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“Profits before people”? A systematic review of the health and safety impacts of privatising public utilities and industries in developed countries
  1. Matt Egan1,
  2. Mark Petticrew1,
  3. David Ogilvie1,
  4. Val Hamilton1,
  5. Frances Drever2
  1. 1
    Medical Research Council Social and Public Health Sciences Unit, University of Glasgow, Glasgow, UK
  2. 2
    Department of Public Health, University of Liverpool, Liverpool, UK
  1. Dr M Egan, MRC SPHSU, 4 Lilybank Gardens, Glasgow G128RZ, UK; m.egan{at}


Debates on government privatisation policies have often focused on the alleged effects of privatisation on health and safety. A systematic review (through Quality of Reporting of Meta-analysis) of the effects of privatising industries and utilities on the health (including injuries) of employees and the public was conducted. The data sources were electronic databases (medical, social science and economic), bibliographies and expert contacts. Experimental and quasi-experimental studies were sought, dating from 1945, from any Organisation for Economic Cooperation and Development member country (in any language) that evaluated the health outcomes of such interventions. Eleven highly heterogeneous studies that evaluated the health impacts of privatisation of building, water, paper, cement, bus, rail, mining, electric and gas companies were identified. The most robust study found increases in the measures of stress-related ill health among employees after a privatisation intervention involving company downsizing. No robust evidence was found to link privatisation with increased injury rates for employees or customers. In conclusion, public debates on the health and safety implications of privatisation have a poor empirical base, which policy makers and researchers need to address. Some evidence suggests that adverse health outcomes could result from redundancies associated with privatisation.

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  • Funding: This study was funded by ESRC Grant No. H141251011, under the auspices of the ESRC Centre for Evidence-based Public Health Policy, and MP is supported by the Chief Scientist Office of the Scottish Executive Health Department. DO is funded by a Medical Research Council fellowship. The funders played no part in the conduct of the research or in the presentation of its findings.

  • Competing interests: None.

  • Ethical approval: Ethical approval was not required for this literature review.

  • ME planned the study; collected, analysed and synthesised the data; led the writing of the article, and is a guarantor. MP and DO assisted in data analysis and synthesis and contributed to the writing of the article. FD conducted statistical analysis and contributed to the writing of the article. VH participated in data collection and contributed to the writing of the article.

  • Abbreviations:
    interrupted time series
    occupational stress indicator

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