Skip to main content
Download PDF

Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews

Systematic Reviews volume 13, Article number: 58 (2024) Cite this article

Abstract

Background

A fairer economy is increasingly recognised as crucial for tackling widening social, economic and health inequalities within society. However, which actions have been evaluated for their impact on inclusive economy outcomes is yet unknown.

Objective

Identify the effects of political, economic and social exposures, interventions and policies on inclusive economy (IE) outcomes in high-income countries, by systematically reviewing the review-level evidence.

Methods

We conducted a review of reviews; searching databases (May 2020) EconLit, Web of Science, Sociological Abstracts, ASSIA, International Bibliography of the Social Sciences, Public Health Database, Embase and MEDLINE; and registries PROSPERO, Campbell Collaboration and EPPI Centre (February 2021) and grey literature (August/September 2020). We aimed to identify reviews which examined social, political and/or economic exposures, interventions and policies in relation to two IE outcome domains: (i) equitable distribution of the benefits of the economy and (ii) equitable access to the resources needed to participate in the economy. Reviews had to include primary studies which compared IE outcomes within or between groups. Quality was assessed using a modified version of AMSTAR-2 and data synthesised informed by SWiM principles.

Results

We identified 19 reviews for inclusion, most of which were low quality, as was the underlying primary evidence. Most reviews (n = 14) had outcomes relating to the benefits of the economy (rather than access to resources) and examined a limited set of interventions, primarily active labour market programmes and social security. There was limited high-quality review evidence to draw upon to identify effects on IE outcomes. Most reviews focused on disadvantaged groups and did not consider equity impacts.

Conclusions

Review-level evidence is sparse and focuses on ‘corrective’ approaches. Future reviews should examine a diverse set of ‘upstream’ actions intended to be inclusive ‘by design’ and consider a wider range of outcomes, with particular attention to socioeconomic inequalities.

Peer Review reports

Introduction

Despite considerable research and policy attention over the past four decades, substantial inequalities in mortality and morbidity persist [1,2,3], and relative inequalities have increased across most European countries [4]. In several high-income countries, particularly the UK and the USA, overall life expectancy trends have stalled since 2012 [1, 5,6,7,8], with rising mortality in the most deprived areas [9].

Reducing health inequalities demands cross-sectoral activity [10] and requires action to reduce inequalities in the ‘fundamental causes’ of income, wealth and power [11, 12]. The past decade has seen the growth of ‘Health-in-all-Policies’ (HiAP) approaches, which aim to consider the health and health inequalities impacts of policies in education, transport, the environment and so on [13, 14]. Tackling health inequalities requires action on economic policy making [15], including changes to social security and taxation systems, reducing poverty, eradicating low pay, increasing employment, improving the quality of work and reducing precarity [1, 2, 8, 15]. Action for health equity necessitates that public health engage with economic policy development [1, 2, 15,16,17,18,19,20,21,22].

Inequality and its damaging effects on health and the economy

The idea that the current economic paradigm is not delivering for society, or the economy, is increasingly recognised by economists and beyond. Alongside stalling life expectancy, increasing economic inequality is a critical challenge for the twenty-first century [23, 24]. Widening inequalities are negatively associated with health outcomes [1, 2], as well as a range of other indicators of societal progress including education, crime, social capital and trust and social unrest [25, 26]. Further, inequality is damaging to the economy and economic growth itself [26,27,28,29,30].

The past decade has seen significant social and economic change. The austerity policies widely implemented across Europe after the financial crisis of 2008 were associated with significant impacts on health [8, 31,32,33]. The social and economic impact of the COVID-19 pandemic further highlighted the health impact of economic inequalities [21, 34, 35]. Fundamental questions have been raised about the objectives of the economic system, increased awareness of pre-pandemic inequalities and support for government intervention to address inequalities and promote recovery [23, 35, 36]. There have been calls to ‘build [the economy] back better’ and ‘build back fairer’ in efforts to address economic injustices and health inequalities [21, 23, 37, 38].

Alternative economic models for health equity

These considerable societal shifts since the mid-2000s have disrupted the status quo, garnered international policy attention on reducing economic inequality [39] and stimulated significant debate regarding alternative ‘heterodox’ economic approaches [15, 40, 41], albeit with less progress in terms of significant policy change. A wide spectrum of (often overlapping) concepts, frameworks and potential policies have been proposed including inclusive growth, community wealth building, strengthening the foundational economy, a universal basic income, universal basic services and frameworks such as Doughnut Economics and the wellbeing economy [23, 40, 42,43,44]. This review is focused on ‘inclusive economy’, which is similar to the term inclusive growth [44, 45] but, as we are using it, is more ‘neutral’ in relation to economic growth [40], more focused on reforming business models and job quality and considers inclusion important in its own right [44, 46, 47].

An inclusive economy: attributes, outcome domains and evidence base

There are differing interpretations of inclusive economy, and this review draws on Shipton et al. [48] that defines four attributes of an inclusive economy:

  • An inclusive economy is deliberately designed to be more inclusive, i.e. the policies, laws, regulations, institutions and governance determine how an economy functions and the extent to which it delivers equity.

  • There is greater equity in the distribution of the benefits of an economy, such as goods and services, employment, wealth, power and economic value.

  • There is equitable access to the resources needed to participate in the economy including good health, social support and access to education and training.

  • The economy functions within the limits of planetary resources [48].

This review focuses on two of these attributes (Table 1).

Table 1 Inclusive economy outcome domains focused on in this reviewa (Shipton et al. 2021b) [48]
Full size table

The policy rhetoric regarding an inclusive economy has not yet translated into coherent policy action. There is a lack of evidence about what would deliver an inclusive economy [49], and policy-making decisions are not yet underpinned by a systematic understanding of the available evidence.

To address such a gap requires a broad overview of a wide range of evidence. Reviews of reviews (sometimes called ‘umbrella reviews’ [50]) are widely used in medicine and public health to synthesise evidence across a topic area to inform decision-making [51, 52]. Given the breadth of potential policies and interventions related to the concept of an inclusive economy, a systematic review of primary evidence would not provide the required scope, and so a review of reviews was indicated to capture diverse evidence across this topic as well as key gaps.

To the best of our knowledge, a review of the review-level evidence on the effects of exposures, interventions and policies on inclusive economy outcomes does not yet exist. This missing synthesised evidence is a vital step in efforts to advance effective action towards inclusive economies and address health inequalities. Our review of reviews is intended to address this gap.

Objectives and review question

We aimed to systematically collate and synthesise existing review-level evidence on the effects of political, economic and social exposures, interventions and policies on inclusive economy outcomes to address the following objectives:

  • To synthesise review-level evidence on the effects of exposures, interventions and policies on inclusive economy outcomes

  • To assess the quality of existing reviews and areas where reviews are missing to inform future work in this area

The review question is as follows: What are the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes in high-income countries?

Methods

Study design

We conducted a review of reviews [53]. A pre-registration form was completed on the Open Science Framework in September 2020 (DOI: https://doi.org/10.17605/OSF.IO/SWT4E) and the full protocol published on SocArXiv papers in January 2021 (https://doi.org/10.31235/osf.io/dctk5) (Supplementary File 1 details amendments to the protocol).

The protocol was written in accordance with the Preferred Reporting Items for Systematic review and Meta-Analysis Protocols (PRISMA) 2015 [54] and results reported using the PRISMA 2020 statement [55] (Supplementary Files 2a and b).

Inclusion and exclusion criteria

  • Inclusion criteria are as follows (amended from protocol, see Supplementary File 1):

  • Population: Humans only and high-income countries only

  • Intervention(s)/exposure(s): Any social, political and economic intervention, policy or exposure

  • Comparison: Eligible reviews had to include primary studies which compared IE outcomes either within or between groups.

  • Outcome(s): Eligible reviews had to include at least one of the following inclusive economy outcomes:

  1. (i)

    Equitable distribution of the benefits of the economy

  2. (ii)

    Equitable access to the resources needed to participate in the economy (see Table 1 for more details).

