"Profits before people"? A systematic review of the health and safety impacts of privatising public utilities and industries in developed countries

Privatization and Multi-Fatality Disasters: A Causal Connection Exposing Both Worker and Citizen Health and Safety Failures in the UK?

Although several countries have experienced large-scale privatization initiatives, relatively little is known about the impact of these initiatives on the health and safety of workers and resident populations. Examining data on technical (as compared to natural) multi-fatality disasters collected in the WHO's Emergency Events Database (EM-DAT) for the UK and a number of European comparator countries for recent decades, this paper shows that the incidence of these disasters and the number of deaths resulting from them rose significantly in the UK during the period from 1979 to 1991 when the country engaged in extensive and aggressive privatization campaigns which were supported by several consecutive Conservative governments. This observed UK blip or abnormal increase in multi-fatality disasters is apparent for the UK both in terms of a "within-country" comparison (i.e., when we compare the privatization period of 1979 to 1997 with other periods), as well as when viewed in terms of comparisons with the comparable European countries of Germany, France, and Italy for the same period (1979 to 1997). Contrary to previous analyses which suggested that there is no clear link between privatization and deterioration of health and safety, this paper concludes that the UK privatization experience (1979-1997) provides robust country-specific evidence of privatization initiatives leading to increases in the number of multi-fatality technological disasters as well as related fatalities. This evidence should be seen as a deterrent to similarly extensive and aggressive initiatives which, particularly in less developed countries, could result in similarly disastrous outcomes.

National or population level interventions addressing the social determinants of mental health - an umbrella review

BACKGROUND

Social circumstances in which people live and work impact the population's mental health. We aimed to synthesise evidence identifying effective interventions and policies that influence the social determinants of mental health at national or scaled population level. We searched five databases (Cochrane Library, Global Health, MEDLINE, EMBASE and PsycINFO) between Jan 1st 2000 and July 23rd 2019 to identify systematic reviews of population-level interventions or policies addressing a recognised social determinant of mental health and collected mental health outcomes. There were no restrictions on country, sub-population or age. A narrative overview of results is provided. Quality assessment was conducted using Assessment of Multiple Systematic Reviews (AMSTAR 2). This study was registered on PROSPERO (CRD42019140198).

RESULTS

We identified 20 reviews for inclusion. Most reviews were of low or critically low quality. Primary studies were mostly observational and from higher income settings. Higher quality evidence indicates more generous welfare benefits may reduce socioeconomic inequalities in mental health outcomes. Lower quality evidence suggests unemployment insurance, warm housing interventions, neighbourhood renewal, paid parental leave, gender equality policies, community-based parenting programmes, and less restrictive migration policies are associated with improved mental health outcomes. Low quality evidence suggests restriction of access to lethal means and multi-component suicide prevention programmes are associated with reduced suicide risk.

CONCLUSION

This umbrella review has identified a small and overall low-quality evidence base for population level interventions addressing the social determinants of mental health. There are significant gaps in the evidence base for key policy areas, which limit ability of national policymakers to understand how to effectively improve population mental health.

The Commercial Determinants of Three Contemporary National Crises: How Corporate Practices Intersect With the COVID-19 Pandemic, Economic Downturn, and Racial Inequity

Policy Points  The United States finds itself in the middle of an unprecedented combination of crises: a global pandemic, economic crisis, and unprecedented civic responses to structural racism.  While public sector responses to these crises have faced much justified criticism, the commercial determinants of these crises have not been sufficiently examined.  In this commentary we examine the nature of the contributions of such actors to the conditions that underpin these crises in the United States through their market and nonmarket activities.  On the basis of this analysis, we make recommendations on the role of governance and civil society in relation to such commercial actors in a post-COVID-19 world.

Identifying profiles of complementary and alternative medicine believers and/or users

The present study focuses on the identification of profiles of CAM believers and/or users. Using data from the Spanish CIS Barometer (2018) and a sample of 2486 Spaniards, a hierarchical and non-hierarchical cluster analysis and discriminant analysis have been performed. Profiles of people with a high level of belief in CAM and/or CAM users were identified. Results reflect relationships between personal factors (healthy lifestyle and status, political and religious ideology) and satisfaction with conventional medicine with the belief/use of CAM. Personal factors and satisfaction are not related to the level of belief in CAM. We have tried to fulfil some gaps detected in the literature: much of the research has been methodologically limited and there is a need to deepen the study of factors and processes that favor the initial uptake and subsequent use of CAM. Doing this, this paper offers diverse recommendations for organizations worried about this theme.

