Understanding Health Inequalities Research Capacities: Insights and Recommendations From Comparing Two High Income Settings

Abstract

Generating evidence on health inequalities (HI) is necessary to raise awareness of these issues, describe and monitor their evolution, analyze their causes, and inform interventions aiming to improve health equity. Yet not all cities and countries have the capacity to produce this type of research. Recent research provides new contextual and causal insights into this research production process, and in-depth understanding on why and how this type of research is produced in certain settings. This article aims to analyze two recent case studies that have uniquely explored this process in two high producers of HI research and high-income country settings to identify learning and distil recommendations, which may be insightful for other settings. Expanding and investing in this line of research is critical, particularly in places with lower HI research output and related capacity, in order to identify key contextual conditions and mechanisms that may enable or hinder this process. This new knowledge could guide the development of new HI research capacity strengthening strategies to foster this research in different settings, worldwide. More understanding is also needed on the relationship between HI research, policy, and action in order to tackle HI.

Keywords

health inequalities health equity research capacity strengthening political determinants comparative case studies knowledge production history realism

Health Inequalities Research: Why Is It Needed?

Over the past four decades there has been growing evidence on health inequalities (HI)—avoidable, systematic, and unjust differences in health outcomes between social groups—within and between countries.^1,2 Generating evidence on HI is essential to raise awareness about their existence, describe and monitor their evolution over time, analyze their underlying causes, and, ideally, inform the design and implementation of interventions aiming to improve health outcomes for all social groups in a given population.^3,4

For instance, during the COVID-19 pandemic urgent questions arose regarding how to quickly and equitably respond, and what were the diverse health, social, and economic effects on individuals and communities.^5–7 Contextualized health-equity oriented analyses based on empirical evidence were needed to address these questions and build comprehensive assessments of the causes, distribution and impact of these events.⁸ However, many countries faced great challenges due to their pre-pandemic limited capacity to produce descriptive and analytical research on HI, and to measure, monitor, and explain HI.^9–13

Although progress is being made, many countries worldwide still face substantial HI research capacity challenges that hinder their ability to measure, monitor, and explain HI,¹⁴ as well as to design and implement effective strategies to address them and to evaluate their impact on citizens health and well-being. Most countries, including high producer HI research countries, also struggle to fully translate their HI research capacity and evidence base into appropriate interventions and effective action to tackle HI.^15–21 There is therefore an urgent need to better understand the nonlinear process of producing HI research, as well as the relationship between HI research, policy, and action to address HI in different settings.²²

Where, Why, and How Is Health Inequalities Research Produced?

Comprehensive understanding on how to effectively strengthen global HI research capacities is needed. Over the past few decades there have been increasing calls and investments in national health research systems in order to strengthen the evidence base and guide effective action on HI, and the analysis of health research capacity has become an emerging line of research.^23–28 Yet, while efforts have been made to comprehend and enhance health research capacity more broadly, there has been limited focus on understanding HI research capacity more specifically.^3,22

To effectively evaluate and strengthen the capacity to produce HI research in particular settings, a strong theoretical understanding of the process is crucial.²² As such, several recent studies have aimed to enhance comprehension of where, why, and how scientific knowledge on HI is produced, and the factors influencing this capacity in certain settings.^{10,22,29–31} These include one study that identified inequalities in global HI research,²⁹ a conceptual model on the process,²⁰ and two novel realist explanatory case studies that established causal explanations for the significant production of HI in two high-income settings: the United Kingdom and the city of Barcelona.^30,32 While a few descriptive studies exist on social determinants of health (SDH) and HI research capacities in some low- and middle-income countries (LMIC; ^11,33–39), to the best of our knowledge, no other studies have attempted to apply this methodological approach to assess the HI research production process in other settings, and identify potential causal mechanisms involved.

Both the United Kingdom and Barcelona were identified as high producers of HI research,^29,31 and the two realist explanatory case studies were conducted with the intention of shedding light on how and why these two settings have been able to generate high volumes of HI research over the past four to five decades.^30,32 Interestingly, both studies found evidence to suggest that a combination of historical sociopolitical-institutional factors have activated many causal mechanisms over time, leading to the generation of a high volume of HI research in these two settings.

Given this context, this article aims to identify similarities, differences, and extract further insights from the case studies, as well as distil research and policy recommendations. This information may be of particular relevance for similar settings (i.e., high producers of HI research and high-income countries). At the same time, it may also be (indirectly) insightful for other settings (i.e., lower producers of HI research and LMIC), where this type of research is urgently needed.

