CHAIN - The Centre for Global Health Inequalities Research

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CHAIN proposes strategy to assess inequalities in COVID-19 mortality

In an article published in the Bulletin for the World Health Organization (WHO), CHAIN presents its strategy to assess social inequalities in COVID-19 mortality worldwide and asks the global research community to contribute.

CHAIN is undertaking this work along with the leadership of the Global Public Health Observatory of the Johns Hopkins Bloomberg School of Public Health, under supervision of the Inequality Working Group within the WHO/UN Technical Advisory Group on COVID-19 Mortality Assessment and in collaboration with a global network of over 50 researchers. So far, over 15 000 abstracts have been screened, and the extraction phase has started. 

That is what CHAIN plans to determine together with its partner the Institute for Health Metrics and Evaluation (IHME). Both all-cause and cause-specific mortality will be examined. The work is a follow-up of a 2021 Lancet article that led to the discovery of a global association between parental education and child mortality. The work has so far led to a study of the association between education and adult mortality of the Asia Pacific Region. The long-term ambition is to include education as the first socioeconomic risk factor in the Global Burden of Disease Study. 

Through the project, CHAIN researcher Alexander Kentikelenis will support the development of a new analytical tool intended to guide policymakers on the EU’s future role in multilateral cooperation. This tool will allow the EU to assess multilateral organisations, and—on this basis—devise action strategies to strengthen multilateralism on climate change, digitalisation, finance and tax, health, migration, and security. 

Dr Courtney McNamara and experts from Public Health Wales gave an interactive masterclass on health and trade, looking at the public health impact of the Comprehensive and Progressive Agreement for Trans-Pacific Partnership (CPTPP) on communities in Wales.   

Watch the recording here: Masterclass – International Trade and Health - Public Health Network Cymru 

A new Unicef Innocenti report focuses on centralising information on the effectiveness of child and adolescent mental health and psychosocial support interventions in low- and middle-income countries. It captures practices implemented within the last 12 years in 78 countries. 

Unicef Innocenti provided a regional analysis on the impact of the Ukrainian war the subsequent economic downturn and the situation of children in Eastern Europe and Central Asia. In particular, the report investigates the impacts on child poverty, school years lost and infant mortality.  

CHAIN advocates for the protection of children in a changing environment during COP27 

During the COP27, the Climate Justice Pavilion organised a session on protecting our children in the face of a climate crisis. CHAIN researcher Dr Kam Sripada contributed as a panellist to this discussion, sharing her expertise on environmental health research and the protection of children from toxic chemicals. 

The International Monetary Fund in review – diving into the green transition

As one of the contributing writers, CHAIN’s Alexander Kentikelenis assesses the IMF’s emerging climate activist role by looking at two countries currently participating in IMF programs: Argentina and Pakistan. The publication further examines the extent to which IMF programs enable these countries to transition away from dependence on fossil fuels, as well as whether such efforts also focus on achieving a fair and just transition in their respective societies.  

Study on structural environmental violence in the Tijuana River demonstrates link between poor health outcomes and homeless, deported inhabitants  

An analysis driven by CHAIN draws on the environmental injustice perspective to document how social forces drive poor health outcomes through the environment.

Many Mexicans that are deported by the US take refuge in the Tijuana River Canal. Results in CHAIN's study demonstrate that the Tijuana River water most proximate to its human inhabitants fails numerous water-quality standards, posing acute health risks. Such risks are additionally exacerbated by routine police violence, which propels individuals into involuntary contact with contaminated water.

Why are social inequalities in health relatively large in the Nordic countries? A recent CHAIN study explains this “Nordic paradox” of inequality. Through the application of multiple correspondence analyses using data from the European Social Survey, the study finds that the magnitude of health inequalities in Norway is mostly driven from the increased social resilience of higher educated with increasing levels of morbidity rather than from the loss of resources of lower educated.

CHAIN Researcher Roosa Tikkanen contributed to the Women in Global Health (WGH) policy brief “Subsidizing global health: Women’s unpaid work in health systems”. The briefing reports that women have shouldered the burden of health systems delivery for more than two years of the pandemic. Poor working conditions faced by women workers further perpetuate gender inequalities, reduce women’s economic empowerment and weaken health systems.  

A new article by the Norwegian Institute for Public Health (FHI) reveals a lesser known connection: the increased likelihood of health problems among immigrants in Norway, linked to insufficient knowledge of the language. Results highlight the importance of obtaining Norwegian education to facilitate language proficiency and the need for more inclusive health services.  

How does one's field of employment impact health-related behaviour?

CHAIN researchers have published a paper exploring the general relationship between peoples’ health-related practices and their affiliation with different fields in the occupational structure. It argues that ‘healthy behaviour’ may be particularly induced in the field of service occupations (jobs where one is providing a service, rather than producing a physical product), rendering such practices an emerging capital in the sense advanced by Bourdieu.

Do socioeconomic conditions impact the development of COVID-19 antibodies?

CHAIN researchers have analysed the association between socioeconomic conditions and having developed antibodies for COVID-19 in a population-based sample in the canton of Geneva, Switzerland. The results showed that people who had been facing financial hardship had antibodies more often, and that educational level, occupational position and household income were not associated.

This study provides tentative evidence that an increase in pension income in England for low-income pensioners can reduce inequalities in mental wellbeing, particularly for men. Findings therefore recommend that future state pension policies need to take this into consideration. 

The report, co-authored by Prof Clare Bambra, demonstrates the disproportionate impact of COVID-19 on mental health in the North of England. These findings reiterate the unequal nature of the pandemic, with people in our most deprived communities suffering the most.  

Led by CHAIN’s partner the Institute for Health Metrics and Evaluation (IHME), the Global Burden of Disease (GBD) study provides a comprehensive picture of mortality and disability across countries, time, age, and sex. 

A review of the 2019 GBD Study demonstrates patterns in the prevalence of tobacco use and attributable disease burden, signaling a large implementation gap in tobacco control.  

An analysis of the 2020 GBD Study showcases the population-level risks of alcohol consumption and calls for stronger interventions to reduce the substantial global health loss attributable to alcohol, particularly in younger individuals.  

While the Global Burden of Disease (GBD) allows to stratify data according to socioeconomic factors between countries, it does not allow to do so within.

A study by CHAIN researchers conducted a Cox regression analysis to stratify on educational groups to examine inequalities in cause-specific mortality and years of life lost, exploring this approach as one possible solution to the integration of social inequalities into the GBD study or when using a burden of disease framework approach more generally.

The WHO International Agency for Research on Cancer (IARC), a partner of CHAIN, contributed to a Europe-wide population-based study on socioeconomic inequalities in cancer mortality.

The study shows that cancer mortality in Europe is predominantly driven by levels and trends of cancer mortality rates in groups with lower education levels. More systematic measures, monitoring frameworks and action are needed to address the prevailing socioeconomic inequalities in cancer in Europe.  

EuroHealthNet has published a Policy Précis that sets out models of ‘health-promoting’ care. Such models value care workers, empower those who need care, strengthen collaboration across sectors, and encourage and enable people to become more socially engaged, and to participate in the formal economy.

The Policy Précis provides an overview of EU policies, tools and programmes that can help governments at all levels strengthen the organisation of care and transition to delivery of care models that promote health, equity and wellbeing. It also showcases inspirational examples from Austria, Slovenia and Spain.