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

Naik, Yannish; Baker, Peter; Ismail, Sharif A.; Tillmann, Taavi; Bash, Kristin; Quantz, Darryl; Hillier-Brown, Frances; Jayatunga, Wikum; Kelly, Gill; Black, Michelle; Gopfert, Anya; Roderick, Peter; Barr, Ben; Bambra, Clare

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 = 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: 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.

Citation

Naik, Y., Baker, P., Ismail, S. A., Tillmann, T., Bash, K., Quantz, D., Hillier-Brown, F., Jayatunga, W., Kelly, G., Black, M., Gopfert, A., Roderick, P., Barr, B., & Bambra, C. (2019). Going upstream – an umbrella review of the macroeconomic determinants of health and health inequalities. BMC Public Health, 19(1), Article 1678. https://doi.org/10.1186/s12889-019-7895-6

• Journal Article Type: Article
• Online Publication Date: Dec 17, 2019
• Publication Date: Dec 17, 2019
• Deposit Date: Jan 10, 2020
• Publicly Available Date: Jan 10, 2020
• Journal: BMC Public Health
• Publisher: BioMed Central
• Peer Reviewed: Peer Reviewed
• Volume: 19
• Issue: 1
• Article Number: 1678
• DOI: https://doi.org/10.1186/s12889-019-7895-6
• Public URL: https://durham-repository.worktribe.com/output/1310587
• Related Public URLs: https://doi.org/10.1186/s12889-023-17273-4
• Additional Information: The original publication of this article [1] contained an error in Fig. 3. The value "regulate tobacco advertising" in Fig. 3 should have been “0” (evidence of no net effect) for the impact on health equity, in line with the statement "restricting advertising was likely to have a neutral equity impact" of the results section. The incorrect and correct figure are shown in this correction article.