  • Study design: Reviews or systematic reviews of empirical studies of quantitative and/or qualitative nature

  • Publication year, language and status: No publication year restrictions, English only, peer-reviewed and grey literature

Exclusion criteria are as follows:

  • Book reviews and books

  • Scoping reviews or commentaries

Information sources

We searched the following:

  • Eight bibliometric databases from inception to May 2020 (EconLit (ProQuest); Web of Science; Sociological Abstracts (SocAbs, ProQuest); Applied Social Sciences Index and Abstracts (ASSIA, ProQuest); International Bibliography of the Social Sciences (IBBS, ProQuest); Public Health Database (ProQuest); Embase (Ovid); MEDLINE (Ovid))

  • Google Scholar and 12 governmental and non-governmental organisational websites (Centre for Local Economic Strategies; Joseph Rowntree Foundation; Scottish Government; UK Government; Wellbeing Alliance; Research Papers in Economics; What Works Scotland; Fraser of Allander Institute; Royal Society of Arts; The Organisation for Economic Cooperation and Development; Institute for Public Policy Research; Health Foundation)

  • Systematic review registries and evidence databases (PROSPERO, the Campbell Collaboration and EPPI Centre)

We undertook hand searching and contacted relevant experts.

Search strategy

Full details of the pilot searches, the search terms and search strategy are available in the protocol. (see Supplementary File 3 for an example search strategy).

Data management

Search results from bibliometric databases were imported to RefWorks and de-duplicated. Results from grey literature searching were imported into Sciwheel and de-duplicated. References were then imported into Covidence (https://www.covidence.org) for screening and data extraction. Additional de-duplication of studies was also performed in Covidence.

Study selection and data extraction

Title, abstract and full-text screening were undertaken by two independent reviewers (SS, DS or GS), and differences were resolved through consensus. A third reviewer was involved where necessary.

See Supplementary File 4 for the data extraction fields. Two independent reviewers extracted data for 12 reviews (SS, DS or GS), and 1 reviewer extracted data for the remaining 8 reviews (SS) which were checked by a second reviewer (DS or GS).

For the comparator criteria, it became clear that:

  1. (i)

    Reviews sometimes included primary studies with a mixture of primary study designs, i.e. some that had a comparator and some which did not.

  2. (ii)

    Not all reviews reported primary studies’ study designs.

Therefore, further data was extracted on how many of the included primary studies with an IE outcome had some form of comparator. Where this information on study design was not available from the review, this data was extracted from primary studies (title, abstract and/or full text where required) for reviews that included < 50 primary studies with IE outcomes.

Quality assessment

Quality assessment of reviews used a modified version of A Measurement Tool to Assess Systematic Reviews-2 (AMSTAR-2) [56] (Supplementary File 4). Quality assessment was undertaken by two independent reviewers (SS or DS or GS) in Covidence and disagreements resolved through consensus. AMSTAR-2 is designed to be adapted [56]. As so few of the included reviews undertook meta-analysis, items 11 and 15 were not considered critical weaknesses. Further, given the cross-disciplinary nature of the included reviews, we did not code item 7 (‘Did the review authors provide a list of excluded studies and justify the exclusions?’) as critical weaknesses (see Supplementary File 7 for the quality assessment scores where item 7 is, and is not, coded as a critical weakness).

Data synthesis: applying synthesis without meta-analysis (SWiM) to a review of reviews

Due to the variety of outcomes, meta-analysis was deemed inappropriate, and so we report our findings applying the Synthesis Without Meta-analysis (SWiM) guidelines [57] as far as possible.

Reviews were grouped by ‘review-level outcome’ and mapped to the two ‘IE outcome domains’ (Table 1). Given there was no consistent reporting of effect sizes, vote counting based on effect direction (ED) was chosen as the standardised metric [58]. For each review, the ED was coded at the review-level based on the review authors’ synthesis as follows:

  1. (i)

    Beneficial impact on IE outcomes

  2. (ii)

    Harmful impact on IE outcomes

  3. (iii)

    No change/mixed effects/conflicting findings/insufficient evidenceFootnote 1

One reviewer coded all EDs (AM), these were cross-checked by a second reviewer (DS or GS) and differences were resolved by consensus. Where a review included more than one exposure/intervention/policy, we have coded the ED separately for distinct exposures/interventions/policies. Where the denominator of included primary studies with an IE outcome was unclear or where there were no included primary studies with a comparator for a particular exposure/intervention/policy, an ED was not coded. ModifiedFootnote 2 ED plots have been chosen to visually represent the results (Tables 3 and 4).

Confidence in cumulative evidence

We were unable to apply GRADE [59] (see Supplementary File 5 for details).

Results

We identified 19 reviews for inclusionFootnote 3 (Fig. 1). See Supplementary Files 6 and 7 for the included reviews and Supplementary File 8 for the excluded reviews. The earliest included review was published in 2005 and the latest in 2020. We excluded duplicate primary studies (only four primary studies occurred in more than one review, Supplementary File 6). Twelve reviews referred to an underlying theory or framework or suggested how the intervention/exposure might impact on outcomes, whilst seven reviews did not refer to theory.

Fig. 1
figure 1

PRISMA 2020 flow diagram [55]

Full size image

Summary of included reviews

The majority of the included reviews (n = 14) focused on disadvantaged populations, of which half (n = 7) focused on either unemployed adults or working age adults with health problems or disabilities, and the rest focused on specific groups such as low-skilled and migrant workers (n = 1), disadvantaged African American young men (n = 1), disadvantaged students (n = 2), low-income mothers (n = 1), homeless families (n = 1) and refugees (n = 1). The remaining reviews (n = 5) considered working age adults or young people or focused at a whole country level.

Of the 19 included reviews, three were high quality, three moderate quality, three low quality and the rest (n = 10) critically low quality.

Primary study quality was assessed and/or reported (to some degree) by 11 reviews, using methods ranging from formal quality assessment tools to more general comments (Tables 3 and 4). Of those that reported formal quality scores, two reviews identified primary studies as high/medium quality [60, 61], three reviews considered primary studies as low/medium quality [62,63,64] and one review reported primary studies as a mixture of weak/moderate/strong quality [65]. Of those that did not report formal quality scores or provide an overall rating, three reviews excluded studies which were at high risk of bias [66], had ‘substantive flaws’ [67] or did not meet validity criteria [68], whilst two reviews critically appraised studies to inform interpretation, but no overall comment on quality was provided [69, 70]. Primary study quality was not reported by eight reviews including one ‘empty’ review which had planned to assess quality, but no studies met inclusion criteria [71].

There were four groups of reviews:

  • n = 7 reviews: All primary studies had a comparator.

  • n = 8 reviews: Some primary studies had a comparator, and we could identify the proportion.

  • n = 3 reviews: Some primary studies had a comparator, but we were unable to identify the proportion.

  • n = 1 review: Was an empty review (i.e. a review where no studies met inclusion criteria), and so assessing the comparator did not apply.

Across the 19 included reviews, we were able to identify 801 primary studiesFootnote 4, of which 525 had inclusive economy outcomesFootnote 5, and of these, at least 60% (315 primary studies) had some form of comparator.

Reviews were mapped to two outcome domains: ‘equitable distribution of the benefits of the economy’ and ‘equitable access to resources needed to participate in the economy’ (Table 1) and grouped reviews by review-level outcomes and by exposure/intervention/policy.

The majority of reviews (n = 14) had outcomes relating to the benefits of the economy, such as employment and earnings. The remaining reviews (n = 5) had outcomes relating to access to resources to participate in the economy such as access to education or training. For most of the inclusive economy domains, we found none or only a few reviews (Table 2), and these were mostly of low quality.

Table 2 Number (n) of reviews mapped by outcome domain and exposure/intervention/policy (n = 19 reviews)
Full size table

We now consider key findings for each outcome domain in turn in terms of (i) the types of outcomes and interventions examined by the included reviews and (ii) the effect directions identified in included reviews structured by review-level outcomes and grouped by intervention.

Equitable distribution of the benefits of the economy

For the first outcome domain, Shipton et al. identify four types of ‘benefits’ of the economy, namely, (a) provision of essential goods and (b) economic inclusion, (c) assets that confer economic power and (d) different parts of the economy are valued (see Table 1).

Types of outcomes and interventions examined by the included reviews

Fourteen reviews examined outcomes that could be categorised as a benefit from the economy, all of which focused on measures of economic inclusion, i.e. employment, income and reduced poverty. No reviews examined outcomes related to any other types of economic benefits (i.e. (a), (c) or (d) in Table 2).

Of those reviews which considered economic inclusion outcomes, more than two-thirds (n = 10 reviews) focused on increased employment/return to work as the main outcome of interest. Other economic inclusion outcomes were reduced poverty and economic/material hardship (n = 3 reviews), and one review considered ways to increase earnings and one review on reducing income inequality. One review examined both employment and earnings [60]. None of the reviews examined other measures of economic inclusion outcomes such as the social benefits of participation in the economy [48], and so measures of economic inclusion were restricted to ‘traditional’ outcomes, primarily gaining paid employment.

