Devolution, health and health inequalities in Greater Manchester

Improving health outcomes and reducing health inequalities are core objectives for policymakers globally. In recent years, devolution has been argued to improve the delivery of health services, but empirical evidence remains limited. I examine the Greater Manchester Health and Social Care Partnership, introduced in April 2016, to estimate the effect of increased sub-national powers on health outcomes. Using Census data from 2011 to 2021, I construct a panel microdata set of 1,326 Greater Manchester (GM) neighbourhoods and propensity score matched non-GM neighbourhoods based on 2011 pre-treatment characteristics. I then estimate ordinary least squares and difference-in-differences models, assessing parallel pre-trends using Census 2001 data. I find that post-devolution neighbourhoods in Greater Manchester reported a +0.45 percentage point higher than expected share of residents in good health (95 % CI [0.06, 0.84]). These improvements are concentrated in the least healthy neighbourhoods, which experienced a +2.27 percentage point gain relative to their matched controls (95 % CI [1.70, 2.84]). The results provide new evidence on the performance of devolved health policy, informing research on the role of healthcare in reducing health inequalities and shaping wider policy debates on devolution.