Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities
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Author(s)
Type
Journal Article
Abstract
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: 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: The review
found a large (n=63) 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: 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: Protocol for umbrella review prospectively
registered with PROSPERO CRD42017068357
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: 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: The review
found a large (n=63) 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: 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: Protocol for umbrella review prospectively
registered with PROSPERO CRD42017068357
Date Issued
2019-12-17
Date Acceptance
2019-11-04
Citation
BMC Public Health, 2019, 19 (1)
ISSN
1471-2458
Publisher
BioMed Central
Journal / Book Title
BMC Public Health
Volume
19
Issue
1
Copyright Statement
© The Author(s) 2019. Open Access. This article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
Sponsor
Wellcome Trust
National Institute for Health Research
Grant Number
215654/Z/19/Z
ACF-2015-21-024
Subjects
Economic policy
Economy
Health inequalities
Macroeconomy
Population health
Public health
Regulation
Social determinants of health
Public Health
1117 Public Health and Health Services
Publication Status
Published
Article Number
1678 (2019)
Date Publish Online
2019-12-17