For this IE outcome domain (‘equitable distribution of the benefits of the economy’), the most common types of interventions to deliver economic inclusion considered by the included reviews were various types of active labour market programmes (ALMP) (n = 7 reviews) (Table 3). These interventions predominantly focused on supply-side interventions such as skills training or employability support and more limited consideration of demand-side interventions such as wage subsidies or job creation programmes. The next most common intervention type (examined by n = 4 reviews) explored was forms of social security (specifically unemployment insurance and disability benefits) and how they relate to economic inclusion. The remaining reviews examined a diverse set of exposures and interventions: social support (n = 1 review), housing interventions for homeless families (n = 1 review) and government policies to tackle income inequality (n = 1 review).

Table 3 Effect directions for exposures/interventions/policies on ‘More equity in distribution of the benefits of the economy’
Full size table

Effect directions identified in included reviews

We now consider effect directions (EDs) identified in included reviews in the first outcome domain, paying attention to higher quality reviews (Table 3).

Review-level outcome: increasing employment/return to work

Most of the included reviews in the economic inclusion outcome area (n = 10) examined interventions aimed at increasing employment/ return to work outcomes (Table 3a). There were three different categories of intervention: (i) social security interventions; (ii) active labour market programmes and (iii) housing interventions.

In relation to the effects of (i) social security interventions on increasing employment, two reviews looked at slightly different aspects of social security in relationship to movement into employment. One high-quality review found that there was an increase in the exit rate from unemployment (i.e. increase in employment) in the months before the benefit came to an end [66]. However, this review highlighted that there was a lack of evidence to assess whether people accept jobs that they then quickly leave, i.e. the ‘exit rate from re-employment’. The second, a low-quality review, found increased generosity of benefits decreased the likelihood of moving into employment. The same study also looked at the relationship between relaxing eligibility and movement into employment, but there was not enough evidence to draw a conclusion [68].

Seven reviews examined various types of (ii) active labour market programmes on increasing employment/return to work. The reviewed programmes were either focused on individuals (such as in-work benefits, skills training (e.g. training in technical/vocational skills, literacy, numeracy, soft skills, employment support services, cognitive behaviour therapy, entrepreneurship promotion programmes) or were aimed at employers (including employer incentives, job creation programmes, anti-discrimination legislation, workplace disability management programmes and workplace adjustments). This variety in intervention type made synthesising across reviews challenging, and so we have considered the effects of active labour market programmes in general.

The two high-quality reviews identified a lack of available evidence. Focusing on workplace disability management programmes, one review found a lack of studies which provided effect sizes and high risk of bias in the two non-randomised studies [62], whilst another, with a focus on ALMP interventions (including ALMP-type programmes) which might improve economic outcomes for refugees, found no primary studies that met their inclusion criteria [71]. One moderate quality review found skills training could have positive (though small) effects on employment outcomes for young people, whilst there were less conclusive effects for three other interventions (entrepreneurship promotion interventions, subsidised employment and employment services) [60].

The remaining four reviews (all critically low quality) identified a variety of effects which appeared to depend on programme type. The low quality of the reviews, and the general lack of quality scores for primary studies, necessitates cautious interpretation of effect directions. Personal advisors and case management [69] as well as workplace adjustments and return-to-work planning could have positive effects [70], but impact was limited for both by low uptake. There was also some limited evidence that work-focused interviews, and employability support could promote employment outcomes [63]. For other programme types, there was a lack of evidence of effect, including for anti-discrimination legislation [70] and cognitive behaviour therapy [63]. There were mixed findings for the other interventions: wage subsidies could be effective but needed to be sufficiently generous and could have unintended consequences (such as excluding people with disabilities from the wider labour market) [70], vocational advice and support services showed positive effects in some studies but not when limited to only the studies with controls [67] and in-work benefits were found to be effective by several studies, but impact was limited by low uptake [67].

Finally, one moderate quality review was the only one to consider the impact of (iii) housing interventions on employment outcomes and found some beneficial impact on employment status of housing interventions for homeless families in the USA [64]. However, participants were often not earning a wage they could live on and continued to experience employment instability. Although this review focuses on a particularly marginalised group and draws on a small set of mixed quality primary studies, it is important in indicating the potential for a noneconomic policy, i.e. ensuring adequate housing, to have effects on a measure of economic inclusion.

Review-level outcome: reducing poverty and economic/material hardship

Three reviews examined the impact of exposures and interventions on reducing poverty and economic/material hardship (Table 3b). One low-quality review [65] and one critically low-quality review [73] identified that unemployment insurance could have positive effects on reducing poverty and material hardship. One of these identified three mechanisms, as follows: that generous eligibility criteria can reduce poverty levels amongst the unemployed, low benefit levels do not reduce poverty as they do not replace wages and flexible eligibility criteria (such as allowing seasonal, migrant or occasional workers) reduces material hardship [73]. The third review (low quality but drawing on high-quality primary studies) identified a positive effect of informal social support for reducing economic/material hardship with low-income mothers in the USA [61]. However, the authors also suggest that the size of the effect was small, and informal support does not benefit other economic outcomes such as employment status, job quality or earnings.

Review-level outcome: increased earnings

Only one review examined increased earnings as an outcome (Table 3c). This moderate-quality review (drawing on mostly high- and medium-quality studies) found negligible effects of two types of interventions on the earnings of young people in high-income country contexts, namely skills training (e.g. training in technical/vocational skills, literacy numeracy, soft skills) and employment services (e.g. job search support, mentoring, placements) [60]Footnote 6. There was insufficient data to examine entrepreneurship promotion interventions, and subsidised employment demonstrated a negative effect on earnings. Thus, there is limited synthesised evidence in the review literature to indicate what types of interventions/exposures can increase earnings.

Review-level outcome: reducing income inequality

One review examined reduced income inequality as an outcome; however, it was not possible to code an effect direction (Table 3d). This critically low-quality review examined various broad government policies including fiscal policies, education policies, trade liberalisation and labour market reform [74]. However, the review did not provide sufficient detail on the specifics of each type of policy for the effects that they identified to be meaningful. For example, different forms of fiscal policies are discussed (e.g. net expenditure, tax cuts, tax credit reform), but without sufficient detail on the specifics of such policies to be able to evaluate specific effects. Nevertheless, this review met our inclusion criteria and is important as it is one of the few identified which focuses at a macro-level, and it underscores the need for high-quality reviews of specific government policies for their impact on income inequality.

Equitable access to resources needed to participate in the economy

For the second IE outcome domain, inclusive economy outcomes include access to the resources required to participate in the economy such as early years experiences, health, education and training (Table 1).

Types of outcomes and interventions examined by the included reviews

Five reviews examined outcomes that could be categorised as access to resources to participate in the economy, but these examined only a limited range of outcomes (Table 2). The most common outcome was improved higher education outcomes (n = 3 reviews), one review examined access to active labour market programmes and one reviewed the effect of improved entrepreneurial knowledge and skills. No reviews examined other outcomes such as good early years experiences, access to primary or secondary education or vocational training.

For this outcome domain (access to resources to participate in the economy), there was no predominant exposure/intervention type, but this domain examined exposures for supporting higher education (such as social/family/peer support and social networks) (n = 2 reviews) as well as a mixture of interventions including active labour market programmes (n = 2 review), outreach and financial aid interventions (n = 1 review). It must be noted that two of these exposures/interventions (specifically social networks [75] and active labour market programmes [76, 77] were also examined in the first outcome domain; however, these were by separate reviews, and no single review is included under both sections (i.e. each review only appears in either the ‘Equitable distribution of the benefits of the economy’ or ‘Equitable access to resources needed to participate in the economy’ section). These reviews have been grouped here under this outcome domain as their outcomes are focused on access to resources, specifically higher education outcomes [75], access to active labour market programmesFootnote 7 and entrepreneurial knowledge and skills.

Effect directions identified in the included reviews

We now consider effect directions identified in included reviews in the second outcome domain (Table 4). All the reviews considered here are critically low quality, and the quality of primary studies was not reported.

Table 4 Effect directions for exposures/interventions/policies on ‘More equity in access to resources to participate in economy’
Full size table

Review-level outcome: improved higher education outcomes

Three critically low-quality reviews looked at exposures/interventions to improve higher education outcomes, primarily drawing on studies conducted in North America (Table 4a). The paucity and low quality of reviews in this area and the variety of exposures/interventions examined make synthesising across reviews difficult. Nevertheless, there is some low-quality review-level evidence that some types of outreach and financial aid interventions [78] as well as personal and institutional networks [75] can have positive effects on higher education outcomes for disadvantaged students. However, the specific characteristics of interventions are likely to be important, for example the effectiveness of financial aid depends on whether the financial amount given covers unmet financial need. A range of enablers of the transition to higher education have also been identified (such as the role of family support, socioeconomic background or the role of educational institutions) [72], which could inform intervention development.