Insights from Two High Producers of Health Inequalities Research and High-Income Settings

Surprisingly, several similarities can be identified between the two case studies mentioned in terms of contextual factors and mechanisms involved in the HI research production process. First, both studies identified that the United Kingdom and Barcelona have strong traditions of public health and recognition of social justice (contextual factors), which date back to the nineteenth century.^30,32,40 In addition, evidence suggests that under certain conditions, this recognition of HI accumulated over time (contextual factor), and when potentially combined with heightened concern (mechanism), it triggered a change in certain agents’ behaviors and actions, initiating a chain of events which likely led to the production of a high volume of HI research in both settings (outcome of interest).

Second, both cases highlighted the significance of allocating (dedicated) resources (mechanism) to invest in local sociodemographic and public health research infrastructure, such as HI observatories, and ensure that reliable, disaggregated health and sociodemographic data are available, collected, and monitored (contextual factors). In addition, dedicated resources must also be allocated (mechanism) to ensure a minimum level of investment in HI-related human resources via creating dedicated training programs and enabling career structures, and to create a critical mass of trained professionals who are able to work on HI (contextual factor).^24,27,30,32 During the COVID-19 pandemic, for example, several public institutions in Barcelona were able to rapidly identify inequalities in COVID-19 incidence and mortality within and between neighborhoods, partly due to the preexisting HI research infrastructure in the city.⁸

Third, the strong political nature of the HI research production process emerges from both case studies, particularly the influential role of politics, and institutional and individual values (contextual factors) in activating certain mechanisms over time. For example, both case studies identified that over the past four decades, left-wing and egalitarian political parties have shown more political recognition and concern for HI (mechanism) than right-wing conservative political parties in the United Kingdom and in Barcelona, leading to more investments in HI research capacity (mechanism) and subsequently more production of HI research (outcome of interest).^30,32 Moreover, compelling evidence suggests that individual egalitarian values and ideologies have played a significant role in initiating and sustaining the production of HI research in both settings, which likely occurred via the activation of a sense of moral responsibility to act (mechanism) and to prove that HI existed to try to address them. The activation of this mechanism seems to have been particularly important during periods of struggles^41,42 or in “hostile socio-political and research environments”.³⁰ ^(p.10)

Fourth, alongside certain individuals, certain institutions, such as local public health and political institutions, seem to have acted as potential stewards of HI research during different time periods (contextual factors and/or mechanisms). Evidence suggests that their guidance (directly or indirectly) may have played a role in strengthening HI research capacities in the United Kingdom and Barcelona, and subsequently enabled the generation of HI research (outcome of interest). In addition, the case studies highlighted how national research funders have played an influential role in inhibiting or facilitating the production of HI research during different historical periods, which has likely influenced the volume of HI research produced in each setting.^43,44 In the case of Spain, domestic funding for HI research has been extremely limited through the past four decades, with the majority of HI research funding coming from international sources.^30,41,42

Lastly, the formation of informal and formal HI research networks (contextual factors) has played a crucial role in both settings, particularly in providing intellectual and emotional support, building trust, solidarity, and mobilizing various resources, and in activating a sense of cognitive social capital (mechanism), which contributed to the co-production of new HI research over time (outcome of interest). These networks seemed to be particularly important in the initiation and development of the research field in the United Kingdom and Barcelona, and during certain periods when domestic research funding for HI research was limited.^30,32

Experiences from other global settings also align with a number of these findings. For example, a study in 2014 mapped Brazil's SDH research capacities and explains how the country has strong HI research infrastructure in terms of human and technical/information resources and how national funding for health research has being increased prior to 2014, which has “undoubtedly contributed” (p. 2085) to the increasing volume of health research, including SDH/HI research produced nationally.¹¹ Whereas Mozambique, which is a low producer of HI research,²⁹ has challenges in monitoring and reporting on HI at national level, partly because it does not have a comprehensive HI-related information system and relies on external donor funding which can influence research priority agendas.¹² Interestingly, other studies have also found that key committed individuals must have the capacity and opportunity to provide leadership to strengthen a national health research system (more broadly), with institutional commitments necessary to sustain these efforts.²⁷ In addition, to strengthen a national health research system, strong political will must exist,²⁷ and politics can have a positive effect on population health particularly in contexts with left-wing and egalitarian political traditions.⁴⁵

Additional Insights

While there were several similarities between the two case studies, some additional insights were also identified from each particular case that are worth highlighting.

