Systematic review of the effectiveness of the health inequalities strategy in England between 1999 and 2010

Ian Holdroyd · Alice Vodden · Akash Srinivasan · Isla L. Kuhn · Clare L Bambra · John Alexander Ford

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Health disparities and outcomes Public Health Policies and Education Public Health and Social Inequalities

Abstract

OBJECTIVES: The purpose of this systematic review is to explore the effectiveness of the National Health Inequality Strategy, which was conducted in England between 1999 and 2010. DESIGN: Three databases (Ovid Medline, Embase and PsycINFO) and grey literature were searched for articles published that reported on changes in inequalities in health outcomes in England over the implementation period. Articles published between January 1999 and November 2021 were included. Title and abstracts were screened according to an eligibility criteria. Data were extracted from eligible studies, and risk of bias was assessed using the Risk of Bias in Non-randomized Studies of Interventions tool. RESULTS: The search strategy identified 10 311 unique studies, which were screened. 42 were reviewed in full text and 11 were included in the final review. Six studies contained data on inequalities of life expectancy or mortality, four on disease-specific mortality, three on infant mortality and three on morbidities. Early government reports suggested that inequalities in life expectancy and infant mortality had increased. However, later publications using more accurate data and more appropriate measures found that absolute and relative inequalities had decreased throughout the strategy period for both measures. Three of four studies found a narrowing of inequalities in all-cause mortality. Absolute inequalities in mortality due to cancer and cardiovascular disease decreased, but relative inequalities increased. There was a lack of change, or widening of inequalities in mental health, self-reported health, health-related quality of life and long-term conditions. CONCLUSIONS: With respect to its aims, the strategy was broadly successful. Policymakers should take courage that progress on health inequalities is achievable with long-term, multiagency, cross-government action. TRIAL REGISTRATION NUMBER: This study was registered in PROSPERO (CRD42021285770).

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2021The PRISMA 2020 statement: an updated guideline for reporting systematic reviews 2020The COVID-19 pandemic and health inequalities 2020Health equity in England: the Marmot review 10 years on 1997Measuring the magnitude of socio-economic inequalities in health: An overview of available measures illustrated with two examples from Europe 2010Implicit Value Judgments in the Measurement of Health Inequalities 2012Use of relative and absolute effect measures in reporting health inequalities: structured review 2011Can we reduce health inequalities? An analysis of the English strategy (1997–2010)2014The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study

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