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BMC Public Health
Published in: BMC Public Health 1/2016

Open Access 01-12-2016 | Research article

Did the English strategy reduce inequalities in health? A difference-in-difference analysis comparing England with three other European countries

Authors: Yannan Hu, Frank J. van Lenthe, Ken Judge, Eero Lahelma, Giuseppe Costa, Rianne de Gelder, Johan P. Mackenbach

Published in: BMC Public Health | Issue 1/2016

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Abstract

Background

Between 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme.

Methods

Data were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000–2010 were more favourable as compared to the period 1990–2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position.

Results

After the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000–2010 in England were not more favourable than those observed in the period 1990–2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries.

Conclusions

In this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities.
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Literature
1.
Abadie A, Diamond A, Hainmueller J. Synthetic control methods for comparative case studies: estimating the effect of California’s Tobacco Control Program. J Am Stat Assoc. 2010;105(490):493–505.CrossRef
2.
Angrist JD, & Pischke JS. Mostly harmless econometrics. Princeton, New Jersey: Princeton University Press; 2009.
3.
4.
Bacigalupe A, Escolar-Pujolar A. The impact of economic crises on social inequalities in health: what do we know so far? Int J Equity Health. 2014;13:52.CrossRefPubMedPubMedCentral
5.
Bambra C. Reducing health inequalities: new data suggest that the English strategy was partially successful. J Epidemiol Community Health. 2012;66:662.CrossRefPubMed
6.
Bambra C, Smith KE, Garthwaite K, Joyce KE, Hunter DJ. A labour of Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review. J Epidemiol Community Health. 2011;65:399–406.CrossRefPubMed
7.
Bartley M, Plewis I. Does health-selective mobility account for socioeconomic differences in health? Evidence from England and Wales, 1971 to 1991. J Health Soc Behav. 1997;38:376–86.CrossRefPubMed
8.
Bauld L, Judge K, Platt S. Assessing the impact of smoking cessation services on reducing health inequalities in England: observational study. Tob Control. 2007;16:400–4.CrossRefPubMedPubMedCentral
9.
10.
Brown T, Platt S, Amos A. Equity impact of population-level interventions and policies to reduce smoking in adults: a systematic review. Drug Alcohol Depend. 2014;138:7–16.CrossRefPubMed
11.
Carreras G, Gorini G. Time Trends of Italian Former Smokers 1980–2009 and 2010–2030 Projections Using a Bayesian Age Period Cohort Model. Int J Environ Res Public Health. 2014;11:1–12.CrossRef
12.
Cavelaars AE, Kunst AE, Geurts JJ, Crialesi R, Grotvedt L, Helmert U, et al. Differences in self reported morbidity by educational level: a comparison of 11 western European countries. J Epidemiol Community Health. 1998;52:219–27.CrossRefPubMedPubMedCentral
13.
Currie L. Appendix A. Tobacco Control Policy Index. In: Nguyen L, Rosenqvist G, Pekurinen M, editors. Demand for Tobacco in Europe: An Econometric Analysis of 11 Countries for the PPACTE Project. Tampere: Juvenes Print; 2012.
14.
De Vogli R. The financial crisis, health and health inequities in Europe: the need for regulations, redistribution and social protection. Int J Equity Health. 2014;13:58.CrossRefPubMedPubMedCentral
15.
16.
17.
18.
19.
20.
21.
22.
23.
Eikemo TA, Huisman M, Bambra C, Kunst AE. Health inequalities according to educational level in different welfare regimes: a comparison of 23 European countries. Sociol Health Illn. 2008;30:565–82.CrossRefPubMed
24.
25.
Exworthy M, Berney L, Powell M. ‘How great expectations in Westminster may be dashed locally’: the local implementation of national policy on health inequalities. Policy Polit. 2002;30:79–96.CrossRef
26.
Giskes K, Kunst AE, Benach J, Borrell C, Costa G, Dahl E, et al. Trends in smoking behaviour between 1985 and 2000 in nine European countries by education. J Epidemiol Community Health. 2005;59:395–401.CrossRefPubMedPubMedCentral
27.
28.
29.
Hu Y, van Lenthe FJ, Borsboom GJ, Looman CWN, Bopp M, Burström B, Dzúrová D, Ekholm O, Klumbiene J, Lahelma E, Leinsalu M, Regidor E, Santana P, de Gelder R, Mackenbach JP. Trends in socioeconomic inequalities in self-assessed health in 17 European countries between 1990 and 2010. Journal of Epidemiology and Community Health, 2016. doi:10.​1136/​jech-2015-206780.