Evidence from the United Kingdom case suggests that certain academic peer-reviewed journals and media outlets have played a role in fostering (scientific and social) recognition and concern for HI (mechanism) over the years.^44,46 This support has most likely facilitated the dissemination of scientific recognition and concern with other agents, particularly during periods when political recognition and concern were lacking in the 1980s and 1990s.⁴⁰ While this aspect was not explicitly mentioned in the Barcelona case study, there is some evidence to suggest that Gaceta Sanitaria (Sanitary Gazette), a public health peer-reviewed journal, served as a valuable tool from the late 1980s onwards to strengthen local and national human resource research capacities to produce solid public health and HI research, share findings, and enhance the visibility of researchers throughout Spain. The journal, as it exists today, was created in 1987 as part of the Spanish Society of Public Health and Health Administration (SESPAS acronym in Spanish), and had historical ties to the public health bulletin in Barcelona.⁴⁷ There is also some evidence to suggest that this finding and process may also hold relevance in other global settings.⁴⁸

The United Kingdom case provided compelling evidence to suggest that the political controversy surrounding the release of the first commissioned government report on HI in 1980—the so-called “Black Report” developed by the Working Group on Inequalities in Health and chaired by Sir Douglas Black⁴⁹—and the lack of official recognition of its evidence by Thatcher's conservative government helped to fuel some of the HI scientific production in the United Kingdom during the 1980s and 1990s (outcome of interest).^40,50,51 Throughout that period, there seemed to be a persistent underlying sociopolitical and scientific “struggle for recognition” of HI intertwined with concerns about political misrecognition and denial (mechanism) over the existence of HI.^32,40,46 These conditions seemed to have motivated certain individuals and groups with strong egalitarian values to persevere in their efforts to prove that HI existed, as well as trying to address them. In Spain, a similar negative political reaction occurred in 1996 and 2011 when the conservative government run by the Popular Party (PP) rejected the evidence and recommendations from the so-called “Spanish Black Reports,” which were Commissioned by the former government run by the socialist workers’ party (PSOE; ^30,41,52,53). Also, evidence suggests that during 2011–2015, the city council, a center-right political party, “censored” work on HI in local Public Health Institutions.³⁰ ^{(p. 7)}. It is therefore plausible that a similar reaction may have occurred in Spain where certain motivated individuals, driven by strong egalitarian values (contextual factors), were incentivized to persevere in their efforts to prove the existence of HI, and challenge this negative political reaction, which might have then fueled the local HI research production during and after this period (outcome of interest).

Strong evidence suggests that individual values, disciplinary training, and personal relationships (contextual factors) have played an important role in shaping the formation of HI research networks (contextual factors) in the United Kingdom which, in turn, likely interact and ultimately impact the HI research field itself, even influencing the type of HI research produced (e.g., the psychosocial explanations versus the social-material conditions).^32,54,55 While these specific issues were not explicitly mentioned in the Barcelona case, there is some evidence to suggest that these contextual factors may also be at play in other global settings.^11,55

There was some evidence to suggest that in the United Kingdom, other “professional benefits (i.e., potential new intellectual territory) and/or scientific interests” (mechanism) may have also motivated some individuals to enter this research field during different periods.³² This motivation likely occurred when the topic of HI gained prominence as a political and research (funding) priority, such as after 1997 when the United Kingdom's New Labour Government came into power, for example. This finding aligns with previous research on HI research in the United Kingdom, which suggests that scientists often view themselves as competing for resources, credibility, and territory.^50,56,57

While these issues were not explicitly mentioned in the Barcelona study, it is plausible that they hold relevance in other settings as well. A study on social movements for “Health for All,” for example, also found evidence suggesting that certain employes of nongovernment organizations are often motivated by career advancement rather than by purely political or ideological values, potentially influencing the actions taken and, subsequently, impacting health equity outcomes.⁵⁸

Collectively, these findings provide valuable insights into the HI research production process in two distinct settings, spanning several decades. These findings may or may not be relevant for other settings.

Recommendations

Several research and policy recommendations could be drawn from these findings to work towards strengthening the capacity to produce HI research in different settings worldwide.

