Background Improving health and reducing health inequalities are important joint policy objectives. Income is a key social determinant of health, but robust evidence about the relative impacts of redistributive policies is rare. Our study aimed to estimate the potential impacts on health (premature mortality) and health inequalities of 15 fiscal policies in Scotland, including changes to income tax, council tax, and benefits, and two Universal Basic Income (UBI) schemes.
Methods EUROMOD, a detailed tax-benefit microsimulation model, was used to estimate changes in household income for each quintile of the Scottish Index of Multiple Deprivation (SIMD). Parametric survival models were used to model baseline mortality rates, and log-log models were used to estimate policy effect sizes. We estimated the impacts of each policy on premature mortality across the Scottish population after 3 years of follow up, compared to the baseline no-policy scenario, and assessed inequalities between SIMD quintiles. Data processing and modelling was conducted in R, Stata and Excel.
Results Policies predicted to both improve health and reduce health inequalities included one UBI scheme (while the other UBI scheme worsened health), replacing council tax with a local income tax, increasing Job Seeker’s Allowance and Income Support, increasing tax credits, and increasing the Carer’s Allowance. The health-beneficial UBI scheme would result in a 0.2% reduction in premature mortality for the whole Scottish population, a 6.1% reduction for the most deprived quintile, and a 24.7% reduction in relative inequality (as measured by the relative index of inequality). Policies that were less targeted to deprived communities either worsened health but reduced inequalities, or improved health while worsening inequalities.
Conclusion Fiscal policies have the potential for substantial effects on health and health inequalities in Scotland. The most effective policies for reducing health inequalities were those that disproportionately increased incomes in the most deprived areas. The modelling is subject to various assumptions and sources of uncertainty, but nonetheless highlights the importance of applying an inequalities lens to economic policy options.
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