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The impact of NHS resource allocation policy on health inequalities in England 2001-11: longitudinal ecological study

BMJ 2014; 348 doi: (Published 27 May 2014) Cite this as: BMJ 2014;348:g3231
  1. Ben Barr, senior clinical lecturer in applied public health1,
  2. Clare Bambra, professor of public health policy2,
  3. Margaret Whitehead, professor, and W H Duncan professor of public health1
  1. 1Department of Public Health and Policy, Institute of Psychology, Health and Society, University of Liverpool, Liverpool L69 3GB, UK
  2. 2Department of Geography, Wolfson Research Institute for Health and Wellbeing, Durham University, Stockton on Tees, UK
  1. Correspondence to: B Barr benbarr{at}
  • Accepted 2 May 2014


Objective To investigate whether the policy of increasing National Health Service funding to a greater extent in deprived areas in England compared with more affluent areas led to a reduction in geographical inequalities in mortality amenable to healthcare.

Design Longitudinal ecological study.

Setting 324 lower tier local authorities in England, classified by their baseline level of deprivation.

Intervention Differential trends in NHS funds allocated to local areas resulting from the NHS resource allocation policy in England between 2001 and 2011.

Main outcome measure Trends in mortality from causes considered amenable to healthcare in local authority areas in England. Using multivariate regression, we estimated the reduction in mortality that was associated with the allocation of additional NHS resources in these areas.

Results Between 2001 and 2011 the increase in NHS resources to deprived areas accounted for a reduction in the gap between deprived and affluent areas in male mortality amenable to healthcare of 35 deaths per 100 000 population (95% confidence interval 27 to 42) and female mortality of 16 deaths per 100 000 (10 to 21). This explained 85% of the total reduction of absolute inequality in mortality amenable to healthcare during this time. Each additional £10m of resources allocated to deprived areas was associated with a reduction in 4 deaths in males per 100 000 (3.1 to 4.9) and 1.8 deaths in females per 100 000 (1.1 to 2.4). The association between absolute increases in NHS resources and improvements in mortality amenable to healthcare in more affluent areas was not significant.

Conclusion Between 2001 and 2011, the NHS health inequalities policy of increasing the proportion of resources allocated to deprived areas compared with more affluent areas was associated with a reduction in absolute health inequalities from causes amenable to healthcare. Dropping this policy may widen inequalities.


  • Contributors: BB is the lead author and guarantor. He planned the study, conducted the analysis, and led the drafting and revising of the manuscript. MMW and CB contributed to data interpretation, drafting of the manuscript, and revisions. All authors agreed the submitted version of the manuscript.

  • Funding: BB is supported by a National Institute for Health Research doctoral research fellowship (DRF-2009-02-12). The National Institute for Health Research had no role in the study design, data collection and analysis, decision to publish, or preparation of the manuscript. MMW is supported by the DEMETRIQ project, which is funded from the Commission of the European Communities seventh framework programme under grant agreement No 278511. The study does not necessarily reflect the commission’s views and in no way anticipates the commission’s future policy in this area.

  • Competing interests: All authors have completed the ICMJE uniform disclosure form at and declare: no support from any organisation for the submitted work; no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; CB is a member of the Labour party, however, the authors have no other relationships or activities that could appear to have influenced the submitted work.

  • Ethical approval: Not required.

  • Data sharing: The statistical code and dataset available from the corresponding author (

  • Transparency: The lead author affirms that the manuscript is an honest, accurate, and transparent account of the study being reported; that no important aspects of the study have been omitted; and that any discrepancies from the study as planned have been explained.

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