Going upstream - an umbrella review of the macroeconomic determinants of health and health inequalities

BACKGROUND

The social determinants of health have been widely recognised yet there remains a lack of clarity regarding what constitute the macro-economic determinants of health and what can be done to address them. An umbrella review of systematic reviews was conducted to identify the evidence for the health and health inequalities impact of population level macroeconomic factors, strategies, policies and interventions.

METHODS

Nine databases were searched for systematic reviews meeting the Database of Abstracts of Reviews of Effects (DARE) criteria using a novel conceptual framework. Studies were assessed for quality using a standardised instrument and a narrative overview of the findings is presented.

RESULTS

The review found a large (n = 62) but low quality systematic review-level evidence base. The results indicated that action to promote employment and improve working conditions can help improve health and reduce gender-based health inequalities. Evidence suggests that market regulation of tobacco, alcohol and food is likely to be effective at improving health and reducing inequalities in health including strong taxation, or restriction of advertising and availability. Privatisation of utilities and alcohol sectors, income inequality, and economic crises are likely to increase health inequalities. Left of centre governments and welfare state generosity may have a positive health impact, but evidence on specific welfare interventions is mixed. Trade and trade policies were found to have a mixed effect. There were no systematic reviews of the health impact of monetary policy or of large economic institutions such as central banks and regulatory organisations.

CONCLUSIONS

The results of this study provide a simple yet comprehensive framework to support policy-makers and practitioners in addressing the macroeconomic determinants of health. Further research is needed in low and middle income countries and further reviews are needed to summarise evidence in key gaps identified by this review.

TRIAL REGISTRATION

Protocol for umbrella review prospectively registered with PROSPERO CRD42017068357.

The effects of public health policies on health inequalities in high-income countries: an umbrella review

BACKGROUND

Socio-economic inequalities are associated with unequal exposure to social, economic and environmental risk factors, which in turn contribute to health inequalities. Understanding the impact of specific public health policy interventions will help to establish causality in terms of the effects on health inequalities.

METHODS

Systematic review methodology was used to identify systematic reviews from high-income countries that describe the health equity effects of upstream public health interventions. Twenty databases were searched from their start date until May 2017. The quality of the included articles was determined using the Assessment of Multiple Systematic Reviews tool (AMSTAR).

RESULTS

Twenty-nine systematic reviews were identified reporting 150 unique relevant primary studies. The reviews summarised evidence of all types of primary and secondary prevention policies (fiscal, regulation, education, preventative treatment and screening) across seven public health domains (tobacco, alcohol, food and nutrition, reproductive health services, the control of infectious diseases, the environment and workplace regulations). There were no systematic reviews of interventions targeting mental health. Results were mixed across the public health domains; some policy interventions were shown to reduce health inequalities (e.g. food subsidy programmes, immunisations), others have no effect and some interventions appear to increase inequalities (e.g. 20 mph and low emission zones). The quality of the included reviews (and their primary studies) were generally poor and clear gaps in the evidence base have been highlighted.

CONCLUSIONS

The review does tentatively suggest interventions that policy makers might use to reduce health inequalities, although whether the programmes are transferable between high-income countries remains unclear.

TRIAL REGISTRATION

PROSPERO registration number: CRD42016025283.

Work organization, job insecurity, and occupational health disparities

BACKGROUND

Changes in employment conditions in the global economy over the past 30 years have led to increased job insecurity and other work organization hazards. These hazards may play a role in creating and sustaining occupational health disparities by socioeconomic position, gender, race, ethnicity, and immigration status.

METHODS

A conceptual model was developed to guide the review of 103 relevant articles or chapters on the role of work organization and occupational health disparities identified through a comprehensive search conducted by NIOSH. A second review was conducted of employment and workplace policies and programs designed to reduce the health and safety risks due to job insecurity and other work organization hazards.

RESULTS

There is consistent evidence that workers in lower socioeconomic or social class positions are exposed to greater job insecurity and other work organization hazards than workers in higher socioeconomic positions. Likewise, racial and ethnic minorities and immigrants are exposed to greater job insecurity. Limited research examining the effects of interventions targeting work organization hazards on disparities has been conducted; nonetheless, intervention strategies are available and evidence suggests they are effective.

CONCLUSIONS

Job insecurity and work organization hazards play a role in creating and sustaining occupational health disparities. Employment and workplace policies and programs have the potential to reduce these hazards, and to reduce disparities.

A new urban planning code's impact on walking: the residential environments project

OBJECTIVES

We examined whether people moving into a housing development designed according to a state government livable neighborhoods subdivision code engage in more walking than do people who move to other types of developments.

METHODS

In a natural experiment of 1813 people building homes in 73 new housing developments in Perth, Western Australia, we surveyed participants before and then 12 and 36 months after moving. We measured self-reported walking using the Neighborhood Physical Activity Questionnaire and collected perceptions of the environment and self-selection factors. We calculated objective measures of the built environment using a Geographic Information System.