Review-level outcome: access to active labour market programmes

There was evidence from one critically low-quality review that some disadvantaged groups (low-skilled and migrant workers) could be underrepresented in accessing active labour market programmes, but this varied by programme type and group [76] (Table 4b). Although the quality of the primary evidence is unclear, this does suggest the potential for inequalities in accessing programmes intended to support participation in the labour market. Crucially, this was the only review to explicitly focus on access to such programmes and to consider equity (or lack of) which demonstrates a paucity of evidence in this area. However, this review focused on two specific groups (low-skilled and migrant workers), and a more general consideration of underrepresentation in relation to protected characteristics such as gender, ethnicity or disability was not considered.

Review-level outcome: improved entrepreneurial knowledge and skills

Finally, there was some tentative evidence from one critically low-quality review that entrepreneurial programmes could have positive impacts on business knowledge, intending to or actually starting a business, specifically for disadvantaged young Black men in the USA [77] (Table 4c). However, these findings were primarily based on participant self-report rather than measures of economic outcomes, and the authors highlight the very limited evidence base and lack of methodologically robust evaluations.

Summary of results

Our review of reviews has identified review-level evidence from an inclusive economy perspective, appraised the quality of that evidence and identified key gaps and examined the effects of exposures, interventions and policies on inclusive economy outcomes. The small body of review-level evidence we identified was mostly low quality, and the underlying primary studies were either unknown or mostly low quality. We have also identified a highly heterogenous set of reviews such that (when specific intervention types are considered) there is little overlap between reviews. In addition, significant evidence gaps exist for many inclusive economy outcome domains. That said, we can draw out some key findings.

First, our mapping of review-level outcomes to IE outcome domains showed that the review-level outcomes in the included reviews largely focused on outcomes related to economic benefits (n = 14) rather than access to resources needed to participate in the economy (n = 5). Outcomes related to economic benefits were generally limited to a neoclassical economic view of economic benefits [15, 40], such as employment or returning to work, and some limited consideration of measures of income or poverty. Within reviews focused on employment, there was little or no consideration of the quality of workFootnote 8 or stability of income. There was very little focus on economic activity that a more heterodox economic perspective would consider essential to a well-functioning economy, such as the sufficient production and equitable delivery of essential goods and services and participation in the unpaid economy. Those reviews that considered outcomes related to access to resources needed to participate in the economy also focused on a limited set of review-level outcomes, primarily access to higher education. Only one review explicitly considered inclusive growth as a concept [74]. Reviews generally focused on specific outcomes, which individually are not sufficient to deliver an inclusive economy.

Second, the identified reviews focused on a limited set of interventions. Across the full set of included reviews, the focus was predominantly on various types of active labour market programmes (n = 9) and social security interventions (n = 4). Within this, there was some consideration of interventions which might be considered further ‘upstream’, such as focusing on living/working conditions or macro-level policies. Over half of the reviews (n = 11) examined interventions focused at the level of the individual, either on interventions intended to improve knowledge and skills.

Third, in terms of intervention effects for the benefits of the economy, we identified only three high-quality reviews, and two of these concluded that there was insufficient evidence to draw upon. Of the one high-quality review available, this was still of limited use in terms of our focus on an inclusive economy as it focused on intermediate economic outcomes (i.e. moving into employment), and the review authors acknowledge that the review was more limited in its ability to synthesise evidence on job quality or the longer-term stability of the jobs that people enter. Other reviews did look at outcomes more connected to the fairness of the economy and found that unemployment insurance can have positive effects on reducing poverty and material hardship; however, these reviews were low quality [65, 73]. For active labour market programmes, despite being the most extensively evaluated intervention, much of the review-level evidence is low quality, and issues of low uptake and methodological issues limit our understanding of which specific intervention is most effective in delivering IE outcomes. The higher-quality reviews we identified indicated that there was a lack of good quality evidence to draw upon, whilst some (mostly lower-quality reviews) reported positive intervention effects. Overall, the review-level evidence suggests that programme type is likely to be important.

Fourth, in terms of intervention effects on access to the resources needed to participate in the economy, there is much more limited review-level evidence to draw upon (n = 5), and this is exclusively drawn from critically low-quality reviews, and there is a lack of overlap in specific intervention types. This means that it is not possible to synthesise across reviews (as we are not comparing ‘like with like’) as intended by the review-of-reviews methodology, and instead, high-quality reviews of primary evidence on specific interventions are indicated.

Finally, the majority of the review-level evidence (n = 14) focused on disadvantaged groups, and so the evidence base we have identified is drawn primarily from studies which are not concerned with the general population but with various smaller sub-sections. Furthermore, just two of the included reviews examined review-level outcomes which involved an inequalities/equity dimension: one looked at income inequality [74], and another examined differences in access to active labour market programmes for two minority groups. However, there was a general lack of consideration of the equity impact of exposures, interventions and policies by protected characteristics or by measures of socioeconomic status.

Discussion

We have identified a small body of review-level evidence (n = 19 reviews), of mostly low quality, which examined exposures/interventions/policies for their effects on inclusive economy outcomes. To our knowledge, this is the first review of reviews which examines the review-level evidence base through the lens of an inclusive economy.

The identified reviews focused on a small range of IE outcomes, generally limited to neoclassical view of the economy such as moving people into employment. There was limited focus on action to deliver structural-level reform in the economy; the majority of reviews focused on disadvantaged groups, with much less attention on population-wide interventions. Active labour market programmes and social security interventions were the subject of most reviews. Some positive effects were seen with these programmes on IE outcomes, although programme characteristics were likely to be important, and low uptake limited the impact at the population level.

How this review fits with existing evidence

Previous overviews have examined ‘upstream’ interventions/policies that impact on population health, including the following: the role of ‘wider’ and macro-economic determinants [16, 79], fiscal policy [20], political factors and political economy (such as the welfare state generosity, political tradition, income inequality [17, 19]), public health policies (including taxing and regulating unhealthy products) [80] and social protection and welfare-to-work policies [81, 82]. However, with one exception [20], existing reviews have focused on health or health inequalities outcomes. Intermediate outcomes (such as employment, poverty, material hardship) are key determinants of health and crucial in addressing health inequalities. Our review examines these key non-health outcomes from the perspective of an inclusive economy.

Our review also identified a general lack of consideration of the distribution of outcomes or the equity impact of the identified mechanisms; a crucial finding given equity is a fundamental principle of an inclusive economy [48]. This lack of an equity lens has been noted by others [83, 84].

The included reviews mostly focused on ‘corrective’ interventions for an economic system that has failed particular sub-groups, rather than focusing on altering the economic conditions for the general population to ensure the economy results in greater inclusion and wellbeing ‘by design’ [15, 48].

This resonates with wider health inequalities research, which has demonstrated a tendency for both research and policy to ‘drift downstream’ [85] towards interventions at the level of the individual, and to ‘treat the symptoms rather than the underlying cause of the problem, which may be located in the socioeconomic environment’ [86]. It can be harder to generate empirical evidence for ‘upstream’, macro-level change, particularly as evaluation methods from health research are not appropriate for wider public policy [79, 87]. This has contributed to the ‘inverse evidence law’: ‘we know least about the effects of those interventions that are most likely to influence the wider determinants of health’ [88].

Two recent reviews of reviews have examined the impact of the macroeconomic determinants of health and political economy on population health and health inequalities [16, 17]. A comparatively larger body of review-level evidence was identified, including reviews which examined structural-level factors (such as economic recession, income inequality and the welfare state). In comparison, we have identified a smaller body of review-level evidence. One possible explanation for this difference may be that (systematic) reviews may be a much less well-established methodology in non-health fields.

Key evidence gaps

There is a lack of reviews examining interventions and policies from the perspective of inclusive growth or inclusive economy. Included reviews did examine outcomes relevant to inclusive economy outcomes, but inclusive economy (or related concepts) was not generally the focus of the reviews. By reducing inclusive economy to its constituent parts, we identified conflicting findings across the reviews. For example, whilst one review identified that unemployment insurance coming to an end can be associated with return to work, two others suggested that unemployment insurance was important for reducing poverty. Complexity and systems thinking in appraising evidence for an inclusive economy might be needed to examine how policies connect and impact on different outcomes in different ways and how different variants of policies may have unintended consequences or negative feedback loops [15, 89, 90].

