Table 2 Extraction table of literature examining the impact of disinvestment from public health services
From: The impact of disinvestment on alcohol and drug treatment delivery and outcomes: a systematic review
Author and year published | Paper title | Peer reviewed | Population | Country setting | Sample size | Focus of paper | Method(s) | Publication type | Findings |
|---|---|---|---|---|---|---|---|---|---|
Anderson et al., 2017 [35] | Political priorities and public health services in English local authorities: the case of tobacco control and smoking cessation services | Yes | 152 Tobacco control leads from each upper tier authority | England | 116 in 2014; 124 in 2015 and 129 in 2016 | Smoking cessation services in England | Quantitative: cross-sectional survey. Longitudinal comparing 87 local authorities | Journal study | Political support for tobacco control mitigates the risk of cuts to smoking cessation budgets. |
British Medical Association, 2018 [46] | Feeling the squeeze. The local impact of cuts to public health budgets in England | No | Public Health Professionals | England | N/A | Public health services | Quantitative: Secondary data analysis | Professional body research report | Changes in public health spending do not reflect the needs of local populations. Disinvestment leading to variation in quality and quantity of service provision. |
Chang, 2010 [37] | Quit smoking advice from health professionals in Taiwan: The role of funding policy and smoker socioeconomic status | Yes | Participants of the Taiwan Adult Tobacco Survey | Japan | 16,688 in 2004, 16,749 in 2005, 16,922 in 2006 and 16,588 in 2007 | Smoking cessation services in Japan | Quantitative: secondary data analysis | Journal study | Quit prevalence increases were associated with increases in funding. Quit prevalence reduced, but not significantly, following disinvestment. |
Davies et al. (Quality Watch), 2016 [47] | Focus on: Public Health and prevention | No | 120 Directors of Public Health, service providers and advocacy organisations | England | 37 for survey and 11 interviews | Public health services | Mixed methods: secondary data analysis, cross-sectional survey and interviews | Health think tank research report | 6/10 public health indicators deteriorated between 2009 and 15, including alcohol-related hospital admissions but completion of substance use treatment improved. Positive views regarding local government procurement processes but concerns regarding effect of financial pressures on service accessibility and effectiveness. |
Daube, 2012 [10] | A bleak outlook for public health? | No | Government funded public health programmes | Australia | N/A | Public health services | Editorial | Journal editorial | Concerns regarding the impact of public sector austerity on public health services, on de-prioritisation of public health, loss of specialist staff, and the withdrawal of specialist services to reduce inequalities. Concerns government legislative changes are at odds with public health ambitions. |
Freudenberg et al., 2006 [32] | The impact of New York City’s 1975 Fiscal Crisis on the tuberculosis, HIV, and homicide syndemic | Yes | New York City’s population | US | N/A | Drug treatment and other public services | Secondary data analysis and literature review | Journal study | Estimated that $10 billion cuts to public services, including public health, resulted in $50 billion costs in controlling the TB, HIV and homicide endemics. |
Iacobucci, 2014 [48] | Raiding the public health budget | No | 152 Upper Tier local authorities | England | 143 | Public health services | Editorial - Freedom of information request analysis | Journal opinion piece | Concerns regarding increasing use of public health grant to support broader local authority services and variation in commissioning across the country. |
Iacobucci, 2016 [49] | Public health - the frontline cuts begin | No | 152 Upper Tier local authorities | England | 132 | Public health services | Editorial - Freedom of information request analysis | Journal opinion piece | Decrease in public health grant and concurrent cuts to frontline public health services. |
McFarlane and Meier, 1993 [36] | Restructuring Federalism: the impact of Reagan Policies on the Family Planning Program | Yes | Population to benefit from family planning programmes | U.S. | N/A | Family planning services | Secondary data analysis and literature review | Journal study | Disinvestment from family planning services concurrent to a reduction in people supported and increased variation in services within more deprived groups. |
Robertson et al., 2017 [50] | Understanding NHS financial pressures (from p26) | No | Population to benefit from GUM services | England | 99 stakeholders from NHS | Sexual health services (and other NHS funded services) | Qualitative: semi-structured interviews | Charitable organisation research report | Continued financial pressures on services and for sexual health services, evidence of reduced accessibility and quality of provision. Increasing gap between demand and availability. Commissioners working to identify ways to maintain services. |
White, 2016 [51] | Sexual health services: divided and unprotected | No | 152 Upper Tier local authorities | England | 150/152 local authorities | Sexual health services | Editorial - Freedom of information request analysis | Journal opinion piece | Large variation in local authority prioritisation of sexual health, and related investment in services. Evidence of cuts / planned cuts to sexual health services despite need. |