RESULTS

After relocation, participants in livable versus conventional developments had greater street connectivity, residential density, land use mix, and access to destinations and more positive perceptions of their neighborhood (all P < .05). However, there were no significant differences in walking over time by type of development (P > .05).

CONCLUSIONS

Implementation of the Livable Neighborhoods Guidelines produced more supportive environments; however, the level of intervention was insufficient to encourage more walking. Evaluations of new urban planning policies need to incorporate longer term follow-up to allow time for new neighborhoods to develop.

Health equity: evidence synthesis and knowledge translation methods

BACKGROUND

At the Rio Summit in 2011 on Social Determinants of Health, the global community recognized a pressing need to take action on reducing health inequities. This requires an improved evidence base on the effects of national and international policies on health inequities. Although systematic reviews are recognized as an important source for evidence-informed policy, they have been criticized for failing to assess effects on health equity.

METHODS

This article summarizes guidance on both conducting systematic reviews with a focus on health equity and on methods to translate their findings to different audiences. This guidance was developed based on a series of methodology meetings, previous guidance, a recently developed reporting guideline for equity-focused systematic reviews (PRISMA-Equity 2012) and a systematic review of methods to assess health equity in systematic reviews.

RESULTS

We make ten recommendations for conducting equity-focused systematic reviews; and five considerations for knowledge translation. Illustrative examples of equity-focused reviews are provided where these methods have been used.

CONCLUSIONS

Implementation of the recommendations in this article is one step toward monitoring the impact of national and international policies and programs on health equity, as recommended by the 2011 World Conference on Social Determinants of Health.

Comparing the effectiveness of using generic and specific search terms in electronic databases to identify health outcomes for a systematic review: a prospective comparative study of literature search methods

OBJECTIVE

To compare the effectiveness of systematic review literature searches that use either generic or specific terms for health outcomes.

DESIGN

Prospective comparative study of two electronic literature search strategies. The 'generic' search included general terms for health such as 'adolescent health', 'health status', 'morbidity', etc. The 'specific' search focused on terms for a range of specific illnesses, such as 'headache', 'epilepsy', 'diabetes mellitus', etc.

DATA SOURCES

The authors searched Medline, Embase, the Cumulative Index to Nursing and Allied Health Literature, PsycINFO and the Education Resources Information Center for studies published in English between 1992 and April 2010.

MAIN OUTCOME MEASURES

Number and proportion of studies included in the systematic review that were identified from each search.

RESULTS

The two searches tended to identify different studies. Of 41 studies included in the final review, only three (7%) were identified by both search strategies, 21 (51%) were identified by the generic search only and 17 (41%) were identified by the specific search only. 5 of the 41 studies were also identified through manual searching methods. Studies identified by the two ELS differed in terms of reported health outcomes, while each ELS uniquely identified some of the review's higher quality studies.

CONCLUSIONS

Electronic literature searches (ELS) are a vital stage in conducting systematic reviews and therefore have an important role in attempts to inform and improve policy and practice with the best available evidence. While the use of both generic and specific health terms is conventional for many reviewers and information scientists, there are also reviews that rely solely on either generic or specific terms. Based on the findings, reliance on only the generic or specific approach could increase the risk of systematic reviews missing important evidence and, consequently, misinforming decision makers. However, future research should test the generalisability of these findings.

Occupational musculoskeletal and mental health: Significance of rationalization and opportunities to create sustainable production systems - A systematic review

This literature review aims to identify occupational musculoskeletal and mental health effects of production system rationalization as well as organizational-level measures that may improve health outcome ("modifiers" in this review). A short review of the effect of ergonomic interventions is included as background and rationalization is discussed as a theoretical concept. Indicator variables for occupational musculoskeletal and mental health and related risk factors are presented. Variables with a generalized format were allowed in the literature searches (e.g., job satisfaction and absenteeism were accepted as risk factor and health indicator, respectively), suitable for the research fields of work sociology, organization science, human resource management (HRM) and economics research. One hundred and sixty-two studies of rationalization effects on health and risk factors and 72 organization-level modifier results were accepted into the final database. Entries were sorted by rationalization strategy and work life sector, and trends in outcome (positive, mixed, no effect, or negative effect on health and risk factors) were determined. Rationalizations have a dominant negative effect on health and risk factors (57% negative, 19% positive); the most negative effects were found for downsizing and restructuring rationalizations in general (71 studies negative, 13 positive) and for the health care sector in particular (36 studies negative, 2 positive). The rationalization strategy High Performance Work System (HPWS) was associated with the highest fraction positive outcome studies (6 of 10 studies). Other rationalization strategies (lean practices, parallel vs. serial production and mechanization level) reported intermediate results, in part dependent on work life sector, but also on the year when studies were carried out. Worker participation, resonant management style, information, support, group autonomy and procedural justice were modifiers with favourable influence on outcome. It is concluded that production system rationalization represents a pervasive work life intervention without a primary occupational health focus. It has considerable and mostly negative influence on worker health, but this can be reduced by attention to modifiers. The results create a basis for new priorities in ergonomic intervention research.

