Health Equity and its Economic Determinants (HEED): A Pan-European Microsimulation model for Health impacts of Income and Social Security Policies

Economic determinants, such as income and employment, are key drivers of population health and health inequalities, but have rarely been included in modelling studies to inform policy. This innovative project will develop the Health Equity and its Economic Determinants (HEED) model to investigate the impacts of taxation and social security policies on population health and mortality across Europe. There are 4 phases: 1) creating effect estimates for model inputs, 2) developing the model, 3) trialling policy simulations in one European country (UK), and 4) Europe-wide policy simulations. In phase 1, we will use causal approaches to analyse longitudinal data (the UK Household Longitudinal Study and Swedish registers), to estimate effects of changes in household income and employment status on health status (SF-12), mental health (GHQ-12 and psychotropic medications), life satisfaction and all-cause mortality. In phase 2, we will build a microsimulation policy model based on a representative synthetic UK population. We will develop projections for one, five and 10-year time periods, accounting for pre-existing demographic, epidemiological and economic trends. We will validate HEED by comparing projections with data not used in model construction. In phase 3, we will model the health equity impacts of alternative income tax and social security policies, developed with policymakers. Probabilistic sensitivity analyses will test key model assumptions and uncertainties. In phase 4, we will adapt the microsimulation model for implementation across a further 23 European Union countries. We will populate the model using available survey and demographic data to study impacts on levels of and inequalities in all-cause mortality, self-rated health, depression (PHQ-9) and life satisfaction over one and five years. Ex-ante impacts of reforms, as well as contemporaneous policy swaps, will be investigated to understand how best to reduce health inequalities across Europe.