title: Informing Investment to Reduce Inequalities: A Modelling Approach.
abstract: BACKGROUND
  Reducing health inequalities is an important policy objective but there is limited quantitative information about the impact of specific interventions.
  
  
  OBJECTIVE
  To provide estimates of the impact of a range of interventions on health and health inequalities.
  
  
  METHODS
  Literature reviews were conducted to identify the best evidence linking interventions to mortality and hospital admissions. We examined interventions across the determinants of health: a 'living wage'; changes to benefits, taxation and employment; active travel; tobacco taxation; smoking cessation, alcohol brief interventions, and weight management services. A model was developed to estimate mortality and years of life lost (YLL) in intervention and comparison populations over a 20-year time period following interventions delivered only in the first year. We estimated changes in inequalities using the relative index of inequality (RII).
  
  
  RESULTS
  Introduction of a 'living wage' generated the largest beneficial health impact, with modest reductions in health inequalities. Benefits increases had modest positive impacts on health and health inequalities. Income tax increases had negative impacts on population health but reduced inequalities, while council tax increases worsened both health and health inequalities. Active travel increases had minimally positive effects on population health but widened health inequalities. Increases in employment reduced inequalities only when targeted to the most deprived groups. Tobacco taxation had modestly positive impacts on health but little impact on health inequalities. Alcohol brief interventions had modestly positive impacts on health and health inequalities only when strongly socially targeted, while smoking cessation and weight-reduction programmes had minimal impacts on health and health inequalities even when socially targeted.
  
  
  CONCLUSIONS
  Interventions have markedly different effects on mortality, hospitalisations and inequalities. The most effective (and likely cost-effective) interventions for reducing inequalities were regulatory and tax options. Interventions focused on individual agency were much less likely to impact on inequalities, even when targeted at the most deprived communities.
authors.affiliation: Public Health Science Directorate, NHS Health Scotland, Glasgow, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: McAuley
authors.affiliation: Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom.
authors.forename: Cheryl
authors.initials: C
authors.lastname: Denny
authors.affiliation: Public Health Science Directorate, NHS Health Scotland, Glasgow, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Taulbut
authors.affiliation: Public Health Science Directorate, NHS Health Scotland, Glasgow, United Kingdom.
authors.forename: Rory
authors.initials: R
authors.lastname: Mitchell
authors.affiliation: Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom.
authors.forename: Colin
authors.initials: C
authors.lastname: Fischbacher
authors.affiliation: Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom.
authors.forename: Barbara
authors.initials: B
authors.lastname: Graham
authors.affiliation: Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom.
authors.forename: Ian
authors.initials: I
authors.lastname: Grant
authors.affiliation: Information Services Division, NHS National Services Scotland, Edinburgh, United Kingdom.
authors.forename: Paul
authors.initials: P
authors.lastname: O'Hagan
authors.affiliation: Public Health, NHS Fife, Kirkcaldy, United Kingdom.|Centre for Population Health Sciences, University of Edinburgh, Edinburgh, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: McAllister
authors.affiliation: Public Health Science Directorate, NHS Health Scotland, Glasgow, United Kingdom.
authors.forename: Gerry
authors.initials: G
authors.lastname: McCartney
mesh_terms: D006293:Health Promotion / Q000379:methods*; D054624:Health Status Disparities; D006801:Humans; D007449:Investments; D008962:Models, Theoretical; D009026:Mortality; D010343:Patient Admission / Q000706:statistics & numerical data; D057766:Policy; D013660:Taxes / Q000145:classification*; D006113:United Kingdom