scholarly journals The COVID-19 pandemic and health inequalities

2020 ◽  
pp. jech-2020-214401 ◽  
Author(s):  
Clare Bambra ◽  
Ryan Riordan ◽  
John Ford ◽  
Fiona Matthews
Keyword(s):  
Health Inequalities ◽  
Public Health Policy ◽  
Influenza Pandemic ◽  
Mortality Rates ◽  
Future Generations ◽  
Spanish Influenza ◽  
Policy Responses ◽  
Geographical Inequalities ◽  
The Social ◽  
H1n1 Outbreak

This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a syndemicpandemic. It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.

Health inequalities in the Great Depression: a case study of Stockton on Tees, North-East England in the 1930s

2019 ◽  
Vol 42 (2) ◽  
pp. e126-e133 ◽  
Author(s):  
Michael Langthorne ◽  
Clare Bambra
Keyword(s):  
Great Depression ◽  
Health Inequalities ◽  
Local Level ◽  
Mortality Rates ◽  
Inequalities In Health ◽  
The Great Depression ◽  
North East ◽  
Geographical Inequalities ◽  
Overall Mortality

Abstract Background Parallels have been drawn between the ‘Great Depression’ of the 1930s and the more recent ‘Great Recession’ that followed the 2007/8 financial crisis. Austerity was the common policy response by UK governments in both time periods. This article examines health inequalities at a local level in the 1930s, through a historical case study. Methods Local and national historical archives, Medical Officer for Health reports, and secondary sources were examined from 1930 to 1939 to obtain data on inequalities in health (infant mortality rates, stillbirths and neonatal mortality rates, 1935 and crude overall mortality rates, 1936) and ward-level deprivation (over-crowding rates, 1935) in Stockton-on-Tees, North-East England. Results There were high geographical inequalities in overcrowding and health in Stockton-on-Tees in the 1930s. Rates of overall mortality, in particular, were higher in those wards with higher levels of overcrowding. Conclusions There were geographical inequalities in health in the 1930s and the most deprived areas had the worst overall mortality rates. The areas with the worst housing conditions and health outcomes in the 1930s remain so today - health inequality is extant over time across different periods of austerity.

scholarly journals Addressing the social determinants of health at the local level: Opportunities and challenges

2018 ◽  
Vol 46 (20_suppl) ◽  
pp. 47-52 ◽  
Author(s):  
E. Fosse ◽  
M.K. Helgesen ◽  
S. Hagen ◽  
S. Torp
Keyword(s):  
Public Health ◽  
Health Policy ◽  
Health Inequalities ◽  
Public Health Policy ◽  
Social Inequalities ◽  
Local Level ◽  
Qualitative Interviews ◽  
Social Gradient ◽  
New Public Health ◽  
The Social

Aims: The gradient in health inequalities reflects a relationship between health and social circumstance, demonstrating that health worsens as you move down the socio-economic scale. For more than a decade, the Norwegian National government has developed policies to reduce social inequalities in health by levelling the social gradient. The adoption of the Public Health Act in 2012 was a further movement towards a comprehensive policy. The main aim of the act is to reduce social health inequalities by adopting a Health in All Policies approach. The municipalities are regarded key in the implementation of the act. The SODEMIFA project aimed to study the development of the new public health policy, with a particular emphasis on its implementation in municipalities. Methods: In the SODEMIFA project, a mixed-methods approach was applied, and the data consisted of surveys as well as qualitative interviews. The informants were policymakers at the national and local level. Results: Our findings indicate that the municipalities had a rather vague understanding of the concept of health inequalities, and even more so, the concept of the social gradient in health. The most common understanding was that policy to reduce social inequalities concerned disadvantaged groups. Accordingly, policies and measures would be directed at these groups, rather than addressing the social gradient. Conclusions: A movement towards an increased understanding and adoption of the new, comprehensive public health policy was observed. However, to continue this process, both local and national levels must stay committed to the principles of the act.

scholarly journals Canadian trends in the social determinants of health inequalities, a census-mortality linkage approach

2018 ◽  
Vol 3 (4) ◽  
Author(s):  
Katie Irvine ◽  
Michael Smith ◽  
Reinier De Vos ◽  
Adrian Brownell ◽  
Anna Ferrante ◽  
...  
Keyword(s):  
Cause Of Death ◽  
Health Inequalities ◽  
Methodological Approach ◽  
Mortality Rates ◽  
Income Quintile ◽  
Time Period ◽  
The Social ◽  
Education Levels ◽  
Socioeconomic Dimension ◽  
The University

IntroductionMortality inequalities by income and education levels have historically been estimated using an area-based approach in Canada. Although useful in measuring socioeconomic inequalities overtime, this method underestimates the level of inequality and only allows the examination of a single dimension at a time. Objectives and ApproachTo create a series of census linked datasets that allowed for the examination of health inequalities across different socioeconomic dimensions. Specifically, five census cycles (beginning with the 1991 Census) were probabilistically and deterministically linked to different health outcomes (mortality, cancer, hospitalization) to create the Canadian Census Health and Environment Cohort (CanCHEC). Each dataset was created using a similar methodological approach which allowed for the measurement of these health inequalities over time. Mortality inequalities by both income and education level (including multidimensional) for all causes and cause-specific groups were examined. ResultsFive census linked datasets were constructed that followed mortality for a period of up to 20 years. The 1991 CanCHEC includes 2.6 million adults, the 1996 and 2001 CanCHECs include 3.5 million adults respectively, and the 2006 and 2011 CanCHECs include 5.9 and 6.5 million people respectively. Findings revealed a stair-stepped gradient in all-cause and cause-specific mortality by educational attainment and income quintile across each time period. The lowest mortality rates were among the university educated and richest income quintile and highest mortality rates among those with less than high school graduation and the poorest income quintile. The gradient differed by cause of death groupings. Over the 25-year time period, the mortality gradient trend varied by socioeconomic dimension and cause of death. Conclusion/ImplicationsThese data show clear mortality inequalities by socioeconomic position across the different time periods. These linked datasets can help advance knowledge in understanding health inequalities in Canada as well as provide a tool for on-going surveillance of health inequalities by different socioeconomic dimensions.

