Research Question(s)
- What are the health and health inequality impacts of interventions to deliver inclusive economies?
A recent analysis suggests the UK is the most regionally unequal advanced economy, with some growing regional inequalities in outcomes including productivity, income, employment, pollution, emissions, and education. The link between economic factors and health is well evidenced in the public health literature. As life expectancy follows a ‘social gradient’, people living in more deprived areas of the UK have shorter life expectancies, higher levels of avoidable mortality, and spend more of their lives in ill-health.
Health and wealth inequalities increased significantly between 2010 and 2020 and were further exacerbated during the Covid-19 pandemic. The current cost-of-living crisis represents a significant threat of widening health and wealth inequalities, particularly as lower-income households spend comparatively more of their income on essential goods (e.g. food, energy), the cost of which has risen above headline inflation. Additionally, a 2022 report highlighted that black and ethnic minority people have been disproportionately affected by the pandemic and cost-of-living crisis and are more likely to be in poverty and deep poverty than white people. They are over-represented in the lowest-income groups, experience higher levels of food insecurity, and are significantly more likely to experience fuel poverty due to the rising energy costs. Health and wealth inequalities can also be caused by disability, age, gender, sexuality, experience of mental health, etc.
There is growing interest in pursuing inclusive economies in UK governments. In Scotland, for example, an inclusive and sustainable economy is one of the six national public health priorities. The other three UK nations are undertaking similar work. In England, Public Health England’s 2021 inclusive and sustainable economies strategy focused on place-based approaches to reducing health inequalities. The Marmot Review 10 Years On highlighted that these types of inclusive economy approaches hold promise for reducing health inequalities and redefining ‘progress’ to mean more than economic growth. They recommend placing value on health and wellbeing as well as (or more than) economic efficiency in the pursuit of inclusive growth.
A number of frameworks have been proposed to understand the core tenets of an inclusive economy. For example, Public Health England’s inclusive and sustainable economies strategy sets out a framework to support local areas to take whole-system action (see Figure 1). The framework describes 3 domains requiring action on the economic, social and environmental determinants of health and 12 sub-domains (or ‘building blocks’) of a sustainable and inclusive economy.
The Public Health Research (PHR) Programme is interested in research on the health and health inequality impacts of interventions intended to deliver inclusive economies at local or regional authority level. While the evaluation of national policy is outside of the Programme’s remit, researchers can investigate the variation in outcome of implementation of national policy at local or regional level. The PHR Programme is interested in a broad range of interventions that deliver inclusive economies. For example, interventions might focus on one sub-domain of the framework set out by Public Health England’s Inclusive and Sustainable Economies Strategy or interventions might target more than one sub-domain of the framework (or other equivalent frameworks). The inclusive and sustainable approach framework is described textually below and depicted in Figure 1 of the report and executive summary). It has three domains, each with four sub-domains:
- Economic
- Good work
- Income
- Inclusive labour markets
- Community wealth building
- Social
- Empowered & engaged communities
- Social capital & community infrastructure
- Services & amenities
- Education, training & skills
- Environmental
- Built environment
- Natural environment
- Transport, travel & connectivity
- Green economy
The Programme is predominantly interested in the evaluation of interventions operating at a population level rather than at an individual level and their impact on health inequalities and the wider determinants of health. The PHR Programme recognises that interventions are likely to impact different (sub)populations in different ways and encourages researchers to explore the impact of population-level interventions on such inequalities in their study design. Of particular interest is the impact of interventions on people from ethnic minority backgrounds.
Research areas of interest could include, but are not limited to, the evaluation of the health and health inequality impacts of new or existing:
- Interventions that target any (sub)domains of the framework mentioned in the Public Health England report (or equivalent frameworks) to build inclusive economies. This includes whole system approaches that might target multiple (sub)domains.
- Local variations to national minimum wage or living wage
- Initiatives that encourage investments in the local economy
- Initiatives that impact local provision of, and demand for, services e.g. 20-minute neighbourhoods.
- A major employer (e.g. university, the NHS) in the local community, acting as an anchor institution
- Local schemes to establish inclusive labour markets (e.g. ensuring a focus on inclusivity or good work, skills building and routes into employment), including those tailored for specific populations or sectors
The PHR Programme recognises that, for some proposals, underpinning work to understand epidemiology or intervention development might be beneficial to inform the evaluation of interventions. The Programme is willing to consider applications that include underpinning or development work. Please contact the PHR Programme before applying to discuss further.
A range of study designs and outcome measures can be used. Researchers will need to clearly describe and justify their choice of outcomes, target population group, as well as the rationale for their methodological approach. Researchers will need to specify how outcomes will be measured in the short, medium, and long term. The PHR Programme typically requires primary outcomes to be direct health outcomes. Given the focus of this commissioned call and the research question posed, the Programme will accept proxy measures for health as long as the link to health is clearly justified. Researchers are encouraged to consider additional outcome measures including those relating to the broader determinants of health and health inequalities, and the lifecourse, which should be specified and justified.
Understanding the value of public health interventions - whether the outcomes justify their use of resources - is integral to the PHR Programme, where resources relating to different economic sectors and budgets are potentially relevant. The main outcomes for health economic evaluation are expected to include health (including health-related quality of life) and the impact on health inequalities as a minimum, with consideration of broader outcomes welcomed. Different approaches to health economic evaluation are encouraged as long as they assess the value and distributive impact of interventions. Applications that do not include a health economic component should provide appropriate justification.
In the design and planning of the intervention, researchers are strongly encouraged to ensure that people with lived experience from the target audience are involved as potential, suitably rewarded, members of the research team. Researchers should demonstrate the relevance of their proposed research to decision-makers and people with lived experiences and they might do this through involving them as costed/rewarded members of the research team. Researchers are encouraged to explain how they will share their findings with policy makers, public health officers, special interest groups, charities, community audiences, and other relevant stakeholders. Researchers are expected to be aware of other studies in this area, development in practice, and ensure their proposed research is complementary.
For further information on submitting an application to the PHR Programme, please refer to the Stage 1 guidance notes and PHR supporting information. These can be found by clicking on the relevant commissioned call on the main funding opportunities page. This also includes closing dates and details about how to apply.