Periodic Reporting for period 1 - HEED (Health Equity and its Economic Determinants (HEED): A Pan-European Microsimulation model for Health impacts of Income and Social Security Policies)
Reporting period: 2021-01-01 to 2022-06-30
What is the problem/issue being addressed?
A large body of evidence has accumulated which demonstrates the central role of the economy on health outcomes of a country and the unfair differences in health across social groups (health inequalities). For example, poverty is a well-established and potentially modifiable cause of poor health. However, quantifying the links between economic determinants and health is not straightforward. A focus on the economic determinants of health requires a consideration of employment, as well as income. Being in paid work, rather than in unemployment, is linked to better health and might help reduce health inequalities. Policies to provide greater income may therefore result in unintended adverse consequences if people stop working and therefore experience adverse health effects of unemployment.
To try to help policymakers and others explore these complex interplays, computer-based models may help. Modelling studies integrate existing evidence and real-world data and apply mathematical processes to create ‘what if’ scenarios. Policy modelling has been highly impactful, bridging the gap between basic science and policymaking. However, existing policy models have typically not studied the links between the economy, related government policies and health. This project therefore develops the understanding of causal relationships needed between economic factors, social security policies and health. It will then create a policy model to allow the health impacts of different government policies to be explored.
Why is it important for society?
A country’s health outcomes are strongly influenced by the conditions in which people are born, work and live. These ‘social determinants of health’ lie largely outside of healthcare, with government policies having the potential to substantially improve health. Health inequalities are the finding of poorer health outcomes which are unfair and avoidable across different social groups (such as by socioeconomic background, gender and ethnicity). Health inequalities are largely driven by the social determinants of health too.
Government policies on income and social security policies are thought to be particularly important drivers of a country’s overall health outcomes and health inequalities. There are considerable efforts to encourage governments and others to actively consider the health consequences of broader policies such as these. However, evidence is often unavailable to help with this. An integrated perspective to economic and health policy is therefore potentially very valuable to inform government policymaking. This project therefore aims to create a computer-based policy model to allow the health impacts of different policies to be simulated. Our work therefore has the potential to contribute to addressing three major societal challenges: health, economics and inequalities.
What are the overall objectives?
Aim: To assess the potential impacts of different European taxation and social security policies on a country’s health outcomes and inequalities in these outcomes across social groups.
Research Objectives (ROs):
1. To estimate the effects of changes in being employed and changes in income on self-reported health outcomes and risk of death.
2. To create projections for the above future health outcomes, by age, sex and socioeconomic group, for the UK over: a) one, b) five and c) 10 years.
3. To develop a computer-based policy simulation model that explores the health impacts of changes in taxation and social security policy for a) the UK and b) selected other European countries.
4. To estimate the impact of income tax and social security policies in the UK on the above health outcomes.
5. To estimate the impact of income tax and social security reforms on the above health outcomes across selected European countries.
A large body of evidence has accumulated which demonstrates the central role of the economy on health outcomes of a country and the unfair differences in health across social groups (health inequalities). For example, poverty is a well-established and potentially modifiable cause of poor health. However, quantifying the links between economic determinants and health is not straightforward. A focus on the economic determinants of health requires a consideration of employment, as well as income. Being in paid work, rather than in unemployment, is linked to better health and might help reduce health inequalities. Policies to provide greater income may therefore result in unintended adverse consequences if people stop working and therefore experience adverse health effects of unemployment.
To try to help policymakers and others explore these complex interplays, computer-based models may help. Modelling studies integrate existing evidence and real-world data and apply mathematical processes to create ‘what if’ scenarios. Policy modelling has been highly impactful, bridging the gap between basic science and policymaking. However, existing policy models have typically not studied the links between the economy, related government policies and health. This project therefore develops the understanding of causal relationships needed between economic factors, social security policies and health. It will then create a policy model to allow the health impacts of different government policies to be explored.
Why is it important for society?
A country’s health outcomes are strongly influenced by the conditions in which people are born, work and live. These ‘social determinants of health’ lie largely outside of healthcare, with government policies having the potential to substantially improve health. Health inequalities are the finding of poorer health outcomes which are unfair and avoidable across different social groups (such as by socioeconomic background, gender and ethnicity). Health inequalities are largely driven by the social determinants of health too.
Government policies on income and social security policies are thought to be particularly important drivers of a country’s overall health outcomes and health inequalities. There are considerable efforts to encourage governments and others to actively consider the health consequences of broader policies such as these. However, evidence is often unavailable to help with this. An integrated perspective to economic and health policy is therefore potentially very valuable to inform government policymaking. This project therefore aims to create a computer-based policy model to allow the health impacts of different policies to be simulated. Our work therefore has the potential to contribute to addressing three major societal challenges: health, economics and inequalities.
What are the overall objectives?
Aim: To assess the potential impacts of different European taxation and social security policies on a country’s health outcomes and inequalities in these outcomes across social groups.
Research Objectives (ROs):
1. To estimate the effects of changes in being employed and changes in income on self-reported health outcomes and risk of death.
2. To create projections for the above future health outcomes, by age, sex and socioeconomic group, for the UK over: a) one, b) five and c) 10 years.
3. To develop a computer-based policy simulation model that explores the health impacts of changes in taxation and social security policy for a) the UK and b) selected other European countries.
4. To estimate the impact of income tax and social security policies in the UK on the above health outcomes.
5. To estimate the impact of income tax and social security reforms on the above health outcomes across selected European countries.
The focus of this initial 1.5 years has been on work packages 1 (parameter estimation) and 2 (development of a microsimulation model). We have published a protocol paper in BMJ Open which explains the project and specifies our approach to developing and conducting the policy modelling.
My team has developed effect estimates of income (both log income and relative poverty), employment status and mental health using a fixed-effects model which has now been published. We have further used an alternative effect estimation approach (g-methods) to estimate the effects of poverty (paper under review) and the extent to which the effects of unemployment are mediated by poverty (paper also under review). Having now developed the estimation approach using UK data, we are now in the early stages of conducting similar analyses in Sweden to study mortality outcomes. Lastly, in relation to work package 1, we have conducted a systematic review and meta-analysis of the effects of income on mental health – now published.
With regards to developing the microsimulation model, we have created a functioning microsimulation model which incorporates effect estimates of income, poverty and non-employment on mental health. This model is in the process of validation and refinement.
My team has developed effect estimates of income (both log income and relative poverty), employment status and mental health using a fixed-effects model which has now been published. We have further used an alternative effect estimation approach (g-methods) to estimate the effects of poverty (paper under review) and the extent to which the effects of unemployment are mediated by poverty (paper also under review). Having now developed the estimation approach using UK data, we are now in the early stages of conducting similar analyses in Sweden to study mortality outcomes. Lastly, in relation to work package 1, we have conducted a systematic review and meta-analysis of the effects of income on mental health – now published.
With regards to developing the microsimulation model, we have created a functioning microsimulation model which incorporates effect estimates of income, poverty and non-employment on mental health. This model is in the process of validation and refinement.
The work is producing state of the art estimates of the effects of income and employment status on health outcomes. This has demonstrated that the effects are often smaller than often thought by public health researchers. A proof-of-principle microsimulation model has been created already and it is expected that this model will continue to be developed and refined. A policy simulation model will therefore be produced by the end of the project, alongside estimates of the impacts of specific policy options on both population health and health inequalities.