The Impact of Income-Based Policies on Population Health and Health Inequalities in Scotland: A Modelling Study

Abstract

Background: The unequal distribution of income is a fundamental cause of health inequalities. Decision making around redistributive policies could be enhanced by demonstrating their potential health effects. We used scenario modelling to assess the impacts of 12 income-based policies on premature deaths and inequalities in premature deaths in Scotland. Methods: EUROMOD, a tax-benefit microsimulation model, was used to estimate policy effects on income for a representative sample of Scottish households (n=2871; 2014/15 Family Resources Survey). 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 policy impacts on premature mortality (<75 years) and government spending after 5 years. Findings: The best policy for improving health and narrowing health inequalities was a 50% increase to means-tested benefits rates (4·7% fewer premature deaths, 8·0% reduction in relative index of inequality (RII)). Citizen's Basic Income (CBI) schemes also substantially narrowed inequalities (3·6% RII for basic scheme, 5·9% for CBI with additional payments for disabled individuals), and modestly reduced premature mortality (0·7% and 1·4%, respectively). The CBI policies were most cost-effective for reducing inequalities. Interpretation: Policies that affect incomes have the potential for marked effects on health and health inequalities in Scotland. The most effective policies for reducing health inequalities were those that disproportionately increased incomes in the most deprived areas. The modelling was subject to various assumptions, but nonetheless highlights how the approach can be used to inform decisions around the upstream determinants of health inequalities. Funding Statement: NHS Health Scotland. Declaration of Interests: The authors declare no competing interests. Ethics Approval Statement: Not required.