The effects of public health policies on health inequalities: a review of reviews

Abstract

BackgroundSocioeconomic inequalities are associated with unequal exposure to social, economic, and environmental risk factors, which in turn contribute to health inequalities. In a review of systematic reviews, we aimed to understand the impact of public health policy interventions on health inequalities. MethodsSystematic review methodology was used to identify systematic reviews (meta-analyses and narrative syntheses) from high-income countries that described the health equity effects of upstream public health interventions (eg, taxation, educational campaigns). Examples of health equity effects are differential effects across socioeconomic groups, or effects of interventions targeted at disadvantaged groups. 20 databases were searched from inception to May 4, 2017: Medline, EMBASE, CINAHL, PsycINFO, Social Science Citation Index, Applied Social Sciences Index and Abstracts, International Bibliography of the Social Sciences, Sociological Abstracts, Social Services Abstracts, PROSPERO, Campbell Library, Cochrane Library, Database of Promoting Health Effectiveness Reviews, Social Care Online, and Health Systems Evidence. We did not exclude papers on the basis of language or publication date. We included reviews of studies with longitudinal experimental and observational designs. Quality was determined with AMSTAR. Findings24 systematic reviews reporting 128 unique relevant primary studies were identified. The reviews summarised evidence of policies (fiscal, regulation, education, preventive treatment, and screening) across eight public health domains (tobacco; food and nutrition; the control of infectious diseases; screening; road traffic injuries; air, land, and water pollution; built environment; and workplace regulations). Most of the reviews were of moderate quality, as assessed by AMSTAR, although the included primary studies mainly followed repeat cross-sectional and interrupted time-series designs and were generally considered to be low in quality. Results were mixed across the public health domains; however, there was evidence from the tobacco, food and nutrition, and control of infectious diseases domains to suggest that fiscal and regulation policies were more beneficial for reducing or preventing health inequalities than educational campaigns. InterpretationThis umbrella review has identified effective public health regulation interventions that could reduce socioeconomic inequalities in health. FundingThis research is part of the Health Inequalities in European Welfare States project funded by the New Opportunities for Research Funding Agency Cooperation in Europe Welfare State Futures programme (grant ref 462-14-110).