Unintended consequences of social and economic policies for population health: towards a more intentional approach

Abstract

Over the last decade there has been a growing interest in exploring the unanticipated health impacts of social and economic policies designed mainly to improve well-being, reduce discrimination, maintain family stability and improve mobility for disadvantaged populations. Since many of these policies are closely linked to the channels through which ‘social determinants’ may impact health, this is an intuitively appealing and in fact, compelling area of investigation. In addition, many evaluations of such policies have strong experimental elements, thereby avoiding some of the downfalls of observational studies where selection undermines our ability to make causal inferences. However, these evaluations have not been without significant problems. I outline three reasons to conduct this work and another three challenges to the interpretability of results. A major rationale to evaluating social and economic policies in terms of population health is that it is likely that conditions which improve population health will have to be modified in the public policy arena. Action to change policies that prove to be harmful to health are as important as implementing those that are likely to have positive effects. Over and over again, we have learned that asking individuals to change behaviour in …