Decentralising health management: Heterogenous effects on health behaviours and health outcomes

Many countries have implemented decentralisation reforms to address efficiency and equity concerns in health management. Most evidence on their impact focuses on average health outcomes and provides mixed results. We examine effects of administrative decentralisation of population health management on health behaviours in Greater Manchester, England, in 2016. Using data on 26,773 adult respondents to the UK Household Longitudinal Study between 2009 and 2020, we use a generalized random forests framework to examine how the effects of the decentralisation vary across individuals. We find that decentralisation was associated with reductions in smoking, alcohol misuse, and poor diet, but had no impact on physical inactivity. Individuals with higher socioeconomic status and better health and well-being before decentralisation experienced the largest beneficial impacts. Lifestyle improvements following decentralisation were unequally distributed, suggesting that more targeted interventions are needed for more disadvantaged groups.