Assessing the Impact of Changes to the Social Security System on Health Outcomes in the UK Since 2010: A Systematic Review

This article systematically reviews quantitative studies of the impacts of changes to the UK social security system since 2010 on health outcomes from 10 peer reviewed databases and the grey literature as outlined in the Prospero protocol CRD42021282605. Study quality was assessed using an adaptation of the Effective Public Health Practice Project tool (EPHPP). Studies were reported following the Synthesis without Meta-analysis (SWiM) guidelines. Certainty of the impact of welfare reform on mental health was considered using GRADE principles. Of 8504 records screened, eighteen studies were included in the review. Fifteen looked at mental health outcomes: 12 showed worsening mental health, two showed mixed effects and one showed no effect. Three studies showed that reforms harmed health when measured using life expectancy or mortality. No effects on physical health were reported from three studies, and findings were mixed for the impact on general health. Four studies reported on the impact of reforms on inequalities in one or more health outcome with mixed results. The certainty of our findings on mental health was rated very low. Changes to the UK social security system between 2010 and 2020 were associated with poorer population level mental health and mortality derived health measures.