Abstract
BackgroundThe welfare state is potentially an important macro-level determinant of health that also moderates the extent, and impact, of socio-economic inequalities in exposure to the social determinants of health. The welfare state has three main policy domains: health care, social policy (e.g. social transfers and education) and public health policy. This is the protocol for an umbrella review to examine the latter; its aim is to assess how European welfare states influence the social determinants of health inequalities institutionally through public health policies.Methods/designA systematic review methodology will be used to identify systematic reviews from high-income countries (including additional EU-28 members) that describe the health and health equity effects of upstream public health interventions. Interventions will focus on primary and secondary prevention policies including fiscal measures, regulation, education, preventative treatment and screening across ten public health domains (tobacco; alcohol; food and nutrition; reproductive health services; the control of infectious diseases; screening; mental health; road traffic injuries; air, land and water pollution; and workplace regulations). Twenty databases will be searched using a pre-determined search strategy to evaluate population-level public health interventions.DiscussionUnderstanding the impact of specific public health policy interventions will help to establish causality in terms of the effects of welfare states on population health and health inequalities. The review will document contextual information on how population-level public health interventions are organised, implemented and delivered. This information can be used to identify effective interventions that could be implemented to reduce health inequalities between and within European countries.Systematic review registrationPROSPERO CRD42016025283Electronic supplementary materialThe online version of this article (doi:10.1186/s13643-016-0235-3) contains supplementary material, which is available to authorized users.
Highlights
The welfare state is potentially an important macro-level determinant of health that moderates the extent, and impact, of socio-economic inequalities in exposure to the social determinants of health
Welfare states may impact the health of citizens either indirectly through influencing the social determinants of health or directly through health care systems or policies aimed at promoting public health [6, 7]
These groups are based on the ten areas of public health policy that Mackenbach and McKee [7, 14] identify as contributing to major population health gains: tobacco; alcohol; food and nutrition; reproductive health services; the control of infectious diseases; screening; mental health; road traffic injuries; air, land and water pollution; and workplace regulations
Summary
This umbrella review will provide evidence of macro, population-level public health interventions which affect health and reduce health inequalities amongst European welfare states. Understanding the impact of specific public health policy interventions will help to establish causality in terms of the effects of welfare states on population health and health inequalities and, most importantly, identify effective interventions that could be implemented to reduce health inequalities across European countries. The review will seek to establish (where reported) how such public health interventions are organised, implemented and delivered. Context is increasingly recognised as an important factor in the success of public health interventions [33] and has begun to be taken into account in systematic reviews. We will develop and refine existing methodological tools and apply them to
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