There is a need for reviews to examine a much wider set of outcomes relevant to an inclusive economy, to move beyond gaining employment as the predominant outcome and consider, for example, quality of work, adequacy and stability of income [91], as well as other economic outputs such as essential goods and services and assets such as wealth [48]. There is also a need for reviews to examine outcomes related to access to the resources needed to participate in the economy, such as access to early years/primary/secondary education and training.

The focus on, primarily, ‘corrective’ interventions/policies examined by the reviews suggests that future synthesis should examine a wide range of more ‘upstream’ exposures/interventions/policies in economic development [16, 22]. Fruitful areas for future reviews would include the following: income-based policies such as minimum income standards [92]; good work [2]; community wealth building (including anchor institutions and different forms of ownership models [93]; the delivery of affordable essential services including housing, transport, digital connectivity and food; education, training and skills (e.g. early years, childcare, primary, secondary and further education); social capital and community infrastructure (including the nonpaid economy such as caring, volunteering or mutual aid); community empowerment and engagement; and addressing equitable wealth distribution.

Finally, there is a need for review-level evidence on the equity impact of interventions and policies and how to reduce structural drivers of economic inequalities in characteristics such as gender, ethnicity and socioeconomic status in order that the evidence base considers what types of actions can result in greater economic inclusion for all.

Strength and weaknesses

This review provides a ‘bird’s-eye view’ of a broad evidence base for researchers and policymakers seeking to advance policies which might support an inclusive economy. However, a number of limitations must be considered.

First, review-level evidence provides only a partial account of the evidence across this field, and further evidence may be available in primary studies which have not yet been included in a review. A review of reviews is reliant on the information reported by review authors [94]. We were not always able to determine whether primary studies had comparators or the quality of primary studies due to incomplete reporting. Many of the included reviews highlighted a lack of primary studies with robust and controlled evaluations, and we were unable to code the effect directions for some interventions due to a lack of studies with a comparator, which limits our findings. Nevertheless, the review-of-review methodology allowed us to assess the scope of a very broad evidence base [52], which would not otherwise have been possible.

Second, it is possible some review-level evidence may be published in databases we did not search. For example, we identified only one review which examined the role of housingFootnote 9 — other evaluations of the impact of affordable housing may be published in specialised town planning or public services literature. Although we set out to examine economic, social and political exposures/interventions/policies, we did not identify any reviews which focused on the relationship between political factors (such as welfare state generosity or political tradition) and inclusive economy outcomes. Again, it may be that our search strategy was not sufficient to capture this type of literature.

Third, we defined a review as one that reported a search strategy in terms of named databases or specified search terms in order that we were able to capture literature from a range of fields and disciplines where review methodology might not apply or may be defined differently. However, this meant that we included some less well-defined reviews, which is likely reflected in the relatively low-quality scores of some of the review papers.

Fourth, the tool we used to assess the quality of included reviews is commonly used in health sciences but may be inappropriate to apply to a field where such tools are not widely applied. Although ideally we would have adjusted the ‘critical weakness’ domains prospectively, these were adjusted post hoc when we considered that we may be underestimating quality by applying stricter criteria. Furthermore, some of our included reviews date back to more than 10 years, prior to (or around the time of) the publication of the first PRISMA statement in 2009, which may explain their lower quality ratings. The degree of awareness of such guidelines in non-health fields is unknown and may also explain the lower quality ratings of some reviews.

Fifth, we are conscious that the amendment to the protocol to exclude reviews focused on low- and middle-income countries (LMIC) may have introduced bias in terms of the gaps identified in the evidence base. There were reviews which covered relevant topics examined in LMIC contexts (such as microfinance) but which were excluded and so are missing from our synthesis of review-level evidence.

Finally, our use of the outcome domains framework [48] is only one way of synthesising the evidence, and we are aware alternative conceptual models may have provided a different perspective. As there no universally agreed conceptual frameworks regarding inclusive economy outcomes or interventions, the gaps we have identified are likely partial and may miss important topics.

Implications

Three wider points for discussion are important for those working to develop and implement policy actions in this space.

First, there is the perennial issue of the methodological limitations of evaluations of policy actions, particularly as far as ‘upstream’ interventions and policies are concerned. This calls for greater collaboration between public health and economic policy to ensure that research questions and methods align and are fit for purpose in strengthening an evidence base to inform economic policy-making decisions. The necessity for public health to ‘become more economically literate’ [23] and calls for greater collaboration between public health professionals and economists, finance ministries and central banks has been previously articulated [40, 96]. Our review adds to this work and suggests the need for strong, long-term, cross-disciplinary research and policy-focused collaborations.

Second, although we identified a small review-level evidence base, this does not mean that there are no primary studies of actions relevant to an inclusive economy. Nevertheless, given that economic policy is being developed, it is necessarily happening in the absence of a clear synthesised evidence base. Systematic reviews of the areas for which there are gaps in the synthesised evidence is clearly needed. In the meantime, it may be worth examining what complimentary types of intelligence may be useful in informing policy decisions and to consider public health’s role in contributing to and appraising this evidence. For example, alongside reviews, scenario modelling of likely policy impacts [97], deliberative democracy approaches [98] and evidence on public values [99, 100] may be important.

Third, outcomes, metrics and measurement are crucial to ensure policies address their intended impacts. However, there is a lack of consensus regarding a clear set of outcomes and metrics for an inclusive economy, to what extent these are informed by citizen perspectives or how best to evaluate trade-offs [101, 102]. To date, review-level evidence has examined a restricted set of outcomes relevant to an inclusive economy, and these largely reflect a neoclassical view of economics. Key measures of an inclusive economy do not appear to be routinely monitored in evaluations of economic policies and interventions, and there is limited consideration of the ‘equity impact’ of such actions. Furthermore, we focused on inclusive economy outcomes, whilst other reviews have considered health outcomes. Combining both health and economic outcomes in future evidence synthesis might help to make trade-offs explicit. A review of ‘welfare-to-work’ policies for lone parents in receipt of social security highlighted negative impacts of such policies on health and wellbeing [81]. This illustrates that the ‘effects’ of interventions are highly dependent on the choice of outcome measure. Those working to develop policy actions to promote an inclusive economy must pay attention to the type of outcome measures chosen to evaluate policies, the need for combining economic and health measures and the equity dimension of evaluations.

Conclusions

This review has highlighted a small body of mostly low-quality review-level evidence on actions in relation to their impact on inclusive economy outcomes. The current literature focuses largely on ‘corrective’ interventions and policies, primarily focused on supporting disadvantaged groups, rather than ‘upstream’ policies intended to deliver an inclusive economy for the general population ‘by design’. Our review has identified a focus on gaining employment, at the expense of outcomes such as the quality or fairness of work, access to the resources needed to participate in the economy or whether there is greater equity (or not) in such outcomes. This review identifies key gaps in synthesised evidence and highlights the need for greater cross-disciplinary and cross-sectoral collaborations between economics and public health to support evidence-informed economic policy decision-making which can support population health and reduce health inequalities.

Availability of data and materials

All data generated or analysed during this study are included in this published article (and its supplementary information files: (1) amendments to the protocol, (2a) PRISMA 2020 checklist, (2b) PRISMA 2020 abstract checklist, (3) example search strategy, (4) data extraction and quality assessment templates, (5) Pilot GRADE assessment, (6) summary table of included reviews, (7) data extraction table for included reviews and (8) table of excluded reviews with reasons for exclusion. The full protocol was published on SocArXiv papers in January 2021 (https://doi.org/10.31235/osf.io/dctk5).

Notes

  1. ‘Insufficient evidence’ was added to the original categories in the ED template as some review authors had made this explicit.

  2. The study design column was removed as all included studies are reviews; ED arrows were not adjusted by sample size, and the study quality key was amended to reflect the AMSTAR-2 categories (high, moderate, low, critically low)

  3. Included reviews have an asterisk in the reference list.

  4. These totals include some primary studies which were conducted in settings other than high-income countries because of five reviews, whilst the majority of primary studies were conducted in high-income countries, it was not possible to specify how many due to incomplete reporting.

  5. The difference between 801 and 525 is largely due to Mocca et al. [72] which reported including 191 primary studies, but it was unclear how many PS focused on an IE outcome as the authors did not provide a list of included studies.

  6. Kluve et al. [60] examined both employment outcomes and earnings outcomes and so appears twice in Table 3.

  7. In this section, the outcome of interest is access to ALMP, and the relevant review [76] looks at which types of ALMP programmes are associated with greater access for marginal groups. In contrast, in the ‘Equitable distribution of the benefits of the economy’ section, the outcomes of interest are employment and earning, and the relevant reviews look at ALMP are a means of achieving this.

