Impact of income-based policies on population health and health inequalities in Scotland: a modelling study

Abstract

BackgroundImproving health and reducing health inequalities are important joint policy objectives. Income is a key social determinant of health, but robust evidence about the relative impacts of redistributive policies is rare. In a modelling study, we aimed to assess the effects on population health and health inequalities of income-based policies in Scotland. MethodsEUROMOD, a detailed tax–benefit microsimulation model, was used to estimate income change for a representative sample of Scottish households from the Family Resources Survey 2014–15 (n=2871). Income change was estimated for each quintile of the 2016 Scottish Index of Multiple Deprivation. Triple I, a health inequalities scenario modelling tool, was used to estimate projected impacts of income-based policies, including two Citizen Basic Income (CBI) schemes (basic scheme and one with additional payments for disabled) on premature mortality (<75 years) and inequalities after 5 years, compared with baseline. Implications for government revenue were also estimated. FindingsThe best policies for achieving both policy objectives were increases to means-tested benefits (−4·1% premature mortality, −21·7% Relative Index of Inequality [RII]), increases to benefits devolved to the Scottish Government (−1·6%, −6·1%), and the introduction of a mandatory living wage (−2·2%, −5·2%). The increase in household incomes in the most deprived areas under these three policies was ten, five, and three times higher than in the least deprived areas, respectively. The CBI schemes had a substantial narrowing effect on inequalities (−11·5% RII basic scheme, −17·9% CBI with additional payments), and a modest effect on premature mortality (−0·3%, −0·8%). Increases to benefits were most cost-effective at improving health, whereas the CBI policies were most cost-effective at reducing inequalities. InterpretationPolicies that affect incomes have the potential for substantial effects on health and health inequalities in Scotland. We estimated that the most effective policies for reducing health inequalities were those that disproportionately increased incomes in the most deprived areas. The modelling is subject to various assumptions and sources of uncertainty, but nonetheless highlights the importance of applying an inequalities lens to income-based policy options. FundingNone.