Background The English health inequalities strategy (1999–2010) aimed to reduce health inequalities between the most deprived local authorities and the rest of England. The multifaceted strategy included increased investment in healthcare, the early years, education and neighbourhood renewal. The objective of this study was to investigate whether the strategy was associated with a reduction in geographical inequalities in the infant mortality rate (IMR).
Methods We used segmented regression analysis to measure inequalities in the IMR between the most deprived local authorities and the rest of England before, during and after the health inequalities strategy period.
Results Before the strategy was implemented (1983–1998), absolute inequalities in the IMR increased between the most deprived local authorities and the rest of England at a rate of 0.034 annually (95% CI 0.001 to 0.067). Once the strategy had been implemented (1999–2010), absolute inequalities decreased at a rate of −0.116 annually (95% CI −0.178 to −0.053). After the strategy period ended (2011–2017), absolute inequalities increased at a rate of 0.042 annually (95% CI −0.042 to 0.125). Relative inequalities also marginally decreased during the strategy period.
Conclusion The English health inequalities strategy period was associated with a decline in geographical inequalities in the IMR. This research adds to the evidence base suggesting that the English health inequalities strategy was at least partially effective in reducing health inequalities, and that current austerity policies may undermine these gains.
- infant mortality
- health inequalities
- health Policy
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Contributors TR conducted the empirical analysis and led the drafting and revising of the manuscript with support from HB and CB. HB designed the analytical strategy, led data interpretation and substantially supported the drafting and revising of the manuscript. HB is the guarantor of the analysis. PDN provided the data, contributed to data interpretation and revisions of the manuscript. LKF contributed to data interpretation and commented on manuscript drafts. BB advised on the analytical strategy and data interpretation. CB is the corresponding author and the guarantor of the study. She planned the study, contributed to analytical design, data interpretation and substantially supported the drafting and revising of the manuscript. All authors agreed the final version.
Funding This study is funded by a Leverhulme Trust Research Leadership Award (reference RL-2012-006), awarded to CB. CB and HB are also members of Fuse, the Centre for Translational Research in Public Health (www.fuse.ac.uk). Fuse is a UK Clinical Research Collaboration (UKCRC) Public Health Research Centre of Excellence. Funding for Fuse from the British Heart Foundation, Cancer Research UK, Economic and Social Research Council, Medical Research Council, the National Institute for Health Research, under the auspices of the UKCRC, is gratefully acknowledged. Grant reference number is MR/K02325X/1.
Disclaimer The views expressed in this paper do not necessarily represent those of the funders, the Leverhulme Trust or UKCRC. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.
Competing interests None declared.
Patient consent for publication Not required.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement The statistical code is available from the lead author on request (firstname.lastname@example.org).
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