Research Recommendations

First, further research is urgently needed to gain a comprehensive understanding of the HI research production process and related research capacities in different settings globally. For instance, more realist explanatory case studies, guided by conceptual models and theories of change^22,31 should be conducted to evaluate the HI scientific processes in settings where a lower producer of HI research has been found, and in lower-income country settings. These in-depth studies should build on and complement existing descriptive or specific assessments of HI research capacities available in certain contexts.^11,33–39 These realist explanatory case studies should be theory-driven,^29,31,59 and seek to identify and evaluate enabling and inhibiting mechanisms. In addition, they should consider the historical, political, and socioeconomic determinants and power dynamics that influence the volume and type of HI research generated in different settings.³¹

Furthermore, these types of case studies should consider examining the roles of different agents, academic journals, the media, and research funders in this research production process, including their motivations and interest during different periods. In addition, the the role of gender in this scientific production should be examined,³² given the known gender bias in science,^5,60,61 as well as other factors and dynamics that create epistemic injustices within this field of study.^29,48,62

Second, descriptive content analyses of the HI research generated in particular settings are essential to better understand the HI being investigated in different settings, as well as the types of theoretical and methodological approaches employed in HI research globally.

Third, extensive research on the relationship between HI research, policy, and action in different global settings is urgently needed. This includes the type of HI research used in policies and interventions aiming to tackle HI and the enabling and inhibiting factors involved. Some research exists on the relationship between HI research and policy in the United Kingdom,⁴⁴ and on some of the factors that may be facilitating or inhibiting the HI research-to-policy process.^63–66 More specifically, some scholars have discussed why policy attempts to tackle HI in the United Kingdom and some other settings (i.e., other high producers of HI research and high-income countries) may have failed. For example, they suggest limitations of HI policies have been connected to the type of HI evidence and the terminology and language that has been used to inform the policy initiative. More specifically, there has been a tendency to predominantly invest in individual behavioral interventions rather than sociopolitical root causes of HI that require long-term structural changes.^16–21

Some evidence from Tanzania suggests that a number of SDH/HI research-to-policy challenges exist because researchers’ often lack skills and/or time to disseminate findings outside academic circles; researchers and/or development actors are often unaware of the reality of how policy making works in country; there is heavy reliance on external funds; and there are conflicting ideologies, among other factors.³⁹

Lastly, further evaluations of the design, implementation and impact of HI-related policies and interventions are essential to advance our understanding in this field in terms of what works, what does not, and how to be more effective.^67–69

Policy Recommendations

Several policy recommendations were discussed in the United Kingdom case study, which are worth reiterating and building on here. Firstly, it is essential to foster recognition and concern for HI at multiple levels, including the individual, societal, and political levels. This includes emphasizing the benefits of having and using locally-relevant evidence on HI.^32,41 Also, efforts should be made to find effective mechanisms that enable the diffusion of these ideas to support positive social change.^70,19

Secondly, commission and conduct comprehensive assessments of HI research capacities at local, national, and global levels to identify strengths and weaknesses, and establish comprehensive recommendations for action.^22,30,32,62 This information can then be used to develop context-specific HI research capacity strengthening strategies and investment plans.

Thirdy, prioritize and invest in critical HI research that uses integrated, transdisciplinary perspectives and novel methods such as realist evaluations, participatory action research, and systems thinking.^22,62,67 This research can be supported via the development of dedicated international, regional and/or national strategic commissions on HI, which should include new research and evaluation of existing HI research.^71,72

Fourthly, invest in HI-related information resources.^3,22,62 This must include investment in comprehensive health information systems, local HI observatories, and data surveillance systems that collect reliable, disaggregated, as well as linked health and sociodemographic data for regular measurement and monitoring of population health and HI at local, national, and regional levels.^{3,12,14,22,38,41}

Fifthly, invest in HI-related human resources to foster HI scientific leadership and stewardship, and develop a critical mass of trained professionals capable of producing critical HI research.^3,62 This should include enabling HI-related career structures at different career stages.^{22,30,32,62,67}

Lastly, support the formation of fair and sustainable HI research collaborations and networks at different levels through dedicated research funding programs, including at the national and international level.⁶² Particularly, build networks that aim to foster the co-development of causal explanations of these complex global political and sociocultural issues, and foster innovative ideas to address HI by working across disciplines, sectors, institutions, and settings.^{22,25,73–75}

