title: Impact on health inequalities of rising prosperity in England 1998-2007, and implications for performance incentives: longitudinal ecological study.
abstract: OBJECTIVE
  To investigate whether the uneven rise in prosperity between 1999 and 2008 accounted for differential increases in life expectancy in English local authorities.
  
  
  METHODS
  Longitudinal ecological study.
  
  
  METHODS
  324 local authorities in England, classified by their baseline level of deprivation. M: ain outcome measures Multivariable regression was used to investigate the association between trends in prosperity between 1998 and 2007 and trends in life expectancy. Trends in health inequalities were assessed by comparing the experience of Spearhead local authorities (the 70 most deprived in 1998) with the average for all English local authorities.
  
  
  RESULTS
  Those local authorities that experienced the greatest improvement in prosperity experienced greater increases in life expectancy. With each 1% absolute decline in unemployment, life expectancy increased by 2.2 (95% confidence interval 0.5 to 3.8) months in men and by 1.7 (0.4 to 3.1) months in women. With each £1000 increase in average household income in a local authority, life expectancy increased by 1.4 (0.3 to 2.5) months in men and by 1.1 (0.2 to 1.9) months in women. The more deprived a local authority was in 1998, the lower the rate at which life expectancy improved.
  
  
  CONCLUSIONS
  Decreases in unemployment and increases in average income in an area explained, to a large extent, why some local authorities "performed" better than others. Health inequalities between Spearhead and all local authorities widened during the period of rising prosperity, but they would have widened to an even greater extent had unemployment not fallen at a faster rate in more deprived areas. With worsening economic trends over the next 10 years, this research suggests that increases in life expectancy are likely to be smaller and health inequalities may widen at a faster rate than in the previous decade. Allocating resources to local authorities on the basis of their "performance" at increasing life expectancy is likely to reward more affluent areas rather than disadvantaged areas with greater needs, exacerbating the problem.
authors.affiliation: Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GB, UK. benbarr@liverpool.ac.uk
authors.forename: Ben
authors.initials: B
authors.lastname: Barr
authors.forename: David
authors.initials: D
authors.lastname: Taylor-Robinson
authors.forename: Margaret
authors.initials: M
authors.lastname: Whitehead
mesh_terms: D004522:Educational Status; D004651:Employment / Q000191:economics / Q000639:trends; D004739:England; D005260:Female; D006291:Health Policy; D054624:Health Status Disparities; D006801:Humans; D007182:Income / Q000639:trends*; D008017:Life Expectancy / Q000639:trends*; D016014:Linear Models; D008137:Longitudinal Studies; D008297:Male; D015999:Multivariate Analysis; D011204:Poverty Areas; D012052:Reimbursement, Incentive; D014478:Unemployment / Q000639:trends*