  8. Kluve et al. [60] considered quality of employment (e.g. contract type, job type) as one of their outcomes of interest; however, there was limited specific consideration of this outcome in the results synthesis; it appears only skills training had clear effects on measures of job equality, and this was more common for low-income country contexts.

  9. One notable review on housing improvements was identified but excluded as health was the primary outcome [95].

References

  1. Marmot M, Allen J, Boyce T, Goldblatt P, Morrison J. Health Equity in England: the marmot review 10 years on - The Health Foundation. 2020 [cited 2022 Mar 29]. Available from: https://www.health.org.uk/publications/reports/the-marmot-review-10-years-on

  2. Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, et al. Fair Society, Healthy Lives. The Marmot Review. Strategic Review of Health Inequalities in England post-2010. 2010. Available from: http://fair-society-healthy-lives-full-report.pdf

  3. McNamara CL, Balaj M, Thomson KH, Eikemo TA, Solheim EF, Bambra C. The socioeconomic distribution of non-communicable diseases in Europe: findings from the European Social Survey (2014) special module on the social determinants of health. Eur J Public Health. 2017;27(suppl_1):22–6.

    Article  PubMed  Google Scholar 

  4. Mackenbach JP, Kulhánová I, Artnik B, Bopp M, Borrell C, Clemens T, et al. Changes in mortality inequalities over two decades: register based study of European countries. BMJ. 2016;353:i1732.

    Article  PubMed  PubMed Central  Google Scholar 

  5. Ho JY, Hendi AS. Recent trends in life expectancy across high income countries: retrospective observational study. BMJ. 2018;362:k2562.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Fenton L, Minton J, Ramsay J, Kaye-Bardgett M, Fischbacher C, Wyper GMA, et al. Recent adverse mortality trends in Scotland: comparison with other high-income countries. BMJ Open. 2019;9(10):e029936.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Marmot M. Social causes of the slowdown in health improvement. J Epidemiol Community Health. 2018;72(5):359–60.

    Article  PubMed  Google Scholar 

  8. McCartney G, Walsh D, Fenton L, Devine R. “Resetting the course for population” health: evidence and recommendations to address stalled mortality improvements in Scotland and the rest of the UK. Glasgow: Glasgow Centre for Population Health / University of Glasgow; 2022.

    Google Scholar 

  9. Fenton L, Wyper GM, McCartney G, Minton J. Socioeconomic inequality in recent adverse all-cause mortality trends in Scotland. J Epidemiol Community Health. 2019;73(10):971–4.

    Article  PubMed  Google Scholar 

  10. Such E, Smith K, Woods HB, Meier P. Governance of intersectoral collaborations for population health and to reduce health inequalities in high-income countries: a complexity-informed systematic review. Int J Health Policy Manag. 2022;11(12):2780–92.

    PubMed  PubMed Central  Google Scholar 

  11. Smith KE, Eltanani MK. What kinds of policies to reduce health inequalities in the UK do researchers support? J Public Health. 2015;37(1):6–17.

    Article  Google Scholar 

  12. McCartney G, Dickie E, Escobar O, Collins C. Health inequalities, fundamental causes and power: towards the practice of good theory. Sociol Health Illn. 2021;43(1):20–39.

    Article  PubMed  Google Scholar 

  13. World Health Organization. The Helsinki Statement on Health in All Policies. Health Promot Int. 2014;29(Suppl 1):i17–8.

    Article  Google Scholar 

  14. WHO, Government of South Australia. The Adelaide Statement on Health in All Policies: moving towards a shared governance for health and well-being. Health Promot Int. 2010;25(2):258–60.

    Article  Google Scholar 

  15. Brand-Correa L, Brook A, Büchs M, Meier P, Naik Y, O’Neill DW. Economics for people and planet-moving beyond the neoclassical paradigm. Lancet Planet Health. 2022;6(4):e371–9.

    Article  PubMed  PubMed Central  Google Scholar 

  16. Naik Y, Baker P, Ismail SA, Tillmann T, Bash K, Quantz D, et al. Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities. BMC Public Health. 2019;19(1):1678.

    Article  PubMed  PubMed Central  Google Scholar 

  17. McCartney G, Hearty W, Arnot J, Popham F, Cumbers A, McMaster R. Impact of political economy on population health: a systematic review of reviews. Am J Public Health. 2019;109(6):e1–e12.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Sayer A, McCartney G. Economic relationships and health inequalities: improving public health recommendations. Public Health. 2021;199:103–6.

    Article  CAS  PubMed  Google Scholar 

  19. Barnish M, Tørnes M, Nelson-Horne B. How much evidence is there that political factors are related to population health outcomes? An internationally comparative systematic review. BMJ Open. 2018;8(10):e020886.

    Article  PubMed  PubMed Central  Google Scholar 

  20. Mosquera I, Gonzalez-Rabago Y, Bacigalupe A, Suhrcke M. The impact of fiscal policies on the socioeconomic determinants of health: a structured review. Int J Health Serv. 2017;47(2):189–206.

    Article  PubMed  Google Scholar 

  21. Marmot M, Allen J, Goldblatt P, Herd E, Morrison J. Build back fairer: the COVID-19 Marmot Review - the Health Foundation. London: Institute of Health Equity; 2020.

    Google Scholar 

  22. Naik Y, Abbs I, Elwell-Sutton T, Bibby J, Spencelayh E. Using economic development to improve health and reduce health inequalities. The Health Foundation; 2020.

    Book  Google Scholar 

  23. Shipton D, McCartney G, McMaster R. Population health post-pandemic: critiquing the economic approach to recovery. Public Health Pract (Oxf). 2021;2:100098.

    Article  PubMed  Google Scholar 

  24. OECD. Divided We Stand. OECD Publishing; 2011.

    Book  Google Scholar 

  25. Wilkinson R, Pickett K. In: Wilkinson, editor. The spirit level. Why more equal societies almost always do better. London: Allen Lane; 2009.

    Google Scholar 

  26. Rowlingson K. Does income inequality cause health and social problems? Joseph Rowntree Foundation; 2011.

    Google Scholar 

  27. de Dominicis L, Florax RJGM, de Groot HLF. A meta-analysis on the relationship between income inequality and economic growth. Scott J Polit Econ. 2008;55(5):654–82.

    Article  Google Scholar 

  28. Aghion P, Caroli E, García-Peñalosa C. Inequality and economic growth: the perspective of the new growth theories. J Econ Lit. 1999;37(4):1615–60.

    Article  Google Scholar 

  29. Keeley B. Income inequality: the gap between rich and poor. OECD; 2015.

    Book  Google Scholar 

  30. OECD. In it together: why less inequality benefits all. Paris: OECD Publishing; 2015.

    Book  Google Scholar 

  31. van der Wel KA, Saltkjel T, Chen W-H, Dahl E, Halvorsen K. European health inequality through the “Great Recession”: social policy matters. Sociol Health Illn. 2018;40(4):750–68.

    Article  PubMed  Google Scholar 

  32. Rajmil L, Fernández de Sanmamed M-J. Austerity policies and mortality rates in European countries, 2011-2015. Am J Public Health. 2019;109(5):768–70.

    Article  PubMed  PubMed Central  Google Scholar 

  33. Hiam L, Dorling D, McKee M. The cuts and poor health: when and how can we say that one thing causes another? J R Soc Med. 2018;111(6):199–202.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Bambra C, Lynch J, Smith KE. The unequal pandemic. Covid-19 and health inequalities. Bristol: Bristol University Press; 2021.

    Book  Google Scholar 

  35. Suleman M, Sonthalia S, Webb C, Tinson A, Kane M, Bunbury S, et al. Unequal pandemic, fairer recovery: the COVID-19 impact inquiry report. The Health Foundation; 2021.

    Book  Google Scholar 

  36. Douglas M, Katikireddi SV, Taulbut M, McKee M, McCartney G. Mitigating the wider health effects of covid-19 pandemic response. BMJ. 2020;369:m1557.

    Article  PubMed  PubMed Central  Google Scholar 

  37. McCartney G, Douglas M, Taulbut M, Katikireddi SV, McKee M. Tackling population health challenges as we build back from the pandemic. BMJ. 2021;375:e066232.