Conclusions

HI are growing within and between countries, and it is therefore important to monitor their evolution and analyze their causes. However, strong capacity to produce research on HI does not exist everywhere. Recent research has shed light on some of the potential causal mechanisms and key political, social, and institutional factors that have been involved in generating a high volume of HI research over the past four decades in certain places (i.e., high-income countries and high producers of HI research). Valuable insights have been identified on these processes, and several research and policy recommendations have been distilled which may be useful for other settings. Fostering this line of research is essential to identify HI research capacity strengths and limitations and key contextual conditions and mechanisms that may be facilitating or hindering the production of HI evidence in different settings worldwide. This type of knowledge could help guide the development of effective strategies to strengthen HI research capacity, particularly in settings with lower levels of HI research output. At the same time, more understanding about the relationship between HI research, policy, and action on HI in different settings is needed to know how to effectively work towards achieving health equity.

Footnotes

Acknowledgements

Joan Benach is a recipient of an ICREA Acadèmia (Generalitat de Catalunya).

Authors contributions

Conceptualization: LCG; Writing – original draft: LCG; Writing – review & editing: LCG, JB.

Declaration of Conflicting Interests

The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

ORCID iDs

Lucinda Cash-Gibson

Joan Benach

Author Biographies

Lucinda Cash-Gibson is Senior Lecturer at Universitat Pompeu Fabra-Barcelona School of Management (UPF-BSM), Researcher at the Johns-Hopkins University-UPF Public Policy Center, and Researcher at the Research Group on Health Inequalities, Environment and Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, UPF. She holds a PhD in Public Health from UPF, an MA in Sociology and Demography from UPF, an MSc in Research in Sexual and Reproductive Health from the London School of Hygiene and Tropical Medicine in London, and a BSc in Molecular Cell Biology from University College London. Her research focuses on health inequalities, sociology of science, research capacity strengthening, critical realism, healthy cities, health systems strengthening, and health policies.

Joan Benach is Professor of Sociology in the Department of Political and Social Sciences at the Pompeu Fabra University (UPF) in Barcelona. He is co-director of the Johns Hopkins–UPF Public Policy Center and director of the Research Group on Health Inequalities, Environment, Employment Conditions Network (GREDS-EMCONET). He led the first Spanish Black Report, co-chaired the EMCONET study of the World Health Organization's Commission on Social Determinants of Health, and is currently the coordinator of the Spanish Commission on Precarious Employment and Mental Health. His research focusses on social determinants of health inequities; precarious employment and employment relations; the intersections between class, gender, migration, and geography; health policy analysis; and the complex political and environmental problems linked to health equity.

References

Whitehead

. The concepts and principles of equity and health. Int J Health Serv. 1992;22(3):429–445. doi:https://doi.org/10.2190/986L-LHQ6-2VTE-YRRN

Braveman

. Health disparities and health equity: Concepts and measurement. Annu Rev Public Health. 2006;27(1):167–194. doi:https://doi.org/10.1146/ANNUREV.PUBLHEALTH.27.021405.102103

CSDH. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health ; 2008.

Muntaner

Benach

. Why social (political, economic, cultural, ecological) determinants of health? Part 1: Background of a contested construct. J Soc Determinants Health and Health Serv. 2023;53(2):117–121. doi:https://doi.org/10.1177/27551938231152996

Bambra

Riordan

Ford

Matthews

. The COVID-19 pandemic and health inequalities. J Epidemiol Community Health. 2020;74(11):964–968. doi:https://doi.org/10.1136/JECH-2020-214401

Blundell

Costa Dias

Joyce

. COVID-19 and inequalities*. Fisc Stud. 2020;41(2):291–319. doi:https://doi.org/10.1111/1475-5890.12232

McGowan

Bambra

. COVID-19 mortality and deprivation: Pandemic, syndemic, and endemic health inequalities. Lancet Public Heal. 2022;7(11):e966–e975. doi:https://doi.org/10.1016/S2468-2667(22)00223-7/ATTACHMENT/8EABC6C5-6DD2-48DE-984E-CC9A0ECD12B4/MMC1.PDF

Cash-Gibson

Pericàs

Martinez-Herrera

Benach

. Health inequalities in the time of COVID-19: The globally reinforcing need to strengthen health inequalities research capacities. Int J Health Serv. 2021;51(3):300–304. Published online March 8, 2021. doi:https://doi.org/10.1177/0020731421993939.