scholarly journals COVID-19 and the gender health paradox

2020 ◽  
pp. 140349482097560
Author(s):  
Clare Bambra ◽  
Viviana Albani ◽  
Paula Franklin
Keyword(s):  
Mortality Rate ◽  
Economic Crisis ◽  
Health Inequalities ◽  
Government Policy ◽  
International Research ◽  
Social Economic ◽  
Mortality Rates ◽  
Policy Responses ◽  
Gender Based ◽  
Health Paradox

This article examines gender-based health inequalities arising from the COVID-19 pandemic by drawing on insights from research into the ‘gender health paradox’. Decades of international research shows that, across Europe, men have shorter life expectancies and higher mortality rates than women, and yet, women report higher morbidity. These gender-based health inequalities also appear to be evident within the pandemic and its aftermath. The article starts by providing an overview of the ‘gender health paradox’ and the biological, social, economic and political explanations for it. It then outlines the international estimates of gender-based inequalities in COVID-19 morbidity and mortality rates – where emerging data suggests that women are more likely to be diagnosed with COVID-19 but that men have a higher mortality rate. It then explores the longer term consequences for gender-based health inequalities of the aftermath of the COVID-19 pandemic, focusing on the impacts of government policy responses and the emerging economic crisis, suggesting that this might lead to increased mortality amongst men and increased morbidity amongst women. The essay concludes by reflecting on the pathways shaping gender-based health inequalities in the COVID-19 pandemic and the responses needed to ensure that it does not exacerbate gender-based health inequalities into the future.

An egalitarian society? Widening inequalities in premature mortality from non-communicable diseases in Australia, 2006-16

2020 ◽  
Author(s):  
Tim Adair ◽  
Alan D Lopez
Keyword(s):  
Premature Mortality ◽  
Mortality Rates ◽  
Communicable Diseases ◽  
Public Health Issue ◽  
Major Public Health Issue ◽  
Non Communicable Diseases ◽  
Chronic Respiratory Diseases ◽  
Policy Responses ◽  
Geographical Inequalities ◽  
Life Expectancy Increase

Abstract Background The recent slowdown in life expectancy increase in Australia has occurred concurrently with widening socioeconomic and geographical inequalities in all-cause mortality risk. We analysed whether, and to what extent, mortality inequalities among specific non-communicable diseases (NCDs) in Australia at ages 35–74 years widened during 2006–16. Methods Registered deaths that occurred during 2006–16 in Australia were analysed. Inequalities were measured by area socioeconomic quintile [ranging from Q1 (lowest) to Q5 (highest)] and remoteness (major cities, inner regional, outer regional/remote/very remote). Age-standardized death rates (ASDR) for 35–74 years were calculated and smoothed over time. Results NCD mortality inequalities by area socioeconomic quintile widened; the ratio of Q1 to Q5 ASDR for males increased from 1.96 [95% confidence interval (CI) 1.91–2.01] in 2011 to 2.08 (2.03–2.13) in 2016, and for females from 1.78 (1.73–1.84) to 1.96 (1.90–2.02). Moreover, Q1 NCD ASDRs did not clearly decline from 2011 to 2016. CVD mortality inequalities were wider than for all NCDs. There were particularly large increases in smoking-related mortality inequalities. In 2016, mortality inequalities were especially high for chronic respiratory diseases, alcohol-related causes and diabetes. NCD mortality rates outside major cities were higher than within major cities, and these differences widened during 2006–16. Higher mortality rates in inner regional areas than in major cities were explained by socioeconomic factors. Conclusions Widening of inequalities in premature mortality rates is a major public health issue in Australia in the context of slowing mortality decline. Inequalities are partly explained by major risk factors for CVDs and NCDs: being overweight or obese, lack of exercise, poor diet and smoking. There is a need for urgent policy responses that consider socioeconomic disadvantage.

Race and Sex Differences and Fear of Dying: A Test of Two Hypotheses — High Risk or Social Loss?

1987 ◽  
Vol 17 (3) ◽  
pp. 229-236 ◽  
Author(s):  
Alan Marks
Keyword(s):  
Sex Differences ◽  
High Risk ◽  
Mortality Rates ◽  
National Sample ◽  
Zero Order ◽  
Fear Of Death ◽  
Level Of Education ◽  
Social Loss ◽  
Education And Health ◽  
The Social

A national sample of noninstitutionalized adult Americans is used to test two hypotheses and their relation to fear of death, The first hypothesis, referred to as the high risk hypothesis (i.e., groups with higher mortality rates will express more fear of death than groups with lower rates of mortality), is rejected. The second hypothesis, referred to as the social loss hypothesis, is developed and tested across six status categories—race, sex, age, religion, level of education, and health status. Zero order differences did appear for sex and race, however, these differences were eliminated with the introduction of controls. Both hypotheses are rejected.

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