Two citizens' juries of 25 people each will decide which income support policies—such as changes to child benefit or pension credits—get tested in a computer model that simulates their effects on UK health over 30 years. This matters because child poverty drives lifelong health inequalities, yet policymakers lack clear evidence on which income support policies actually improve health without causing unintended economic side effects like inflation or job losses. Current models either ignore macroeconomic feedback or fail to track health effects across childhood and old age. If successful, the project will produce an open-source simulation tool that lets government analysts test policies before implementation. The model will show how changes in household income affect health at five life stages—from toddlers to pensioners—while simultaneously estimating impacts on regional employment, wages, and productivity. This could transform how the Treasury and Department for Work and Pensions evaluate the health consequences of tax and benefit changes, replacing guesswork with quantified projections of inequality reduction over 5, 20, and 30-year horizons.
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Economic circumstances are major drivers of health and health inequalities. Child poverty is particularly important as effects accrue over the life course. Government income support policies could improve population health, but we do not know which policies will be most effective. Appraisal requires integration of microeconomic (individual/household) and macroeconomic (country/region) modelling to ensure there are no unintended consequences. This proposal for a simulation that incorporates such complexity builds on an NIHR Application Development Award (NIHR154243) from a call for actionable evidence on the health impacts of major income support policies (MISPs). Aim: evaluate the potential for publicly acceptable MISPs to improve population health and reduce health inequalities RQ1. What are public and stakeholder preferences for the design of MISPs? RQ2. Would income changes from MISPs causally affect the health of children and pensioners? RQ3. What are the macroeconomic consequences (e.g. inflation) of MISPs for UK regions? RQ4. How effective would MISPs be in reducing multiple and intersecting health inequalities over the next 5, 10, 20, and 30 years? RQ5. Taking macroeconomic responses into account, what are the costs and benefits of implementing MISPs? The project involves a mixed methods design across five linked work packages. WP1. Developing policy scenarios with citizens’ juries (RQ1) Decisions around policy characteristics, such as the level of income support, could alter any resulting health or economic impacts. Two citizens’ juries of 25 people from a range of backgrounds will be held to design MISPs to be modelled in WP4. WP2. Extending existing microsimulation model to cover the entire life course (RQ2) We will extend our existing microsimulation model to cover the entire life course using causal epidemiological methods to estimate the effects of parents’ income changes on health in early childhood (age under 5), mid-childhood (age 7-8), and adolescence (age 10-15), plus health effects of income changes on adults entering (16-24) or permanently leaving (age 65 and over) the labour market. WP3. Integrating macroeconomic and microsimulation modelling (RQ3) An open-source macroeconomic model will be constructed and linked with the extended microsimulation from WP2. The macroeconomic model will estimate the inter-relationships between productivity, consumption, employment, and wages for regions under MISPs defined in WP1. An iterative process will ensure the predicted level of employment is consistent between the microsimulation and macroeconomic model. WP4. Conducting policy scenario analysis (RQ4) MISP interventions specified in WP1 will be run in the linked micro-macro simulation model to estimate impacts on population health and health inequalities. To assess uncertainty the model will be run multiple times using different settings for key parameters. WP5. Integrating health economic evaluation (RQ5) Following published guidance for public health interventions, a cost-consequence analysis will be conducted to enable evaluation of multiple outcomes relevant to stakeholders. All analyses will investigate multiple axes of health inequalities. Impact There is limited actionable evidence to utilise MISPs to influence health and health inequalities. Simulation studies can address this evidence gap and inform current public and stakeholder interest in the potential of MISPs.
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