Chowkwanyun

Reed

. Racial health disparities and COVID-19 — caution and context. N Engl J Med. 2020;383(3):201–203. doi:https://doi.org/10.1056/NEJMP2012910

10.

Benach

Cash-Gibson

Rojas-Gualdrón

Padilla-Pozo

Fernández-Gracia

Eguíluz

. Inequalities in COVID-19 inequalities research: Who had the capacity to respond? PLoS One. 2022;17(5):e0266132. doi:https://doi.org/10.1371/JOURNAL.PONE.0266132

11.

Borde

Akerman

Pellegrini Filho

. Mapping of capacities for research on health and its social determinants in Brazil. Cad Saude Publica. 2014;30(10):2081–2091. doi:https://doi.org/10.1590/0102-311X00162513

12.

Llop-Gironés

Cash-Gibson

Chicumbe

Alvarez

Zahinos

Mazive

. Health equity monitoring is essential in public health: lessons from Mozambique. Glob Heal. 2019;15(67):1–7. doi:https://doi.org/10.1186/s12992-019-0508-4

13.

Peralta

Benach

Borrell

, et al. Evaluation of the mortality registry in Ecuador (2001-2013) - Social and geographical inequalities in completeness and quality. Popul Health Metr. 2019;17(3):1–10. doi:https://doi.org/10.1186/S12963-019-0183-Y

14.

Hosseinpoor

Bergen

Kirkby

Schlotheuber

. Strengthening and expanding health inequality monitoring for the advancement of health equity: A review of WHO resources and contributions. Int J Equity Health. 2023;22(1):49. doi:https://doi.org/10.1186/S12939-022-01811-4/TABLES/1

15.

Farrar

Ahuja

. Spike: The Virus vs the People. Profile Books; 2021.

16.

Bambra

Smith

Garthwaite

Joyce

Hunter

. A labour of Sisyphus? Public policy and health inequalities research from the Black and Acheson Reports to the Marmot Review. J Epidemiol Community Heal. 2011;65(5):399–406. doi:https://doi.org/10.1136/jech.2010.111195

17.

Mackenbach

. Can we reduce health inequalities? An analysis of the English strategy (1997–2010). J Epidemiol Community Heal. 2011;65(7):568–575. doi:https://doi.org/10.1136/jech.2010.128280

18.

Holman

Salway

Bell

, et al. Can intersectionality help with understanding and tackling health inequalities? Perspectives of professional stakeholders. Heal Res Policy Syst. 2021;19(1):1–15. doi:https://doi.org/10.1186/S12961-021-00742-W/PEER-REVIEW

19.

Whitehead

. Waving or drowning? A view of health equity from Europe. Aust N Z J Public Health. 2012;36(6):523. doi:https://doi.org/10.1111/J.1753-6405.2012.00947.X

20.

Baum

Fisher

. Why behavioural health promotion endures despite its failure to reduce health inequities. Sociol Heal Illn. 2014;36(2):213–225. doi:https://doi.org/10.1111/1467-9566.12112

21.

Lundberg

. Next steps in the development of the social determinants of health approach: The need for a new narrative. https://doi.org/101177/1403494819894789. 2020;48(5):473–479. doi:https://doi.org/10.1177/1403494819894789

22.

Cash-Gibson

Harris

Guerra

Benach

. A novel conceptual model and heuristic tool to strengthen understanding and capacities for health inequalities research. Heal Res Policy Syst. 2020;18(1). doi:https://doi.org/10.1186/S12961-020-00559-Z

23.

Pang

Sadana

Hanney

Bhutta

Hyder

Simon

. Policy and Practice Knowledge for better health—a conceptual framework and foundation for health research systems. Published online 2003.

24.

Ghaffar

Ijsselmuiden

Zicker

. CHANGING MINDSETS Research capacity strengthening in low- and middle-income countries Changing mindsets Research capacity strengthening in low-and middle-income countries. Counc Heal Res Dev. 1. Published online 2008.

25.

Beran

Byass

Gbakima

Kahn

Sankoh

Tollman

. Research capacity building—obligations for global health partners. Lancet Glob Heal [Internet]. 2017;5(6).

26.

Gonzalez Block

Mills

. Assessing capacity for health policy and systems research in low and middle income countries*. Heal Res Policy Syst. 2003;1(1):1. doi:https://doi.org/10.1186/1478-4505-1-1

27.

