CHAIN - The Centre for Global health Inequalities Research

CHAIN - The Centre for Global Health Inequalities Research

CHAIN is the leading centre and interdisciplinary research network for global health inequalities, based at the Norwegian University of Science and Technology (NTNU). It brings together expert researchers in the field of health, social determinants, civil society, and the UN system to advance health inequalities research, especially for children’s health.
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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. 


What is the global association between adult education and mortality?  

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

CHAIN researcher to work on the newly-funded EU-project “EU Navigating Multilateral Cooperation” 

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. 


What is the link between trade agreements and health across different sectors and settings?

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 


Celebrating 50 years of the Scandinavian Journal of Public Health  

Prof Terje Andreas Eikemo, leader of CHAIN and Chief Editor of the Scandinavian Journal of Public Health, presented a special edition of the journal ahead of the Nordic public health conference “Folkehelsekonferansen, marking 50 years of public health research in the region. The special issue commemorated five decades of the journal and presented research related to health inequalities, social determinants and new public health concepts and methods.

The special edition also included articles from CHAIN researchers, including:  

CHAIN at the European Public Health Conference: Advancing the health equity agenda  

During the 15th European Public Health Conference, CHAIN representatives Prof Terje Andreas Eikemo and Dr Mirza Balaj presented results on the external evaluation of the EU Joint Action on Health Inequalities (JAHEE). As project evaluator, CHAIN analysed JAHEE’s impact on health inequalities, as well as the sustainability of its outcomes.   

During the conference, CHAIN also highlighted efforts related to incorporating social inequalities in the Global Burden of Disease framework at a workshop organised by the European Burden of Disease Network.   

CHAIN’s partner EuroHealthNet was also well-represented at the 2022 EPHC, most notably with its plenary on Reorienting health services: the transformational potential of health promotion.



Child health

Which health problems impact young people's school attendance the most? 

Researchers of the Norwegian Institute for Public Health (FHI) have calculated the “educational burden of disease” and highlight that mental disorders have the most negative impact on schooling, by a good margin. Their research also further explains the link between social inequality and poor health outcomes.


Unicef Innocenti maps evidence and gaps of child and adolescent mental health and psychosocial support in low and middle-income countries 

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. 


The impact of the war in Ukraine and subsequent economic downturn on child poverty 

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.  


Earthlings podcast spotlights CHAIN's research on the impact of plastics on child health

Dr Kam Sripada explains the negative effects of microplastics, and other environmental hazards on children’s health in the Earthlings Podcast episode “Plastic Diet". The podcast discussed the main sources of plastic pollution, the impact on the Global South and research on the health effects of plastics.  


CHAIN researcher co-leads new research consortium focusing on family health and development, inviting interest to join 

The new multi-disciplinary Wits/UCL Lelapa consortium focuses on the study of inequalities in family health and wellbeing within socioecological contexts, where family structures and networks are being transformed by the forces of urbanisation, migration, climate change, pandemics, globalisation and social transformation in low- and middle-income countries.  

The consortium is led by CHAIN-affiliate Prof Frederik Booysen and prof Jolene Skordis of University College London. It welcomes early career researchers to submit expressions of interest to join the Consortium by contacting Professor Booysen


Unicef Innocenti explores 'Implementation Research' and how it can promote successful implement evidence-based interventions

The insights generated by implementation research can help bridge the 'know-do gap' between what we know works and what actually happens on the ground when a policy or intervention is implemented.

Working with the Centre for Evidence and Implementation, Unicef Innocenti has published a paper that promotes a shared understanding of implementation research, and how it can promote the successful implementation of evidence-based interventions.



Environment & health

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.  


Monitoring the social costs of climate change for low- and middle-income countries 

On the topic of social spending, Unicef Innocenti published its third policy brief to generate better understanding of what climate change means for social sector budgets, and the extent to which these sectors are being prioritised to accelerate climate action.  

CHAIN study finds high levels of lead in Greek refugee camp 

Following a deadly fire in September 2020, 13 000 children and their families in the Greek refugee camp Moria were relocated to the nearby Mavrovouni site. The new camp was built on the site of a military shooting range, which are known to have dangerous concentrations of poison.

A CHAIN study found extremely high levels of lead (Pb), antimony (Sb), and bismuth (Bi), where children live and play in the camp. On top of the multiple existing public health crises and traumas that these asylum-seeking families face, exposure to toxic ammunition residues may have profound impacts on children’s development and health for years to come. 


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.


Interventions to reduce exposure to toxic metal cadmium in the early years can help improve public health  

Cadmium pollution is widespread and particularly prevalent in low- and middle-income countries. This presents a threat to children’s health in the earliest years, and so far, there are few identified solutions to tackle this problem. In a systematic review, CHAIN looked into interventions to reduce exposure to cadmium in these countries during pregnancy and childhood.



Socioeconomic inequality & health

CHAIN study explains the Nordic paradox 

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.


Global paid security and women's rights are undermined when female health workers are unpaid of poorly paid

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.  


Exploring the link between health and regional inequalities, and economic performance in the United Kingdom 

CHAIN researcher prof Clare Bambra and Dr Luke Munford published a blog post on the links between health and economic inequalities. The analysis suggests investing in place-based public health, which provides a more holistic approach to improving outcomes in the labour market and promoting health and prevention services across care systems. 

The blog post was built on findings of the Northern Health Science Alliance report, which addresses differences in productivity and health between the north and the rest of the England.  


What is the impact of racism and discrimination on health in Norway? 

The connection between racism, discrimination and health is well documented in studies from other countries, but there has been little attention to this issue in Norway. Findings show that immigrants seeking employment, as well as those already part of workplace settings oftentimes experience discrimination.  


Is there a link between poor health outcomes in immigrants in Norway and their language proficiency?  

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.



Mental health & noncommunicable diseases

CHAIN examines the impact of increased pension income on mental wellbeing in England 

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. 


CHAIN researcher co-authors report on COVID-19 and the parallel mental health pandemic  

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.  


Strategies for promoting workplace wellbeing and protecting older workers from psychosocial risks 

Mounting evidence shows that workers’ health is affected by psychosocial risks, such as conflicting work-family life obligations, job insecurity and work-related stress, with older workers (55-65+) tending to be more at risk than other age groups. However, when adequately supported and protected, older workers are an asset to an organisation, economy, and society.

EuroHealthNet launched a new policy brief offering strategies for mitigating psychosocial risks to older workers’ health in the workplace for employers and policy-makers.


Systematic reviews of the Global Burden of Disease studies for 2019 and 2020 shed further insight into the commercial determinants of health 

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.  


Using individual-level stratification as an approach to integrating social inequalities into the Global Burden of Disease study

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.


Cancer mortality in Europe is largely driven by levels and trends in groups with lower socioeconomic status  

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.  


Reducing inequalities by investing in health-promoting care

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.


This publication is supported by a grant awarded by the Norwegian Research Council (project number 288638) to the Centre for Global Health Inequalities Research (CHAIN) at the Norwegian University for Science and Technology (NTNU).

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