Evidence map›Paper›PMID 27558269›Full record

ArticleBMC public health2016

Did the English strategy reduce inequalities in health? A difference-in-difference analysis comparing England with three other European countries.

Yannan Hu, Frank J van Lenthe, Ken Judge, Eero Lahelma, Giuseppe Costa, Rianne de Gelder, Johan P Mackenbach

Open access · goldAbstract readComparative StudyEvaluation Study
PubMed Full text at PMC Publisher
In one paragraph

Article in BMC public health, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed, 2 pooled it
16.3field-weighted citation impact, top 1% of its field
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed, 2 syntheses or guidelines pooled it, 55 citations in OpenAlex.

  1. Pooled it
  2. Pooled it
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  4. Review
  5. Article
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4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

7 authors at 3 institutions in 3 countries.

Yannan HuDepartment of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Frank J van LentheDepartment of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Ken JudgeDepartment of Health, University of Bath, Bath, UK.
Eero LahelmaDepartment of Public Health, University of Helsinki, Helsinki, Finland.
Giuseppe CostaDepartment of Clinical and Biological Science, University of Turin, Turin, Italy.
Rianne de GelderDepartment of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
Johan P MackenbachDepartment of Public Health, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands. j.mackenbach@erasmusmc.nl.
University of Bath · GBUniversity of Helsinki · FIUniversity of Turin · IT

Funding

Department of Health 278511
6 · The paper itself

Abstract

backgroundBetween 1997 and 2010, the English government pursued an ambitious programme to reduce health inequalities, the explicit and sustained commitment of which was historically and internationally unique. Previous evaluations have produced mixed results. None of these evaluations have, however, compared the trends in health inequalities within England with those in other European countries. We carried out an innovative analysis to assess whether changes in trends in health inequalities observed in England after the implementation of its programme, have been more favourable than those in other countries without such a programme.

methodsData were obtained from nationally representative surveys carried out in England, Finland, the Netherlands and Italy for years around 1990, 2000 and 2010. A modified difference-in-difference approach was used to assess whether trends in health inequalities in 2000-2010 were more favourable as compared to the period 1990-2000 in England, and the changes in trends in inequalities after 2000 in England were then compared to those in the three comparison countries. Health outcomes were self-assessed health, long-standing health problems, smoking status and obesity. Education was used as indicator of socioeconomic position.

resultsAfter the implementation of the English strategy, more favourable trends in some health indicators were observed among low-educated people, but trends in health inequalities in 2000-2010 in England were not more favourable than those observed in the period 1990-2000. For most health indicators, changes in trends of health inequalities after 2000 in England were also not significantly different from those seen in the other countries.

conclusionsIn this rigorous analysis comparing trends in health inequalities in England both over time and between countries, we could not detect a favourable effect of the English strategy. Our analysis illustrates the usefulness of a modified difference-in-difference approach for assessing the impact of policies on population-level health inequalities.

Indexed as

Cross-Cultural ComparisonHealthHealth Status DisparitiesProgram EvaluationAdolescentAdultAgedChronic DiseaseDelivery of Health CareDiagnostic Self EvaluationEnglandFemaleFinlandHealth PromotionHealth SurveysHumansDifference-in-difference analysisEnglish strategyEuropeHealth inequalityLong-standing health problemsObesitySelf-assessed healthSmoking

Identifiers

PMID27558269
PMCPMC4995654
OpenAlexW2514626242

What OpenQuestion holds

Textmetadata
LicenceCC BY
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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.