The lottery is one of the world's largest randomised trials

Most people in the United Kingdom have taken part in one of the world's largest trials of one of the most important determinants of health. Unfortunately, neither the participants nor the organisers know about the trial and no one has collected follow up data.

Each month, more than £150m is randomly redistributed among 60% of the adult population in the National Lottery.1 Over £16bn has been redistributed since the lottery began in 1994. Changing the redistribution of a small fraction of this money could create a randomised trial that reliably assessed the speed and extent to which increases in income improve health. The basic study design would be simple. Instead of lump sums, winners would receive regular, income-like payments (such as £40, £80, or £160 a month for a decade). Follow up of these winners, and a large random selection of non-winners, would assess effects on outcomes such as diet, smoking, admission to hospital and broader …