J Epidemiol Community Health 67:190-193 doi:10.1136/jech-2012-201257
  • Short reports

What types of interventions generate inequalities? Evidence from systematic reviews

  1. Peter Tugwell2
  1. 1Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
  2. 2Centre for Global Health, University of Ottawa, Ottawa, Canada
  1. Correspondence to Dr Theo Lorenc, Department of Social & Environmental Health Research, London School of Hygiene & Tropical Medicine, 15-17 Tavistock Place, London WC1H 9SH, UK; theo.lorenc{at}
  1. Contributors MP and TL originated the idea for the paper. TL carried out searching, screening and data extraction, and wrote the first draft. MP, VW and PT advised on the methods and interpretation of the findings.

  • Accepted 20 July 2012
  • Published Online First 8 August 2012


Background Some effective public health interventions may increase inequalities by disproportionately benefiting less disadvantaged groups (‘intervention-generated inequalities’ or IGIs). There is a need to understand which types of interventions are likely to produce IGIs, and which can reduce inequalities.

Methods We conducted a rapid overview of systematic reviews to identify evidence on IGIs by socioeconomic status. We included any review of non-healthcare interventions in high-income countries presenting data on differential intervention effects on any health status or health behaviour outcome. Results were synthesised narratively.

Results The following intervention types show some evidence of increasing inequalities (IGIs) between socioeconomic status groups: media campaigns; and workplace smoking bans. However, for many intervention types, data on potential IGIs are lacking. By contrast, the following show some evidence of reducing health inequalities: structural workplace interventions; provision of resources; and fiscal interventions, such as tobacco pricing.

Conclusion Our findings are consistent with the idea that ‘downstream’ preventive interventions are more likely to increase health inequalities than ‘upstream’ interventions. More consistent reporting of differential intervention effectiveness is required to help build the evidence base on IGIs.


  • Competing interests None.

  • Provenance and peer review Not commissioned; externally peer reviewed.