{
  "abstract": "Background Health inequity, defined as systematic and avoidable differences in health outcomes, remains entrenched across high-income countries, with socioeconomic gaps in life expectancy exceeding 7–10 years. Public health interventions addressing the social determinants of health are essential. This umbrella review evaluates which macro-level policies and public health interventions most effectively reduce health inequity.Methods An umbrella review of systematic reviews was conducted. Four databases (Embase, Medline, Scopus, Cochrane) were searched from May 2017, the date of the last umbrella review on this topic, to September 2024. Eligible reviews reported population-level interventions in OECD countries with outcomes stratified by socioeconomic status or related disadvantage. Methodological quality was appraised using AMSTAR II. A conceptual Health Equity Pyramid was developed to classify interventions according to their agentic demand and population reach.Results Thirty-five systematic reviews were included, spanning six intervention domains. Redistributive and welfare interventions, including cash transfers, basic income and food-subsidy programmes, consistently improved food security, household financial stability and maternal–child health outcomes. Legislative and regulatory measures, such as smoke-free policies and pharmaceutical-subsidy reforms, produced robust population-level gains, particularly among disadvantaged groups. Community and housing interventions improved psychological health, reduced morbidity and mortality, and enhanced housing stability. Health-system interventions, including tailored smoking-cessation programmes and hospital discharge coordination for people experiencing homelessness, narrowed service-use disparities. In contrast, educational, behavioural and telehealth interventions, often demanding high individual agency, yielded mixed results and, when insufficiently contextualised, risked exacerbating intervention-generated inequalities.Conclusion Public health policies characterised by low agentic demand, such as welfare reform, housing support and legislative measures, consistently reduce health inequities. High-agency interventions can be effective when specifically tailored to disadvantaged populations but may otherwise amplify disparities. To achieve sustainable equity in health outcomes, future policy should prioritise structural, population-wide strategies that minimise individual burden while addressing the root causes of disadvantage.",
  "authors": [
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Jatinder Hayre"
    },
    {
      "affiliations": [
        "Norfolk and Norwich University Hospital, Norwich, UK"
      ],
      "name": "Ellie Canning"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "Helen Pearce"
    },
    {
      "affiliations": [
        "St. Georges University of London, London, UK"
      ],
      "name": "Raj Khera"
    },
    {
      "affiliations": [
        "Wolfson Institute of Population Health, Queen Mary University of London, London, UK"
      ],
      "name": "John Ford"
    }
  ],
  "title": "P13-5 Public health policies and interventions to address health inequities in high-income countries: an umbrella review",
  "uid": "c09af511-0489-556d-a521-ef2d245545a0"
}