权力下放对健康的影响：英格兰大曼彻斯特的广义综合控制分析。
The effect of devolution on health: a generalised synthetic control analysis of Greater Manchester, England.
机构信息
Health Organisation, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK.
Health Organisation, Policy and Economics (HOPE) Research Group, Centre for Primary Care and Health Services Research, University of Manchester, Manchester, UK.
出版信息
Lancet Public Health. 2022 Oct;7(10):e844-e852. doi: 10.1016/S2468-2667(22)00198-0.
BACKGROUND
The devolution of public services from central to local government can increase sensitivity to local population needs but might also reduce the expertise and resources available. Little evidence is available on the impact of devolution on population health. We evaluated the effect of devolution affecting health services and wider determinants of health on life expectancy in Greater Manchester, England.
METHODS
We estimated changes in life expectancy in Greater Manchester relative to a control group from the rest of England (excluding London), using a generalised synthetic control method. Using local district-level data collected between Jan 1, 2006 and Dec 31, 2019, we estimated the effect of devolution on the whole population and stratified by sex, district, income deprivation, and baseline life expectancy.
FINDINGS
After devolution, from November, 2014, life expectancy in Greater Manchester was 0·196 years (95% CI 0·182-0·210) higher than expected when compared with the synthetic control group with similar pre-devolution trends. Life expectancy was protected from the decline observed in comparable areas in the 2 years after devolution and increased in the longer term. Increases in life expectancy were observed in eight of ten local authorities, were larger among men than women (0·338 years [0·315-0·362] for men; 0·057 years [0·040-0·074] for women), and were larger in areas with high income deprivation (0·390 years [0·369-0·412]) and lower life expectancy before devolution (0·291 years [0·271-0·311]).
INTERPRETATION
Greater Manchester had better life expectancy than expected after devolution. The benefits of devolution were apparent in the areas with the highest income deprivation and lowest life expectancy, suggesting a narrowing of inequalities. Improvements were likely to be due to a coordinated devolution across sectors, affecting wider determinants of health and the organisation of care services.
FUNDING
The Health Foundation and the National Institute for Health and Care Research.
背景
公共服务从中央政府下放到地方政府可以提高对当地人口需求的敏感度，但也可能减少可用的专业知识和资源。关于权力下放对人口健康的影响，证据很少。我们评估了权力下放对健康服务和更广泛的健康决定因素对英格兰大曼彻斯特地区预期寿命的影响。
方法
我们使用广义综合控制法，根据英格兰其他地区（不包括伦敦）的对照组，估计大曼彻斯特地区预期寿命的变化。使用当地地区一级 2006 年 1 月 1 日至 2019 年 12 月 31 日期间收集的数据，我们根据性别、地区、收入贫困程度和基线预期寿命对权力下放对整个人口的影响进行了分层估计。
结果
权力下放后，从 2014 年 11 月开始，与具有类似前期权力下放趋势的合成对照组相比，大曼彻斯特地区的预期寿命高出 0.196 岁（95%CI 0.182-0.210）。在权力下放后的两年内，预期寿命免受可比地区下降的影响，并在长期内有所增加。在十个地方当局中的八个地方观察到预期寿命的增加，男性的增加幅度大于女性（男性 0.338 岁[0.315-0.362]；女性 0.057 岁[0.040-0.074]），在收入贫困程度较高的地区（0.390 岁[0.369-0.412]）和权力下放前预期寿命较低的地区（0.291 岁[0.271-0.311]）增幅更大。
解释
权力下放后，大曼彻斯特地区的预期寿命好于预期。权力下放的好处在收入贫困程度最高和预期寿命最低的地区显而易见，表明不平等程度有所缩小。改进可能是由于各部门协调下放，影响更广泛的健康决定因素和护理服务的组织。
资金
健康基金会和国家卫生与保健研究所。
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