30.
Hunter DJ, Popay J, Tannahill C, Whitehead M. Getting to grips with health inequalities at last? Br Med J. 2010;340:c684.CrossRef
31.
32.
33.
34.
Judge K, Bauld L. Learning from policy failure? Health action zones in England. Eur J Public Health. 2006;16:341–3.CrossRefPubMed
35.
36.
Katikireddi SV, Niedzwiedz CL, & Popham F. Trends in population mental health before and after the 2008 recession: a repeat cross-sectional analysis of the 1991–2010 Health Surveys of England. BMJ Open. 2012;2:e001790. doi:10.​1136/​bmjopen-2012-001790.
37.
Kunst AE, Bos V, Lahelma E, Bartley M, Lissau I, Regidor E, et al. Trends in socioeconomic inequalities in self-assessed health in 10 European countries. Int J Epidemiol. 2005;34:295–305.CrossRefPubMed
38.
Macintyre S, Chalmers I, Horton R, Smith R. Using evidence to inform health policy: case studs. Br Med J. 2001;322:222–5.CrossRef
39.
Mackenbach JP. Socio-economic inequalities in health in western Europe: from description to explanation to intervention. In: Siegrist J, Marmot M, editors. Social inequalities in health: New evidence and policy implications. New York: Oxford University Press; 2006.
40.
Mackenbach JP. Has the English strategy to reduce health inequalities failed? Soc Sci Med. 2010;71:1249–53. discussion 1254–1248.CrossRefPubMed
41.
Mackenbach JP. Can we reduce health inequalities? An analysis of the English strategy (1997–2010). J Epidemiol Community Health. 2011;65:568–75.CrossRefPubMed
42.
43.
Mackenbach JP. Socioeconomic inequalities in health in high‐income countries: the facts and the options. In: Gulliford M, Detels R, Karim QA, Tan CC, editors. Oxford Textbook of Global Public Health. Oxford: Oxford University Press; 2015.
44.
Mackenbach JP, Bakker MJ. European Network on I & Policies to Reduce Inequalities in H. Tackling socioeconomic inequalities in health: analysis of European experiences. Lancet. 2003;362:1409–14.CrossRefPubMed
45.
Mackenbach JP, Bos V, Andersen O, Cardano M, Costa G, Harding S, et al. Widening socioeconomic inequalities in mortality in six Western European countries. Int J Epidemiol. 2003;32:830–7.CrossRefPubMed
46.
Mackenbach JP, Kulhanova I, Menvielle G, Bopp M, Borrell C, Costa G, et al. Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. J Epidemiol Community Health. 2014. doi:10.​1136/​jech-2014-204319.
47.
Mackenbach JP, Kunst AE, Cavelaars AE, Groenhof F, Geurts JJ. Socioeconomic inequalities in morbidity and mortality in western Europe. The EU Working Group on Socioeconomic Inequalities in Health. Lancet. 1997;349:1655–9.CrossRefPubMed
48.
Mackenbach JP, Stirbu I, Roskam AJ, Schaap MM, Menvielle G, Leinsalu M, et al. Socioeconomic inequalities in health in 22 European countries. N Engl J Med. 2008;358:2468–81.CrossRefPubMed
49.
50.
51.
Manderbacka K. Examining what self-rated health question is understood to mean by respondents. Scand J Soc Med. 1998;26:145–53.PubMed
52.
Melhuish E, Belsky J, Leyland AH, Barnes J, National Evaluation Of Sure Start Research, T. Effects of fully-established Sure Start Local Programmes on 3-year-old children and their families living in England: a quasi-experimental observational study. Lancet. 2008;372:1641–7.CrossRefPubMed
53.
54.
Lechner M. The Estimation of Causal Effects by Difference-in-Difference Methods. Found Trends Econ. 2011;4(3):165–224.CrossRef
55.
56.
Peters F, Nusselder WJ, Reibling N, Wegner-Siegmundt C, Mackenbach JP. Quantifying the contribution of changes in healthcare expenditures and smoking to the reversal of the trend in life expectancy in the Netherlands. BMC Public Health. 2015;15:1024.CrossRefPubMedPubMedCentral
57.
Suhrcke M, Stuckler D. Will the recession be bad for our health? It depends. Soc Sci Med. 2012;74:647–53.CrossRefPubMed
58.
59.
60.
Wooldridge JM. Introductory Econometrics: A Modern Approach: Cengage Learning; 5 edition. Mason, Michigan. 2012.
Metadata
Title
Did the English strategy reduce inequalities in health? A difference-in-difference analysis comparing England with three other European countries
Authors
Yannan Hu
Frank J. van Lenthe
Ken Judge
Eero Lahelma
Giuseppe Costa
Rianne de Gelder
Johan P. Mackenbach
Publication date
01-12-2016
Publisher
BioMed Central
Published in
BMC Public Health / Issue 1/2016
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-016-3505-z

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