abstract: 'Background: The social determinants of health have been widely

  recognised yet there remains a lack of clarity regarding what constitute

  the macro-economic determinants of health and what can be done to

  address them. An umbrella review of systematic reviews was conducted to

  identify the evidence for the health and health inequalities impact of

  population level macroeconomic factors, strategies, policies and

  interventions.

  Methods: Nine databases were searched for systematic reviews meeting the

  Database of Abstracts of Reviews of Effects (DARE) criteria using a

  novel conceptual framework. Studies were assessed for quality using a

  standardised instrument and a narrative overview of the findings is

  presented.

  Results: The review found a large (n = 62) but low quality systematic

  review-level evidence base. The results indicated that action to promote

  employment and improve working conditions can help improve health and

  reduce gender-based health inequalities. Evidence suggests that market

  regulation of tobacco, alcohol and food is likely to be effective at

  improving health and reducing inequalities in health including strong

  taxation, or restriction of advertising and availability. Privatisation

  of utilities and alcohol sectors, income inequality, and economic crises

  are likely to increase health inequalities. Left of centre governments

  and welfare state generosity may have a positive health impact, but

  evidence on specific welfare interventions is mixed. Trade and trade

  policies were found to have a mixed effect. There were no systematic

  reviews of the health impact of monetary policy or of large economic

  institutions such as central banks and regulatory organisations.

  Conclusions: The results of this study provide a simple yet

  comprehensive framework to support policy-makers and practitioners in

  addressing the macroeconomic determinants of health. Further research is

  needed in low and middle income countries and further reviews are needed

  to summarise evidence in key gaps identified by this review.'
affiliation: 'Naik, Y (Corresponding Author), Leeds Teaching Hosp NHS Trust, Beckett
  St, Leeds LS9 7TF, W Yorkshire, England.

  Naik, Y (Corresponding Author), Univ Liverpool, Dept Publ Hlth \& Policy, 3rd Floor,Whelan
  Bldg,Brownlow Hill, Liverpool L69 3GB, Merseyside, England.

  Naik, Yannish; Kelly, Gill; Roderick, Peter, Leeds Teaching Hosp NHS Trust, Beckett
  St, Leeds LS9 7TF, W Yorkshire, England.

  Naik, Yannish; Barr, Ben, Univ Liverpool, Dept Publ Hlth \& Policy, 3rd Floor,Whelan
  Bldg,Brownlow Hill, Liverpool L69 3GB, Merseyside, England.

  Baker, Peter, Imperial Coll London, Global Hlth \& Dev Grp, Sch Publ Hlth, St Marys
  Campus,Norfolk Pl, London W2 1PG, England.

  Ismail, Sharif A., London Sch Hyg \& Trop Med, Dept Global Hlth \& Dev, 15-17 Tavistock
  Pl, London WC1H 9SH, England.

  Ismail, Sharif A., Imperial Coll London, Dept Primary Care \& Publ Hlth, Reynolds
  Bldg,St Dunstans Rd, London W6 8RP, England.

  Tillmann, Taavi, UCL, Inst Global Hlth, Ctr Global Noncommunicable Dis, 30 Guilford
  St, London WC1N 1EH, England.

  Bash, Kristin; Black, Michelle, Univ Sheffield, Sch Hlth \& Related Res ScHARR,
  30 Regent St, Sheffield S1 4DA, S Yorkshire, England.

  Quantz, Darryl, Hlth Educ England North West, NW Sch Publ Hlth, First Floor Regatta
  Pl,Business Pk,Summers Rd, Liverpool L3 4BL, Merseyside, England.

  Hillier-Brown, Frances, Univ Durham, Dept Sport \& Exercise Sci, 42 Old Elvet, Durham
  DH1 3HN, England.

  Jayatunga, Wikum, UCL, Inst Hlth Informat, 222 Euston Rd, London NW1 2DA, England.

  Bambra, Clare, Newcastle Univ, Fac Med Sci, Royal Victoria Infirm, Sir James Spence
  Bldg, Newcastle Upon Tyne NE1 4LP, Tyne \& Wear, England.'
article-number: '1678'
author: Naik, Yannish and Baker, Peter and Ismail, Sharif A. and Tillmann, Taavi and
  Bash, Kristin and Quantz, Darryl and Hillier-Brown, Frances and Jayatunga, Wikum
  and Kelly, Gill and Black, Michelle and Gopfert, Anya and Roderick, Peter and Barr,
  Ben and Bambra, Clare
author-email: yannishnaik@nhs.net
author_list:
- family: Naik
  given: Yannish
- family: Baker
  given: Peter
- family: Ismail
  given: Sharif A.
- family: Tillmann
  given: Taavi
- family: Bash
  given: Kristin
- family: Quantz
  given: Darryl
- family: Hillier-Brown
  given: Frances
- family: Jayatunga
  given: Wikum
- family: Kelly
  given: Gill
- family: Black
  given: Michelle
- family: Gopfert
  given: Anya
- family: Roderick
  given: Peter
- family: Barr
  given: Ben
- family: Bambra
  given: Clare
da: '2023-09-28'
doi: 10.1186/s12889-019-7895-6
eissn: 1471-2458
files: []
journal: BMC PUBLIC HEALTH
keywords: 'Economy; Social determinants of health; Population health; Economic

  policy; Health inequalities; Macroeconomy; Public health; Regulation'
keywords-plus: 'POPULATION-LEVEL INTERVENTIONS; EXCESSIVE ALCOHOL-CONSUMPTION; INCOME

  INEQUALITY; ECONOMIC CRISES; WELFARE REGIMES; CHILD HEALTH; MORTALITY;

  POLICIES; OUTCOMES; POVERTY'
language: English
month: DEC 17
number: '1'
number-of-cited-references: '99'
orcid-numbers: 'Ismail, Sharif/0000-0001-7246-7337

  Tillmann, Taavi/0000-0002-8428-3719

  Bambra, Clare l/0000-0002-1294-6851

  Black, Michelle/0000-0002-8358-9150

  Barr, Ben R/0000-0002-4208-9475

  Jayatunga, Wikum/0000-0002-3063-8975

  Hillier-Brown, Frances/0000-0001-9031-4801

  Bash, Kristin/0000-0003-3839-3308

  Gopfert, Anya/0000-0002-1678-4773'
papis_id: ca42c5c613ce8096f76216dba25827ca
ref: Naik2019goingupstream
researcherid-numbers: 'Ismail, Sharif/ABD-5364-2021

  Tillmann, Taavi/R-6026-2016

  Bambra, Clare l/C-1392-2010

  Black, Michelle/IUL-1582-2023

  Barr, Ben R/W-9989-2018

  '
tags:
- review
times-cited: '33'
title: Going upstream - an umbrella review of the macroeconomic determinants of health
  and health inequalities
type: Review
unique-id: WOS:000511639000001
usage-count-last-180-days: '1'
usage-count-since-2013: '24'
volume: '19'
web-of-science-categories: Public, Environmental \& Occupational Health
year: '2019'