Informing Investment to reduce health Inequalities (III)

The Informing Investment to reduce health Inequalities (III) in Scotland project includes numerical models of the potential impact of 11 interventions on overall population health and health inequalities. A range of interventions across the determinants of health (including ‘upstream’, ‘downstream’, individually-focused and population-wide) were included. The interventions were chosen based on the highest quality and most generalisable evidence linking them to changes in mortality and hospital admissions.

The III tools supercede the previous HITS intervention tools published in 2009 and 2012. The tools are available as Excel spreadsheets and are accompanied by a user guide, technical guide and a briefing on delayed mortality effects. A separate commentary presents illustrative results and considers findings from the tool that have important implications for tackling health inequalities in Scotland.

NHS Health Scotland have embarked on the next phase of III. Based on feedback received during the last phase of the work, and guidance form the project advisory group, priorities for the next phase include:  

  • Updating existing models where new data/evidence on the intervention are available
  • Modelling new interventions, including where possible those within the influence of local decision makers
  • Economic modelling, adding estimates of intervention costs and other available economic data to the existing tool
  •  Understanding better how the III tool could be made more useful to local users and decision makers.
  • Presenting the tool and its findings in a way that was more accessible and actionable to decision makers.

The initial outputs from this work are anticipated in 2017/18.

Technical note:

The results are generally sensitive to assumptions contained within the models and should be interpreted accordingly. These include effect sizes drawn from observational data and populations at risk drawn from self-reported survey data; the impacts of which are likely to over- and under-estimate the reduction in inequality of the health behaviour interventions respectively.  For more details, please see the appendices  and the commentary below.


Informing Investment to reduce health Inequalities (III) in Scotland: a commentary (529Kb)

III Intervention Tool: Income (573Kb)

III Intervention Tool: Employment (919Kb)

III Intervention Tool: Active Travel (845Kb)
(Please note: the active travel tool was updated in February 2017 to correct two errors affecting local estimates of impact. More detail is provided within the tool.)

III Intervention Tool: Tobacco Taxation (818Kb)

III Intervention Tool: Smoking Cessation (1010Kb)

III Intervention Tool: Alcohol Brief Interventions (1086Kb)

III Intervention Tool: Counterweight (1062Kb)

Appendix A: sensitivity analysis (67Kb)

Appendix B: explaining the delayed mortality effect (49Kb)

Appendix C: user guide (192Kb)

Appendix D: technical guide (615Kb)

Additional Outputs - August 2015:

Separate tools have been created (for Orkney and Shetland only) which calculate inequalities based on populations resident in SIMD quintiles 2-5 only, since these Islands have no residents living in the national SIMD quintile 1 (most deprived). These results are not comparable with the inequalities results presented in the tools above.

III Intervention Tool: Income – Islands (547Kb)

III Intervention Tool: Employment – Islands (884Kb)

III Intervention Tool: Active Travel – Islands (849Kb)

III Intervention Tool: Tobacco Taxation - Islands (796Kb)

III Intervention Tool: Smoking Cessation – Islands (983Kb)

III Intervention Tool: Alcohol Brief Interventions – Islands (1019Kb)

III Intervention Tool: Counterweight  - Islands (1039Kb)