SynthesisBMC public health2019
Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities.
Synthesis in BMC public health, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 48 papers, 7 of them syntheses that pooled 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.
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.
Who cites it
48 citing papers in PubMed, 7 syntheses or guidelines pooled it.
- Public health policies and interventions to address health inequities in high-income countries: an umbrella review.BMC public health · 2026Pooled it
- Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews.Systematic reviews · 2024Pooled it
- The potential of food environment policies to reduce socioeconomic inequalities in diets and to improve healthy diets among lower socioeconomic groups: an umbrella review.BMC public health · 2022Pooled it
- National or population level interventions addressing the social determinants of mental health - an umbrella review.BMC public health · 2021Pooled it
- Examining the effectiveness of place-based interventions to improve public health and reduce health inequalities: an umbrella review.BMC public health · 2021Pooled it
- The impacts of collaboration between local health care and non-health care organizations and factors shaping how they work: a systematic review of reviews.BMC public health · 2021Pooled it
- Non-genetic risk and protective factors and biomarkers for neurological disorders: a meta-umbrella systematic review of umbrella reviews.BMC medicine · 2021Pooled it
- Macroeconomic shock-response functions of health system resilience and equity: a global simulation study.npj health systems · 2026Article
- Mental well-being in 15-19-year-old adolescents and poor school connectedness, dropout, and NEET status: a prospective cohort study.The Lancet regional health. Europe · 2026Article
- Rural health inequalities in perceived HIV vulnerability and nutritional status: a cross-comparison of rural communities in West and Southern Africa.BMC public health · 2026Article
- Article
- Contemporary Area-Level Mortgage Loan Denial Risk and Health-Related Quality of Life Among Cancer Survivors.Cancer medicine · 2025Article
- The upstream-downstream tension in the global health classroom.BMJ global health · 2025Article
- Salutogenesis for thriving nations: Sense of coherence and longevity across income strata.SSM - population health · 2025Article
- The life expectancy gap: Socioeconomic differences in life expectancy between areas in Germany.Journal of health monitoring · 2025Article
- Interrogating Healthy Community Discourse in Municipal Policies: Priorities of a Medium-Sized CMA in Ontario, Canada.International journal of environmental research and public health · 2025Article
- Closing the life expectancy gap: An ecological study of the factors associated with smaller regional health inequalities in post-reunification Germany.Social science & medicine (1982) · 2024Article
- Causes, Solutions and Health Inequalities: Comparing Perspectives of Professional Stakeholders and Community Participants Experiencing Low Income and Poor Health in London.Health expectations : an international journal of public participation in health care and health policy · 2024Article
- Addressing the commercial determinants of mental health: an umbrella review of population-level interventions.Health promotion international · 2024Review
- Reimagining global health scholarship to tackle health inequities.SSM - population health · 2024Article
Corrections and comments
- Erratum issued
Authors and funding
14 authors.
Funding
Abstract
backgroundThe social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions.
methodsNine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented.
resultsThe review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations.
conclusionsThe results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review.
trial registrationProtocol for umbrella review prospectively registered with PROSPERO CRD42017068357.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
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.