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Systematic Reviews
Published in: Systematic Reviews 1/2024

Open Access 01-12-2024 | Research

Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews

Authors: Anna K. Macintyre, Deborah Shipton, Shifa Sarica, Graeme Scobie, Neil Craig, Gerry McCartney

Published in: Systematic Reviews | Issue 1/2024

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Abstract

Background

A fairer economy is increasingly recognised as crucial for tackling widening social, economic and health inequalities within society. However, which actions have been evaluated for their impact on inclusive economy outcomes is yet unknown.

Objective

Identify the effects of political, economic and social exposures, interventions and policies on inclusive economy (IE) outcomes in high-income countries, by systematically reviewing the review-level evidence.

Methods

We conducted a review of reviews; searching databases (May 2020) EconLit, Web of Science, Sociological Abstracts, ASSIA, International Bibliography of the Social Sciences, Public Health Database, Embase and MEDLINE; and registries PROSPERO, Campbell Collaboration and EPPI Centre (February 2021) and grey literature (August/September 2020). We aimed to identify reviews which examined social, political and/or economic exposures, interventions and policies in relation to two IE outcome domains: (i) equitable distribution of the benefits of the economy and (ii) equitable access to the resources needed to participate in the economy. Reviews had to include primary studies which compared IE outcomes within or between groups. Quality was assessed using a modified version of AMSTAR-2 and data synthesised informed by SWiM principles.

Results

We identified 19 reviews for inclusion, most of which were low quality, as was the underlying primary evidence. Most reviews (n = 14) had outcomes relating to the benefits of the economy (rather than access to resources) and examined a limited set of interventions, primarily active labour market programmes and social security. There was limited high-quality review evidence to draw upon to identify effects on IE outcomes. Most reviews focused on disadvantaged groups and did not consider equity impacts.

Conclusions

Review-level evidence is sparse and focuses on ‘corrective’ approaches. Future reviews should examine a diverse set of ‘upstream’ actions intended to be inclusive ‘by design’ and consider a wider range of outcomes, with particular attention to socioeconomic inequalities.
Appendix
Available only for authorised users
Footnotes
1
‘Insufficient evidence’ was added to the original categories in the ED template as some review authors had made this explicit.
 
2
The study design column was removed as all included studies are reviews; ED arrows were not adjusted by sample size, and the study quality key was amended to reflect the AMSTAR-2 categories (high, moderate, low, critically low)
 
3
Included reviews have an asterisk in the reference list.
 
4
These totals include some primary studies which were conducted in settings other than high-income countries because of five reviews, whilst the majority of primary studies were conducted in high-income countries, it was not possible to specify how many due to incomplete reporting.
 
5
The difference between 801 and 525 is largely due to Mocca et al. [72] which reported including 191 primary studies, but it was unclear how many PS focused on an IE outcome as the authors did not provide a list of included studies.
 
6
Kluve et al. [60] examined both employment outcomes and earnings outcomes and so appears twice in Table 3.
 
7
In this section, the outcome of interest is access to ALMP, and the relevant review [76] looks at which types of ALMP programmes are associated with greater access for marginal groups. In contrast, in the ‘Equitable distribution of the benefits of the economy’ section, the outcomes of interest are employment and earning, and the relevant reviews look at ALMP are a means of achieving this.
 
8
Kluve et al. [60] considered quality of employment (e.g. contract type, job type) as one of their outcomes of interest; however, there was limited specific consideration of this outcome in the results synthesis; it appears only skills training had clear effects on measures of job equality, and this was more common for low-income country contexts.
 
9
One notable review on housing improvements was identified but excluded as health was the primary outcome [95].
 
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Metadata
Title
Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews
Authors
Anna K. Macintyre
Deborah Shipton
Shifa Sarica
Graeme Scobie
Neil Craig
Gerry McCartney
Publication date
01-12-2024
Publisher
BioMed Central
Published in
Systematic Reviews / Issue 1/2024
Electronic ISSN: 2046-4053
DOI
https://doi.org/10.1186/s13643-023-02429-5

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