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J Epidemiol Community Health. 2019 Feb;73(2):162-167. doi: 10.1136/jech-2018-211141. Epub 2018 Nov 23.

Evaluating effects of recent changes in NHS resource allocation policy on inequalities in amenable mortality in England, 2007-2014: time-series analysis.

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Public Health Wales, Cardiff, UK.
Department of Public Health, University of Liverpool, Liverpool, UK.
Division of Population Medicine, School of Medicine, Cardiff University, Neuadd Meirionnydd, University Hospital of Wales, Cardiff, UK.



Health investment in England post-2010 has increased at lower rates than previously, with proportionally less being allocated to deprived areas. This study seeks to explore the impact of this on inequalities in amenable mortality between local areas.


We undertook a time-series analysis across 324 lower-tier local authorities in England, evaluating the impact of changes in funding allocations to health commissioners from 2007 to 2014 on spatial inequalities in age-standardised under-75 mortality rates for conditions amenable to healthcare for men and women, adjusting for trends in household income, unemployment and time-trends.


More deprived areas received proportionally more funding between 2007 and 2014, though the reorganisation of commissioning in 2012 stalled this. Funding increases to more deprived local areas accounted for a statistically significant reduction in inequalities in male amenable mortality between local areas of 13 deaths per 100 000 (95% CI 2.5 to 25.9). Funding changes were associated with a reduction in inequalities in female amenable mortality of 7.0 per 100,000, though this finding did not reach significance (p=0.09).


Current National Health Service (NHS) resource allocation policy in England appears to be contributing to a convergence in health outcomes between affluent and deprived areas. However, careful surveillance is needed to evaluate whether diminished allocations to more deprived areas in recent years and reduced NHS investment as a whole is impacting adversely on inequalities between groups.


inequalities; policy; public health; time-series

Conflict of interest statement

Competing interests: VA is supported by the National Centre for Population Health & Wellbeing Research (NCPHWR).

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