    Article  PubMed  PubMed Central  Google Scholar 

  38. McCartney G, Leyland A, Walsh D, Ruth D. Scaling COVID-19 against inequalities: should the policy response consistently match the mortality challenge? J Epidemiol Community Health. 2020;

  39. United Nations. Transforming our world: the 2030 Agenda for Sustainable Development A/RES/70/1. United Nations; 2015.

    Google Scholar 

  40. McCartney G, McMaster R, Shipton D, Harding O, Hearty W. Glossary: economics and health. J Epidemiol Community Health. 2022;

  41. Hynes W. Beyond growth: towards a new economic approach: report of the Secretary General’s Advisory Group on a New Growth Narrative. OECD

  42. Raworth K. Donut Economics. Seven ways to think like a 21st-century economist. London: Penguin Random House Business Books; 2017.

    Google Scholar 

  43. Fioramonti L, Coscieme L, Costanza R, Kubiszewski I, Trebeck K, Wallis S, et al. Wellbeing economy: an effective paradigm to mainstream post-growth policies? Ecol Econ. 2022;192:107261.

    Article  Google Scholar 

  44. Crisp R, Waite D, Green A, Hughes C, Lupton R, MacKinnon D, et al. BeyondGDP’ in cities: assessing alternative approaches to urban economic development. Manuscript submitted for publication. 2022;

  45. Lupton R, Hughes C. “Achieving” inclusive growth in Greater Manchester. What can be done? University of Manchester; 2016.

    Google Scholar 

  46. Burch D, McInroy N. “We need an inclusive economy” not inclusive growth - policy provocation. CLES; 2018.

    Google Scholar 

  47. Lupton R, Hughes C, Macdougall A, Goldwyn-Simpkins H, Hjelmskog A. Inclusive growth in Greater Manchester 2020 and beyond. Taking stock and looking forward. The University of Manchester; 2019.

    Google Scholar 

  48. Shipton D, Sarica S, Craig N, McCartney G, Katikireddi SV, Roy G, et al. Knowing the goal: an inclusive economy that can address the public health challenges of our time. J Epidemiol Community Health. 2021;75(11):1129–32.

    Article  PubMed  Google Scholar 

  49. Lee N. Inclusive growth in cities: a sympathetic critique. Reg Stud. 2018;53(3):1–11.

    MathSciNet  Google Scholar 

  50. Pollock A, Campbell P, Brunton G, Hunt H, Estcourt L. Selecting and implementing overview methods: implications from five exemplar overviews. Syst Rev. 2017;6(1):145.

    Article  PubMed  PubMed Central  Google Scholar 

  51. Hunt H, Pollock A, Campbell P, Estcourt L, Brunton G. An introduction to overviews of reviews: planning a relevant research question and objective for an overview. Syst Rev. 2018;7(1):39.

    Article  PubMed  PubMed Central  Google Scholar 

  52. Bambra C. Case study of public health. In: Biondi-Zoccai G, editor. Umbrella reviews evidence syntehsis with overviews of reviews and meta-epidemiologic studies. Basel: Springer International Publishing; 2016.

    Google Scholar 

  53. Smith V, Devane D, Begley CM, Clarke M. Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol. 2011;11(1):15.

    Article  PubMed  PubMed Central  Google Scholar 

  54. Shamseer L, Moher D, Clarke M, Ghersi D, Liberati A, Petticrew M, et al. Preferred Reporting Items for Systematic Review and Meta-Analysis Protocols (PRISMA-P) 2015: elaboration and explanation. BMJ. 2015;350:g7647.

    Article  PubMed  Google Scholar 

  55. Page MK, Bossuyt B, Hoffmann MCD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021;372:n71.

    Article  PubMed  PubMed Central  Google Scholar 

  56. Shea BJ, Reeves BC, Wells G, Thuku M, Hamel C, Moran J, et al. AMSTAR 2: a critical appraisal tool for systematic reviews that include randomised or non-randomised studies of healthcare interventions, or both. BMJ. 2017;358:j4008.

    Article  PubMed  PubMed Central  Google Scholar 

  57. Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Boon MH, Thomson H. The effect direction plot revisited: application of the 2019 Cochrane Handbook guidance on alternative synthesis methods. Res Synth Methods. 2021;12(1):29–33.

    Article  PubMed  Google Scholar 

  59. Guyatt GH, Oxman AD, Vist G, Kunz R, Brozek J, Alonso-Coello P, et al. GRADE guidelines: 4. Rating the quality of evidence--study limitations (risk of bias). J Clin Epidemiol. 2011;64(4):407–15.

    Article  PubMed  Google Scholar 

  60. Kluve J, Puerto S, Robalino D, Romero JM, Rother F, Stöterau J, et al. Interventions to improve the labour market outcomes of youth: a systematic review of training, entrepreneurship promotion, employment services and subsidized employment interventions. Campbell Syst Rev. 2017;13(1):1–288.

    Article  Google Scholar 

  61. Radey M. Informal support among low-income mothers post welfare reform: a systematic review. J Child Fam Stud. 2018;27(12):3782–805.

    Article  PubMed  PubMed Central  Google Scholar 

  62. Gensby U, Lund T, Kowalski K, Saidj M, Jørgensen AK, Filges T, et al. Workplace disability management programs promoting return to work: a systematic review. Campbell Syst Rev. 2012;8(1)

  63. Hayday S, Rick J, Carroll C, Jagger N, Hillage J. Review of the effectiveness and cost effectiveness of interventions, strategies, programmes and policies to help recipients of incapacity benefits return to employment (paid and unpaid). Brighton: Institute of Employment Studies; 2008.

    Google Scholar 

  64. Bassuk EL, DeCandia CJ, Tsertsvadze A, Richard MK. The effectiveness of housing interventions and housing and service interventions on ending family homelessness: a systematic review. Am J Orthopsychiatry. 2014;84(5):457–74.

    Article  PubMed  Google Scholar 

  65. Renahy E, Mitchell C, Molnar A, Muntaner C, Ng E, Ali F, et al. Connections between unemployment insurance, poverty and health: a systematic review. Eur J Public Health. 2018;28(2):269–75.

    Article  PubMed  Google Scholar 

  66. Filges T, Geerdsen LP, Knudsen AD, Jørgensen AK, Kowalski K. Unemployment benefit exhaustion: incentive effects on job finding rates: a systematic review. Campbell Syst Rev. 2013;9(1):1–104.

    Article  Google Scholar 

  67. Bambra C, Whitehead M, Hamilton V. Does “welfare-to-work” work? A systematic review of the effectiveness of the UK’s welfare-to-work programmes for people with a disability or chronic illness. Soc Sci Med. 2005;60(9):1905–18.

    Article  PubMed  Google Scholar 

  68. Barr B, Clayton S, Whitehead M, Thielen K, Burström B, Nylén L, et al. To what extent have relaxed eligibility requirements and increased generosity of disability benefits acted as disincentives for employment? A systematic review of evidence from countries with well-developed welfare systems. J Epidemiol Community Health. 2010;64(12):1106–14.

    Article  PubMed  Google Scholar 

  69. Clayton S, Bambra C, Gosling R, Povall S, Misso K, Whitehead M. Assembling the evidence jigsaw: insights from a systematic review of UK studies of individual-focused return to work initiatives for disabled and long-term ill people. BMC Public Health. 2011;11:170.

    Article  PubMed  PubMed Central  Google Scholar 

  70. Clayton S, Barr B, Nylen L, Burström B, Thielen K, Diderichsen F, et al. Effectiveness of return-to-work interventions for disabled people: a systematic review of government initiatives focused on changing the behaviour of employers. Eur J Public Health. 2012;22(3):434–9.

    Article  PubMed  Google Scholar 

  71. Ott E, Montgomery P. Interventions to improve the economic self-sufficiency and well-being of resettled refugees: a systematic review. Campbell Syst Rev. 2015;11(1):1–53.

    Article  Google Scholar 

  72. Mocca E, Rojon C, Hernández J. Great expectations? A systematic review of the relationship between the school-to-higher education transition and social mobility. Sociol Spectr. 2019;39(4):264–80.

    Article  Google Scholar 

  73. O’Campo P, Molnar A, Ng E, Renahy E, Mitchell C, Shankardass K, et al. Social welfare matters: a realist review of when, how, and why unemployment insurance impacts poverty and health. Soc Sci Med. 2015;132:88–94.

    Article  PubMed  Google Scholar 

  74. Heshmati A, Kim J, Wood J. A survey of inclusive growth policy. Economies. 2019;7(3):65.

    Article  Google Scholar 

  75. Mishra S. Social networks, social capital, social support and academic success in higher education: a systematic review with a special focus on “underrepresented” students. Educ Res Rev. 2020;29:100307.

