NIHR Global Health Research Unit on Social and Environmental Determinants of Health Inequalities

Brazil and Ecuador manifest stark inequalities, including inequalities in health. These inequalities arise from the social determinants of health – the conditions in which people are born, grow, work, live, age and die. Many environmental factors, including urbanisation and the climate emergency, are increasing priorities for individual and population health.

These tend to have the most harmful impacts on the most deprived in society. The health system needs to respond to such social and environmental threats, but its organisation may mean that it is not protecting the most vulnerable in society.

To try to reduce the impact of social conditions such as poverty, governments have introduced policies such as conditional cash transfers or housing programmes for the very poor. Similarly, governments may introduce environmental policies to protect the environment and mitigate any harmful effects on living conditions. While such policies may not be primarily aimed at improving health, they may still have large impacts on health and health inequalities, with much of the historical improvement in life expectancy attributable to them.

Our Unit will focus on discovering which policies impact health, whether they had a bigger impact on disadvantaged groups (defined by axes such as income, ethnicity, race, sex, geography, migration, urbanicity and deprivation), and how the organisation and provision of the health system (particularly regarding coverage, access and quality) could optimise any positive health impacts.

We will build on our existing GHR Group on Social Policy and Health Inequalities and the experiences and relationships that have been moulded by that Group. Over the next five years, we plan to be global leaders, focused on Latin America, in harnessing existing databases by integrating them to evaluate the impact of social and environmental policies on health and health inequalities, and the extent to which these can be affected by the health system.

We will develop research capacity in data linkage and policy evaluation as a legacy for Brazil and Ecuador. We will achieve this by: 1. Building and developing high quality data resources in Brazil and Ecuador;

2. Conducting rigorous evaluations of the impacts of social and environmental policies, and the effects of large-scale population migration, on health and health inequalities; 3. Updating or creating small area deprivation indices for Brazil and Ecuador;

4. Determining how health systems are best organised to improve health for all social groups and interact with social and environmental policies;

5. Focusing on priority health outcomes with relevance to Brazil, Ecuador and Latin America, in which the research team have expertise: non-communicable diseases including mental health and asthma; maternal and child health; reproductive and sexual health; COVID-19 and emerging health threats; infectious diseases; and violence;

6. Monitoring progress towards the 2030 Agenda for Sustainable Development (particularly Goal 3, but also any impacting on health equity);

7. Working with stakeholders, communities and the public to develop our research agenda, set priorities, disseminate results targeted to specific audiences and in so doing influence regional and national policy; and

8. Building capacity in the relevant disciplines in global health research in Brazil, Ecuador, the UK and globally through the development of training programmes and the promotion of south-south learning.