Work

Devolution, health and health inequalities in Greater Manchester

Year: 2025

Type: article

Abstract: Improving health outcomes and reducing health inequalities are core objectives for policymakers globally. In recent years, devolution has been argued to improve the delivery of health services, but empirical evidence remains limited. I examine the Greater Manchester Health and Social Care Partnership, introduced in April 2016, to estimate the effect of increased sub-national powers on health outcomes. Using Census data from 2011 and 2021, I construct a panel microdata set of 1,326 Greater Manchester (GM) neighbourhoods and propensity score matched non-GM neighbourhoods based on 2011 pre-treatment characteristics. I then estimate ordinary least squares and difference-in-differences models, assessing parallel pre-trends using Census 2001 data. I find that post-devolution neighbourhoods in Greater Manchester reported a +0.45 percentage point higher than expected share of residents in good health (95% CI [0.06, 0.84]). These improvements are concentrated in the least healthy neighbourhoods, which experienced a +2.27 percentage point gain relative to their matched controls (95% CI [1.70, 2.84]). The results provide new evidence on the performance of devolved health policy, informing research on the role of healthcare in reducing health inequalities and shaping wider policy debates on devolution. • Provides the first neighbourhood-level analysis of devolved health and social care in England. • Uses Census microdata, propensity score matching, and DiD to assess health impacts. • Finds modest improvements in average health outcomes after devolution (+0.45 p.p.). • Shows disproportionately larger gains in the least healthy areas (+2.27 p.p. vs controls). • Discusses governance design and institutional context relationship with health devolution.

Source: Social Science & Medicine

DOI: 10.1016/j.socscimed.2025.118763

Author: Nicholas Patrick Sweeney

Institutions: University of Cambridge, University of Manchester

Language: English

Topic: Health Services Management and Policy

Subfield: General Health Professions

Field: Health Professions

Domain: Health Sciences

SDGs: Good health and well-being, Reduced inequalities

Open Access status: hybrid

Estimated APC paid: $3,800