Rail safety and rail privatisation in Japan

Over the period from 1980 to the present, the economic status of the main line railway systems in many developed countries has changed, by privatisation or economic deregulation or both. The principal aims of such changes have been to improve the economic performance of the railways, and not to change the safety performance. Nevertheless, it is recognised that changing the organisational structure of railways might affect safety. The empirical evidence of the effect of restructuring on safety is limited, both in railways and in other industries. This paper adds to the empirical evidence by analysing train accidents in Japan before and after the privatisation of the Japanese National Railways (JNR) in 1987. The paper finds that the JNR achieved downward trends in the mean number of train accidents per train-kilometre in the 16 years 1971-1986, and the paper takes the extrapolation of these favourable trends as the yardstick by which to judge the safety performance of the privatised railways. The paper finds that the privatised railway had fewer train accidents in total than this yardstick in 1987-2006. This finding applies whether or not the high-speed Shinkansen train operations are included. Thus there is no evidence that rail privatisation in Japan had an adverse effect on train accidents. The methods adopted and the results are similar to those previously found by the author for rail privatisation in Great Britain.

Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews

Background

There is increasing pressure to tackle the wider social determinants of health through the implementation of appropriate interventions. However, turning these demands for better evidence about interventions around the social determinants of health into action requires identifying what we already know and highlighting areas for further development.

Methods

Systematic review methodology was used to identify systematic reviews (from 2000 to 2007, developed countries only) that described the health effects of any intervention based on the wider social determinants of health: water and sanitation, agriculture and food, access to health and social care services, unemployment and welfare, working conditions, housing and living environment, education, and transport.

Results

Thirty systematic reviews were identified. Generally, the effects of interventions on health inequalities were unclear. However, there is suggestive systematic review evidence that certain categories of intervention may impact positively on inequalities or on the health of specific disadvantaged groups, particularly interventions in the fields of housing and the work environment.

Conclusion

Intervention studies that address inequalities in health are a priority area for future public health research.

Working for health? Evidence from systematic reviews on the effects on health and health inequalities of organisational changes to the psychosocial work environment

OBJECTIVE

To map the health effects of interventions which aim to alter the psychosocial work environment, with a particular focus on differential impacts by socio-economic status, gender, ethnicity, or age.

METHODS

A systematic approach was used to identify, appraise and summarise existing systematic reviews (umbrella review) that examined the health effects of changes to the psychosocial work environment. Electronic databases, websites, and bibliographies, were searched from 2000-2007. Experts were also contacted. Identified reviews were critically appraised and the results summarised taking into account methodological quality. The review was conducted in the UK between October 2006 and December 2007.

RESULTS

Seven systematic reviews were identified. Changes to the psychosocial work environment were found to have important and generally beneficial effects on health. Importantly, five reviews suggested that organisational level psychosocial workplace interventions may have the potential to reduce health inequalities amongst employees.

CONCLUSION

Policy makers should consider organisational level changes to the psychosocial work environment when seeking to improve the health of the working age population.

Under Pressure, Out of Control, or Home Alone? Reviewing Research and Policy Debates on the Occupational Health and Safety Effects of Outsourcing and Home-Based Work

The practice of outsourcing or subcontracting of work has grown rapidly in most countries over the past two decades. Outsourcing, de-institutionalization, and a range of other practices have also resulted in a growth of home-based work. Home-based workers, even when not part of a subcontracting process, operate in an isolated situation remote from their employer and other workers. Do such work arrangements expose workers to greater risk of injury, illness, or assault? The authors reviewed international studies of the occupational health and safety (OHS) effects of subcontracting and home-based work undertaken over the past 20 years. Of the 25 studies analyzed, 92 percent found poorer OHS outcomes. The studies were examined for clues about the reasons for these negative outcomes. The authors also identified similarities and differences between subcontracting and home-based work. Despite the evidence of poor OHS outcomes, research into outsourcing has stalled in recent years. With notable exceptions, governments have taken little account of findings on these work arrangements in their laws and policies, in part because neoliberal ideas dominate national and global policy agendas. The authors examine policy challenges and regulatory responses and make suggestions for future research and policy interventions.