Economic relationships and health inequalities: improving public health recommendations

Sayer, Andrew; McCartney, Gerry

doi:10.1016/j.puhe.2021.08.017

Cited by 20 publications

(18 citation statements)

References 15 publications

(8 reference statements)

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“…These services provide an avenue for public investment in place-based social determinants of health. Particularly when implemented as part of greater efforts to reduce economic inequalities [5], place-based approaches are widely recognised as effective for improving population health and health equity [6,7]. There are many potential pathways whereby CEP services enhance the health and well-being of the communities that they provide for by influencing determinants of health such as the built environment, communities and activities [8].…”

Section: Introductionmentioning

confidence: 99%

Inequalities in local government spending on cultural, environmental and planning services: a time-trend analysis in England, Scotland, and Wales

et al. 2023

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Background Local government provides Cultural, Environmental, and Planning (CEP) services, such as parks, libraries, and waste collection, that are vital for promoting health and wellbeing. There have been significant changes to the funding of these services over the past decade, most notably due to the UK government’s austerity programme. These changes have not affected all places equally. To understand potential impacts on health inequalities, we investigated geographical patterning of recent CEP spending trends. Methods We conducted a time trend analysis using routinely available data on local government expenditure. We used generalised estimating equations to determine how expenditure trends varied across 378 local authorities (LAs) in Great Britain between 2009/10 and 2018/19 on the basis of country, deprivation, rurality, and local government structure. We investigated the gross expenditure per capita on CEP services, and the CEP expenditure as a proportion of total local authority budgets. We present the estimated annual percentage change in these spend measures. Results Expenditure per capita for CEP services reduced by 36% between 2009/10 and 2018/19. In England, the reduction in per capita spending was steepest in the most deprived quintile of areas, falling by 7.5% [95% CI: 6.0, 8.9] per year, compared to 4.5% [95% CI: 3.3, 5.6] per year in the least deprived quintile. Budget cuts in Scotland and Wales have been more equitable, with similar trends in the most and least deprived areas. Welsh LAs have reduced the proportion of total LA budget spent on CEP services the most (-4.0% per year, 95% CI: -5.0 to -2.9), followed by Scotland (-3.0% per year, 95% CI: -4.2 to -1.7) then England (-1.4% per year, 95% CI: -2.2 to -0.6). In England, rural and unitary LAs reduced their share of spending allocated to CEP more than urban and two-tier structured LAs, respectively. Conclusion Funding for cultural, environmental and planning services provided by local government in the UK has been cut dramatically over the last decade, with clear geographical inequalities. Local areas worst affected have been those with a higher baseline level of deprivation, those with a single-tier local government structure, and English rural local authorities. The inequalities in cuts to these services risk widening geographical inequalities in health and wellbeing.

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Section: Introductionmentioning

confidence: 99%

Inequalities in local government spending on cultural, environmental and planning services: a time-trend analysis in England, Scotland, and Wales

et al. 2023

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“…Governments should act to protect population health and reduce health inequalities by addressing the economic causes of these trends as well as the wider range of social determinants of health, the recommendations for which have been published in detail elsewhere. 9 40 42 43 44…”

Section: Discussionmentioning

confidence: 99%

Trends in psychological distress in Great Britain, 1991-2019: evidence from three representative surveys

Zhang

Gagné

Walsh

et al. 2022

Preprint

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Background. Previously improving UK mortality trends stalled around 2012 due to economic policy changes. This paper examines whether trends in psychological distress across three population surveys show similar trends. Methods. We report the percentages reporting psychological distress (4+ in the 12-item General Health Questionnaire (GHQ-12)) from Understanding Society (Great Britain, 1991-2019), Scottish Health Survey (SHeS, 1995-2019) and Health Survey for England (HSE, 2003-2018) for the population overall, and stratified by sex, age and area deprivation. Summary inequality indices were calculated and segmented regressions fitted to identify turning points after 2010. Results. Psychological distress was higher in Understanding Society than in the SHeS or HSE. There was a slight improvement between 1992 and 2015 in Understanding Society (with prevalence declining from 20.6% to 18.6%) with some fluctuations. After 2015 there is some evidence of an overall deterioration in psychological distress across surveys. Prevalence worsened notably among those aged 16-34 years after 2010 (all three surveys), and aged 35-64 years in Understanding Society and SHeS after 2015. In contrast, the prevalence declined in those aged 65+ years in Understanding Society after around 2008, with less clear trends in the other surveys. The prevalence was around twice as high in the most deprived compared to the least deprived areas, and higher in women, with trends by deprivation and sex similar to the populations overall. Conclusion. Psychological distress worsened amongst working-age adults after around 2015 across British population surveys, mirroring the mortality trends. This indicates a widespread health crisis that pre-dates the COVID-19 pandemic.

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“…Economic inequality describes the degree to which economic opportunities and resources (including income and wealth) are equally or equitably held and experienced across or between social groups or between populations. Within societies, economic inequality is influenced by the nature of the relationships between socioeconomic groups,41 which in turned are structured by social class, race, ethnicity, sex, power and intersectional relationships18–20 42–44 (the study of which is sometimes referred to as stratification economics) 45. Most countries have experienced increases in income and wealth inequalities over the past four decades, with variations in the timing and extent.…”

Section: Economic Inequality and Its Responsesmentioning

confidence: 99%

Glossary: economics and health

McCartney

McMaster

Shipton

et al. 2022

J Epidemiol Community Health

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As we emerge from the COVID-19 pandemic, there is an increasing focus on how the economy is rebuilt and the impact this will have on population health. Many of the economic policy proposals being discussed have their own vocabulary, which is not always understood in the same way within or between disciplines. This glossary seeks to provide a common language and concise summary of the key economic terminology relevant for policymakers and public health at this time.

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Economic relationships and health inequalities: improving public health recommendations

Cited by 20 publications

References 15 publications

Inequalities in local government spending on cultural, environmental and planning services: a time-trend analysis in England, Scotland, and Wales

Inequalities in local government spending on cultural, environmental and planning services: a time-trend analysis in England, Scotland, and Wales

Trends in psychological distress in Great Britain, 1991-2019: evidence from three representative surveys

Glossary: economics and health

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