Solutions focused research
Impacting global health
Reducing global inequalities in health
Prof Alastair Leyland (MRC/CSO Social and Public Health Sciences Unit)
School of Health and Wellbeing research theme
Related University of Glasgow beacon
Health inequalities exist within, as well as between, countries and as such are a priority for global health research. Strategies to reduce inequalities typically look "upstream" (through policy) rather than "downstream" (through individual behaviour change). The policies that affect health are not necessarily health policies; many factors influence health including income and housing. The evaluation of the impact of policies on health inequalities is often hampered by difficulties obtaining high quality health data and data on socioeconomic position.
We have been working with researchers in Brazil through an NIHR-funded Global Health Research Group on Social Policy and Health Inequalities. Our research has built on an existing resource – the Cohort of 100 Million Brazilians – which brings together social security data (payments for welfare and other government support) with health outcomes focusing on infectious diseases for 114 million people. We have linked further data to enable research on the social determinants of health (the conditions in which people are born, grow, live, work and age) and to investigate the increasing problem of non-communicable diseases (e.g. heart disease and stroke) in Brazil.
We have created the first small area deprivation index covering the whole of Brazil (IBP: Indice Brasileiro de Privação). We were able to geocode around 80% of data (with some variation between datasets) meaning that we could break down analyses by area deprivation and in this manner focus on inequalities. We expanded the 100 Million Cohort by adding hospitalisation data and data relating to particular welfare programmes.
We are currently evaluating the impact of two major welfare programmes on health. Bolsa Familia is the world’s largest conditional cash transfer programme, designed to provide additional money for the poorest in society. Minha Casa, Minha Vida is a massive housebuilding programme providing subsidised housing across the country. Both have the potential to impact on health and we are considering how they affect a range of outcomes including cardiovascular disease, leprosy and diabetes.
Improving the health of the poorest people in a country is not just about social justice, it is also key to improving the health of the whole population. "Leave no one behind" is the key focus of the Sustainable Development Goals (SDGs), and monitoring progress towards these goals needs accurate data. We have expanded the research potential of the 100 million cohort by adding further data.
A major achievement has been the creation of the IBP. This will allow a range of users to measure and monitor inequalities in health across Brazil using a consistent measure at the small area level. The IBP can help monitor progress to SDG targets by demonstrating that social policies and health systems are reaching all groups of the population.
We are still writing up the results of our policy evaluations, and will continue to engage stakeholders to discuss our results, including those from the public agencies responsible for the policies.
- Ichihara, M. Y. et al. (2018) Area deprivation measures used in Brazil: a scoping review. Revista de Saúde Pública, 52, 83.
- Bernal, R. T. I., Felisbino-Mendes, M. S., de Carvalho, Q. H., Pell, J. , Dundas, R. , Leyland, A. , Barreto, M. L. and Carvalho Malta, D. (2019) Indicators of chronic noncommunicable diseases in women of reproductive age that are beneficiaries and non-beneficiaries of Bolsa Família. Revista Brasileira de Epidemiologia, 22(S2)
- Malta DC, Bernal RTI, de Carvalho QH, Pell JP, Dundas R, Leyland AH, Barreto ML. Women and assessment of inequalities in the distribution of risk factors for chronic diseases, analysis of Vigitel 2016-2017. Revista Brasileira de Epidemiologia 2019; 22 (suppl 2):e190012.
- Allik, M. , Leyland, A. , Ichihara, M. Y. T. and Dundas, R. (2020) Creating small-area deprivation indices: a guide for stages and options. Journal of Epidemiology and Community Health, 74(1), pp. 20-25.
- Bernal, R. T. I., Hapuque de Carvalho, Q., Pell, J. P. , Leyland, A. , Dundas, R. , Lima Barreto, M. and Carvalho Malta, D. (2020) A methodology for small area prevalence estimation based on survey data. International Journal for Equity in Health, 19, 124.
- Allik, M. , Ramos, D., Agranonik, M., Pinto Júnior, E. P., Ichihara, M. Y., Barreto, M. L., Leyland, A. H. and Dundas, R. (2020) Developing a Small-Area Deprivation Measure for Brazil. Technical Report. University of Glasgow.
- Pescarini, J. M., Craig, P. , Allik, M. , Amorim, L., Ali, S., Smeeth, L., Barreto, M. L., Leyland, A. H. , Aquino, E. M.L. and Katikireddi, S. V. (2020) Evaluating the impact of the Bolsa Familia conditional cash transfer program on premature cardiovascular and all-cause mortality using the 100 million Brazilian cohort: A natural experiment study protocol. BMJ Open, 10, e039658.
- Ferreira, A. J.F. et al. (2021) Evaluating the health effect of a Social Housing programme, Minha Casa Minha Vida, using the 100 million Brazilian Cohort: A natural experiment study protocol. BMJ Open, 11(3), e041722.
- Teixeira RA, Ishitani LH, Marinho F, Pinto Junior EP, Katikireddi SV, Malta DC. Methodological proposal for the redistribution of deaths due to garbage codes in mortality estimates for Noncommunicable Chronic Diseases. Revista Brasileira de Epidemiologia 2021; 24 (suppl 1):e210004.
- Katikireddi, S. V. et al. (2022) Two-dose ChAdOx1 nCoV-19 vaccine protection against COVID-19 hospital admissions and deaths over time: a retrospective, population-based cohort study in Scotland and Brazil. Lancet, 399(10319), pp. 25-35.
- Cerqueira-Silva, T. et al. (2022) Vaccine effectiveness of heterologous CoronaVac plus BNT162b2 in Brazil. Nature Medicine 28(4), pp. 838-843
- NIHR Global Health Research Group on Social Policy and Health Inequalities (SPHI)
- NIHR Global Health Research Group on Social Policy and Health Inequalities led by the University of Glasgow
- Indice Brasileiro de Privação (IBP)
- International Project investigates chronic diseases and social determinants
Contact for further information
Prof Alastair Leyland