    Article  Google Scholar 

  76. Bonoli G, Liechti F. Good intentions and Matthew effects: access biases in participation in active labour market policies. J Eur Public Policy. 2018;25(6):894–911.

    Article  Google Scholar 

  77. Jennings L. Do men need empowering too? A systematic review of entrepreneurial education and microenterprise development on health disparities among inner-city black male youth. J Urban Health. 2014;91(5):836–50.

    Article  PubMed  PubMed Central  Google Scholar 

  78. Herbaut E, Geven K. What works to reduce inequalities in higher education? A systematic review of the (quasi-)experimental literature on outreach and financial aid. Res Soc Stratif Mobil. 2020;65:100442.

    Google Scholar 

  79. Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health. 2010;64(4):284–91.

    Article  CAS  PubMed  Google Scholar 

  80. Thomson K, Hillier-Brown F, Todd A, McNamara C, Huijts T, Bambra C. The effects of public health policies on health inequalities in high-income countries: an umbrella review. BMC Public Health. 2018;18(1):869.

    Article  PubMed  PubMed Central  Google Scholar 

  81. Campbell M, Thomson H, Fenton C, Gibson M. Health and wellbeing of lone parents in welfare to work: a systematic review of qualitative studies. Lancet. 2015;386:S27.

    Article  Google Scholar 

  82. Hillier-Brown F, Thomson K, Mcgowan V, Cairns J, Eikemo TA, Gil-Gonzále D, et al. The effects of social protection policies on health inequalities: evidence from systematic reviews. Scand J Public Health. 2019;47(6):655–65.

    Article  PubMed  Google Scholar 

  83. Lorenc T, Petticrew M, Welch V, Tugwell P. What types of interventions generate inequalities? Evidence from systematic reviews. J Epidemiol Community Health. 2013;67(2):190–3.

    Article  PubMed  Google Scholar 

  84. Macintyre AK, Torrens C, Campbell P, Maxwell M, Pollock A, Biggs H, et al. Socioeconomic inequalities and the equity impact of population-level interventions for adolescent health: an overview of systematic reviews. Public Health. 2020;180:154–62.

    Article  CAS  PubMed  Google Scholar 

  85. Douglas M. Beyond “health”: why don’t we tackle the cause of heatlh inequalities? In: Smith KE, Hill S, Bambra C, editors. Health inequalities: Critical perspectives. Oxford: Oxford University Press; 2016. p. 109–23.

    Google Scholar 

  86. Whitehead M. A typology of actions to tackle social inequalities in health. J Epidemiol Community Health. 2007;61(6):473–8.

    Article  PubMed  PubMed Central  Google Scholar 

  87. Petticrew M, Whitehead M, Macintyre SJ, Graham H, Egan M. Evidence for public health policy on inequalities: 1: the reality according to policymakers. J Epidemiol Community Health. 2004;58(10):811–6.

    Article  PubMed  PubMed Central  Google Scholar 

  88. Ogilvie D, Egan M, Hamilton V, Petticrew M. Systematic reviews of health effects of social interventions: 2. Best available evidence: how low should you go? J Epidemiol Community Health. 2005;59(10):886–92.

    Article  PubMed  PubMed Central  Google Scholar 

  89. Meadows D. Thinking in systems. A Primer. London: Chelsea Green Publishing; 2008.

    Google Scholar 

  90. Hong QN, Bangpan M, Stansfield C, Kneale D, O’Mara-Eves A, van Grootel L, et al. Using systems perspectives in evidence synthesis: a methodological mapping review. Res Synth Methods. 2022;

  91. Tinson A. What the quality of work means for our health. The Health Foundation; 2020.

    Google Scholar 

  92. Gibson M, Hearty W, Craig P. Potential effects of universal basic income: a scoping review of evidence on impacts and study characteristics. Lancet. 2018;392:S36.

    Article  Google Scholar 

  93. Tod E, Shipton D, McCartney G, Sarica S, Scobie G, Parkinson J, et al. What is the potential for plural ownership to support a more inclusive economy? A systematic review protocol. Syst Rev. 2022;11(1):76.

    Article  PubMed  PubMed Central  Google Scholar 

  94. Caird J, Sutcliffe K, Kwan I, Dickson K, Thomas J. Mediating policy-relevant evidence at speed: are systematic reviews of systematic reviews a useful approach? Evid Policy. 2015;11(1):81–97.

    Article  Google Scholar 

  95. Thomson H, Thomas S, Sellstrom E, Petticrew M. Housing improvements for health and associated socio-economic outcomes. Cochrane Database Syst Rev. 2013;(2):CD008657.

  96. Naik Y, Brook A, Perraton J, Meier P. Fiscal and monetary policies: the cutting edge of advocacy and research on population health and climate change. Perspect Public Health. 2021;141(6):325–7.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  97. McAuley A, Denny C, Taulbut M, Mitchell R, Fischbacher C, Graham B, et al. Informing investment to reduce inequalities: a modelling approach. PLoS One. 2016;11(8):e0159256.

    Article  PubMed  PubMed Central  Google Scholar 

  98. Smith KE, Macintyre AK, Weakley S, Hill SE, Escobar O, Fergie G. Public understandings of potential policy responses to health inequalities: Evidence from a UK national survey and citizens’ juries in three UK cities. Soc Sci Med. 2021;291:114458.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  99. McHugh N. Eliciting public values on health inequalities: missing evidence for policy windows? Evid Policy. 2021;

  100. Baker R, Mason H, McHugh N, Donaldson C. Public values and plurality in health priority setting: what to do when people disagree and why we should care about reasons as well as choices. Soc Sci Med. 2021;277:113892.

    Article  PubMed  PubMed Central  Google Scholar 

  101. Hoekstra R. Measuring the wellbeing economy: how to go beyond-GDP. Wellbeing Economy Alliance; 2020 Jan [cited 2020 Jan 1] p. 18. Available from: https://wellbeingeconomy.org/wp-content/uploads/WeAll-BRIEFINGS-Measuring-the-Wellbeing-economy-v6.pdf

  102. Hill O’Connor C, Smith K, Hughes C, Meier P, Purshouse R. Operationalizing inclusive growth: can malleable ideas survive metricized governance? Public Adm. 2023;

Download references

Acknowledgements

We would like to thank Neil Chalmers for his help with screening and Fiona Campbell and Rachel Thomson for their advice on synthesis.

Funding

This work received no external funding. Public Health Scotland is the organisational sponsor of the review.

Author information

Authors and Affiliations

  1. Place and Wellbeing, Public Health Scotland, Edinburgh, EH12 9EB, UK

    Anna K. Macintyre, Deborah Shipton, Shifa Sarica, Graeme Scobie & Neil Craig

  2. School of Social & Political Sciences, University of Glasgow, Glasgow, UK

    Gerry McCartney

Authors
  1. Anna K. Macintyre
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Deborah Shipton
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Shifa Sarica
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Graeme Scobie
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Neil Craig
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Gerry McCartney
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

AM, methodology, validation, formal analysis, investigation and writing — original draft; DS, conceptualisation, methodology, validation, formal analysis, investigation, writing — review and editing, project administration and supervision; SS, conceptualisation, methodology, validation, investigation, writing — review and editing and project administration; GS, formal analysis, methodology, validation, formal analysis, investigation and writing — review and editing; NC, methodology and writing — review and editing; and GMC, methodology and writing — review and editing.

Corresponding author

Correspondence to Anna K. Macintyre.

Ethics declarations

Ethics approval and consent to participate

No ethics was required for the current study.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Additional information

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Additional file 1.

 Amendments to the protocol.

Additional file 2.

 2aPRISMA 2020 Checklist. 2bPRISMA 2020 for Abstracts Checklist.

Additional file 3.

 Example Search Strategy (MEDLINE (Ovid)).

Additional file 4.

 Data extraction and Quality assessment templates.

Additional file 5.

 Pilot GRADE assessment for example intervention area: social security.

Additional file 6.

 Summary table of included reviews.

Additional file 7.

 Data extraction and QA for included reviews.

Additional file 8.

 Excluded reviews.

Rights and permissions

Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Macintyre, A.K., Shipton, D., Sarica, S. et al. Assessing the effects of population-level political, economic and social exposures, interventions and policies on inclusive economy outcomes for health equity in high-income countries: a systematic review of reviews. Syst Rev 13, 58 (2024). https://doi.org/10.1186/s13643-023-02429-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • DOI: https://doi.org/10.1186/s13643-023-02429-5

Keywords

Systematic Reviews

ISSN: 2046-4053