Transcript Title of presentation here

The economics of prevention
and health inequalities:
what do we know?
Neil Craig
Principal Public Health Advisor
NHS Health Scotland
Faculty of Public Health Scottish Conference
6th November 2014
Outline
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•
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Context
Scope
Evidence
Conclusions
Key messages
• The evidence base is limited but growing
• We know quite a lot about the types of
prevention programmes likely to work
• We know less about savings that can be made
• Using evidence to inform decisions needs to
involve dialogue with local partners
Context
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•
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Health inequalities
Social determinants of health
Community planning
Top down and/or bottom up
Financial sustainability
=> Economic analysis
Scope
Potential benefits of prevention
• Better health
• Reduced health inequalities
• Reduced ‘failure demand’
Cost-effective
Savings from
reduced ‘failure
demand’
Likely to reduce health inequalities
Evidence
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•
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NICE
ACE
Marmot
WHO
Inequalities Policy Review, NHS Health
Scotland
• Macintyre
• Kings Fund, PHE and IHE
• Expert opinion….
What does the evidence say?
• Most cost-effective - societal perspective,
fiscal/regulation/legislation-based
• Many cost-saving
• Individual-based prevention interventions –
many cost-effective
• But evidence more mixed…
• …and less likely to reduce HIs
• There is limited evidence on potential savings
Best preventative programmes
• ensure adequate incomes and reduce income
inequalities
• reduce unemployment in vulnerable groups or areas
• improve physical environments
• target vulnerable groups by investing in more
intensive services and other forms of support for
such groups, in the context of universal provision
• early years programmes
• policies that use regulation and price (Minimum Unit
Price or taxes) to reduce risky behaviours
Implications for local decisions?
• Would this evidence generalise:
- circumstances?
- priorities?
• How does it fit with community planning?
• How does it fit with community-led, assetsbased approaches?
• What can be done at local level?
Implications for using evidence
• ‘Non-linear’ and deliberative
• Engagement and co-production
• Labour intensive: need to maximise use of HE
capacity
HENS
• Capacity survey
• Capacity building
• Pilot projects
• Seminars
• Website
http://www.scotphn.net/projects/current_proje
cts/health_economics_network_for_scotland_h
ens
Conclusions
We can say:
• A lot of prevention is cost-effective
• A lot of prevention upstream is cost-effective
and more likely to reduce health inequalities
We can’t say:
• That savings will necessarily follow
‘downstream’
• What is the best mix locally
We need to engage people in the process of
using evidence