{
  "abstract": "Background Health and care interventions may inadvertently worsen health inequalities, so-called intervention-generated inequalities. Understanding the types of interventions which are likely to worsen inequalities is important as policy makers and practitioners design services. The last review of intervention-generated inequalities was a rapid review published in 2013. Here we aim to provide an up-to-date review of the types of interventions which inadvertently worsen socio-economic health or care inequalities.Methods We undertook a systematic search within MEDLINE and Embase databases to identify studies on interventions which worsen inequalities. We used a two-stage process for article screening and inclusion. First we developed inclusion and exclusion criteria to identify systematic reviews examining interventions designed to address health care inequalities that showed worsening of socioeconomic status. Title and abstracts followed by full texts were screened for eligibility. Second, we individually assessed the primary studies within the included reviews against a second inclusion and exclusion criteria, to identify those that described a worsening of outcomes related to socio-economic status such as; income, education and occupation. Editorials, commentaries and studies from low-and middle-income countries were excluded. Results were narratively synthesized to identify common categories and themes.Results We identified 8 systematic reviews published in the past 5 years which included studies which showed a worsening in socio-economic inequalities in health and/or health care. Within these 8 systematic reviews, there were 89 primary studies on interventions which worsened health and care inequalities. The most common types of interventions which tend to increase inequalities were individual behavioural-focused weight reduction programmes, especially if app-based, food labelling, smoking cessation prompts, coaching and combination of pharmacotherapy, chronic disease self-management programmes, and green space interventionsConclusion It appears that interventions which increase inequalities tend to require pre-existing resources and agency, such as digital access and literacy or capacity and capability to make lifestyle changes. Interventions which relied simply on the provision of information to patients or the public also increased inequalities. In the design of healthcare interventions, policy makers should balance potential for overall population improvement with potential impact on inequalities and should introduce mitigation where inequalities are likely to worsen.",
  "authors": [
    {
      "affiliations": [
        "Wolfson Institute of Public Health, Queen Mary University of London, London, UK"
      ],
      "name": "Junayna Ahmed"
    },
    {
      "affiliations": [
        "Wolfson Institute of Public Health, Queen Mary University of London, London, UK"
      ],
      "name": "Anna Gkiouleka"
    },
    {
      "affiliations": [
        "Wolfson Institute of Public Health, Queen Mary University of London, London, UK"
      ],
      "name": "Helena Painter"
    },
    {
      "affiliations": [
        "Wolfson Institute of Public Health, Queen Mary University of London, London, UK"
      ],
      "name": "John Ford"
    }
  ],
  "title": "P50 A systematic review of interventions which worsen socio-economic inequalities in health and care",
  "uid": "ee885d2c-f51f-5b91-af17-08ac43305e29"
}