The causal effects of transition into poverty on mental health in the UK working-age population

Abstract

sufficient reference to the SDGs on a strategic level as well as in the EU's actions and partnerships in global health. The Union has shown during the Covid-19 pandemic that it is a relevant global health actor; however, there seems to be a lack of strategic visions and resources. The poster aims to illustrate on the one hand the weaknesses and challenges of the EU global health policies in times of Covid-19 and beyond. On the other hand, it identifies advantages of the EU in the field of global health and explores future pathways. Applying a mixed-method approach I did a review of academic and grey literature; content analysis of official EU documents and statements, expert interviews and gathered insights from events such as policy dialogues. Preliminary results indicate that the EU has a strong focus on infectious disease control in its external health policies and hereby neglects the health system dimension and interlinkages with other foreign policies such as trade. Covid-19 has highlighted the importance of resilient health systems in a crisis and the interlinkages between different policies for an effective response. To pursue a genuine health-in-all-policies approach prioritising health system strengthening within a updated strategic roadmap is necessary. Moreover, efforts to ensure an equitable distribution of vaccines, therapeutics and diagnostics should be pushed through the development and implementation of respective criteria. Key messages: The focus of the EU in global health should shift from a narrow health security lens towards health system strengthening including disease control. The EU should prioritize and implement the health-in-all-policies approach in its global health policies through an ambitious roadmap. Background: Addressing the impact of poverty through income and welfare policies is likely important for public mental health; however, few studies assess potential effect size using causally-informed methodologies. To provide meaningful information for policymakers, we aimed to estimate the average treatment effect of transitioning into poverty on mental health. Methods: We used data for working-age adults (aged 25-64) from nine waves of the nationally representative UK Household Longitudinal Survey (2009-2019, n = 39,553 obs=155,963). Exposure was transition into poverty (household equiv. income <60% median). Outcome was score 4 on General Health Questionnaire-12, indicating likely common mental disorder (CMD). To minimise the influence of reverse causation and time-varying confounders we used a marginal structural modelling (MSM) approach to create inverse probability of treatment weights. We performed secondary analysis stratifying by sex, and calculated population attributable fractions for each model. Results: Good balance of confounders was achieved between exposure groups. Experiencing new poverty was associated with increased odds of CMD (adjusted OR 1.33, 95% CI 1.24-1.42, p < 0.001) with a 4.8% (3.6-6.0) absolute difference in prevalence: 24.0% vs 19.2%. There was a difference in relative effect by sex, with OR 1.40 (1.25-1.56, p < 0.001) for men vs OR 1.28 (1.18-1.38, p < 0.001) for women. However, there was no marked difference in absolute effect by sex: 4.9% (3.1-6.8) for men vs 4.5% (3.0-6.1) for women. For all analyses