The Impact of Devolution on Health: A Generalised Synthetic Control Analysis of Greater Manchester in England

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Abstract

Background
The devolution of public services from central to local government can increase sensitivity to local population needs but may also reduce the expertise and resources available. There is limited evidence on the impact of devolution on health. We evaluated the impact on health of devolution affecting health services and wider determinants of health in Greater Manchester in England from November 2014.

Methods
We estimated changes in life expectancy in Greater Manchester relative to a control group from the rest of England (excluding London), using the generalised synthetic control method applied to local authority data between 2006 and 2019. We estimated the impact on the whole population and stratified by sex, local authority, income deprivation, and baseline life expectancy.

Findings
Following devolution, life expectancy in Greater Manchester was 0·196 years (95% CI: 0·182 to 0·210) higher than expected in comparison to areas with similar pre-devolution trends. Life expectancy was protected from the decline observed in comparable areas in the first two years and increased in the longer-term. These gains were observed in eight of ten local authorities, larger for males, and larger in areas with high income deprivation and lower life expectancy prior to devolution.

Interpretation
Greater Manchester had better population health than expected following devolution. The benefits of devolution were apparent in the most deprived and poorer health areas, suggesting a narrowing of inequality. Improvements were likely due to a coordinated devolution across sectors, affecting wider determinants of health and the organisation of care services.

Bibliographical metadata

Original languageEnglish
JournalThe Lancet Public Health
Publication statusAccepted/In press - 29 Jul 2022