e164
pubmed: 32113519
Environ Sci Technol. 2011 Mar 1;45(5):1761-72
pubmed: 21291246
Public Health. 2023 Apr;217:22-25
pubmed: 36841035
Int J Environ Res Public Health. 2018 Nov 27;15(12):
pubmed: 30486416
Soc Sci Med. 2008 Sep;67(6):900-14
pubmed: 18599170
J R Soc Promot Health. 2006 Nov;126(6):252-3
pubmed: 17152313
Environ Int. 2019 Sep;130:104923
pubmed: 31228780
Annu Rev Public Health. 2014;35:207-28
pubmed: 24387090
Sports Med. 2000 Mar;29(3):167-80
pubmed: 10739267
Eur J Public Health. 2011 Dec;21(6):738-43
pubmed: 20929903
Environ Res. 2018 Oct;166:628-637
pubmed: 29982151
Am J Epidemiol. 1988 May;127(5):893-904
pubmed: 3282433
J Nurs Scholarsh. 2018 Mar;50(2):117-125
pubmed: 29314746
J Psychiatr Ment Health Nurs. 2000 Jan;7(1):15-24
pubmed: 11022507
Psychol Med. 2016 Apr;46(6):1321-9
pubmed: 26879871
BMJ Open. 2022 Dec 23;12(12):e065747
pubmed: 36564110
J Epidemiol Community Health. 2016 Apr;70(4):339-45
pubmed: 26573235
BMC Public Health. 2016 Feb 03;16:115
pubmed: 26847554
BMC Public Health. 2023 Feb 28;23(1):408
pubmed: 36855080
BMC Psychiatry. 2016 Jun 07;16:189
pubmed: 27267897
Prim Care Companion J Clin Psychiatry. 2006;8(2):106
pubmed: 16862239
J Sport Health Sci. 2019 Sep;8(5):412-421
pubmed: 31534816
J Community Health. 2019 Feb;44(1):192-199
pubmed: 29995303
J Epidemiol Community Health. 2018 Mar;72(3):252-258
pubmed: 29330166
Lancet Public Health. 2023 Jun;8(6):e403-e410
pubmed: 37094594
BMC Public Health. 2010 Aug 04;10:456
pubmed: 20684754
BJGP Open. 2021 Aug 24;5(4):
pubmed: 33985965
J Urban Health. 2001 Sep;78(3):458-67
pubmed: 11564849