Most people in the United Kingdom have taken part in a world-leading, multi-billion pound trial of a major health determinant. Unfortunately, most are unaware the trial exists and no-one knows the results.
The National Lottery is a ready-made trial of increased income, suggests Anthony Rodgers in this week's Christmas issue of the BMJ. It provides a unique opportunity to understand how income improves health, especially among families living in poverty, he argues.
Evidence suggests that modest increases in income, if sustained, could lead to important health benefits. Therefore, some winners could receive regular, income-like payments (such as £40, £80, or £160 a month for a decade). Winners would then be compared to a random selection of non-winners to assess the long term effects on outcomes such as diet and smoking, and broader indicators like employment, education and even entrepreneurship.
Most people buy lottery tickets and winning is purely chance, so the study would be, in effect, a trial of income supplementation in a group drawn at random from the majority of the UK population, says the author.
If just 5% of one year’s worth of prize money was redistributed in this way, more than 15,000 people could be winners for a decade. The project would be entirely self-funding. Long-term prizes are well accepted overseas, but the novelty here could revitalise sales, especially if there was a higher chance of winning and people could use non-winning normal tickets to enter. It would also fit with the government's aim to direct lottery funds more actively to health, education, and the environment, and with the move towards evidence based social policy, adds the author.
If successful, the project could be adopted elsewhere: most countries have lotteries and well over US$100bn is spent on lottery sales world wide each year, says the author. However, because it is so large and well organised the National Lottery provides the best opportunity to see how much and how quickly increased income improves health and wellbeing. It could provide uniquely valuable evidence for social policies, particularly those aiming to lift people out of poverty, he concludes.