My former public health professor Phil Hanlon used to summarise the influences in population health with the phrase: “it all matters”. What he meant was that all aspects of society – whether it is how families communicate, the social fabric of our communities, the economic system or climate change –have important effects on our health.
We need to understand how the economy, politics and policies can help us achieve a fairer, healthier Scotland. As part of this work, we published a research report in the American Journal of Public Health which looked at their role. We identified all the existing evidence reviews in this area and brought them together.
Politics, policies and the economy
From this, we found a huge body of relevant research from 58 review studies. These considered the role of economic recession, income inequality, the type of social security system in place, housing and the physical environment. They also covered employment, workplaces, trade policy, education and specific areas such as healthcare policy. As expected, we found that the economy, politics and policies are all hugely important in determinants of population health and health inequalities.
Countries with a more social democratic approach to providing social security consistently had better health outcomes. In these countries, there was higher public spending and tax rates, more generous welfare payments, universal and high quality public services that were usually free at the point of need and lower income inequality. We also found that increasing the school leaving age benefited health, as did the introduction of more democratic political systems and health and safety laws.
There were some areas where we expected to find more evidence but instead there were gaps, only low quality studies, or contradictory evidence. The next step for this work therefore, is to build on these gaps. Our planned research to better understand the causes of the recent trends in life expectancy in Scotland and across many high income countries will help do this. So far, several factors have been suggested as possible causes, but there is now substantial evidence that cuts to public spending as part of austerity programmes may be particularly important. Our work will examine this possible cause alongside others to understand how important this is.
I suspect, as Professor Hanlon did, that policies, politics and the economy will have their part to play, alongside some of the other things that affect population health. After all, one thing that most of the evidence suggests is that it all matters.
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