Hanney

Kanya

Pokhrel

Jones

Boaz

. How to strengthen a health research system: WHO’s review, whose literature and who is providing leadership? Heal Res Policy Syst. 2020;18(1):72. doi:https://doi.org/10.1186/s12961-020-00581-1

28.

WHO-TDR. Essence- TDR. Seven Principles for Strengthening Research Capacity in Low- and Middle-Income Countries: Simple Ideas in a Complex World.; 2015. available:http://www.who.int/tdr/publications/seven-principles/en/.

29.

Cash-Gibson

Rojas-Gualdrón

Pericàs

Benach

. Inequalities in global health inequalities research: A 50-year bibliometric analysis (1966-2015). PLoS One. 2018;13(1):e0191901. doi:https://doi.org/10.1371/JOURNAL.PONE.0191901

30.

Cash-Gibson

Martinez-Herrera

Escrig-Pinol

Benach

. Why and how Barcelona has become a health inequalities research hub? A realist explanatory case study. J Crit Realis. 2022;22(1):49–68. doi:https://doi.org/10.1080/14767430.2022.2095121

31.

Cash-Gibson

Martinez-Herrera

Benach

. What key conditions and mechanisms generate health inequalities research in different settings? Study protocol for two realist explanatory case studies. Eval Progr Plann. 2021;89:1–15. doi:https://doi.org/10.1016/j.evalprogplan.2021.101986

32.

Cash-Gibson

Martinez-Herrera

Benach

. Why and how has the United Kingdom become a high producer of health inequalities research over the past 50 years? A realist explanatory case study. Heal Res Policy Syst 2023 211. 2023;21(1):1–14. doi:https://doi.org/10.1186/S12961-023-00968-W

33.

Salgado-de Snyder

Guerra Guerra

. Un primer análisis de la investigación en México sobre los determinantes sociales de la salud: 2005–2012. Salud Publica Mex Inst Nac Salud Publica. 2014;56(4):393–340.

34.

Borde

Akerman

Snyder

Janeiro

. Capacidades de investigación sobre determinantes sociales de la salud en Brasil, Colombia y México. Rev Fac Nac Salud Pública. 2016;34(3):330–341.

35.

Hofman

Blomstedt

Addei

Kalage

Maredza

Sankoh

. Addressing research capacity for health equity and the social determinants of health in three African countries: The INTREC programme. Glob Health Action. 2013;6:1. doi:https://doi.org/10.3402/gha.v6i0.19668

36.

Badenhorst

Mansoori

Chan

. Assessing global, regional, national and sub-national capacity for public health research: A bibliometric analysis of the Web of ScienceTM in 1996-2010. J Glob Health. 2016;6(1):1–17. doi:https://doi.org/10.7189/jogh.06.010504

37.

Røttingen

Regmi

Eide

, et al.

Mapping of available health research and development data: What’s there, what’s missing, and what role is there for a global observatory?

Lancet. 2013;382(9900):1286–1307. doi:https://doi.org/10.1016/S0140-6736(13)61046-6

38.

Guerra

Borde

Salgado De Snyder

. Measuring health inequities in low and middle income countries for the development of observatories on inequities and social determinants of health. Int J Equity Health. 2016;15(9):1–10. doi:https://doi.org/10.1186/S12939-016-0297-9

39.

Mtenga

Masanja

Mamdani

. Strengthening national capacities for researching on Social Determinants of Health (SDH) towards informing and addressing health inequities in Tanzania. Int J Equity Heal. 2016;15(23). doi:https://doi.org/10.1186/s12939-016-0308-x

40.

Berridge

Blume

. Poor health: social inequality before and after the Black report. Published online 2003.

41.

Borrell

Pasarín

Díez

, et al. Las desigualdades en salud como prioridad política en Barcelona. Health inequalities as a political priority in Barcelona. Gac Sanit. 2019;34:69–76. doi:https://doi.org/10.1016/j.gaceta.2019.04.004

42.

Borrell

Malmusi

. La investigación sobre los determinantes sociales y las desigualdades en salud: Evidencias para la salud en todas las políticas. Inf SESPAS 2010 Gac Sanit. 2010;24(1). doi:https://doi.org/10.1016/j.gaceta.2019.04.004

43.

Cash-Gibson

. Where, why and how scientific knowledge on health inequalities is generated?: An integrated perspective to strengthen understanding of health inequalities research capacities: Key insights from the United Kingdom and the City of Barcelona. Published online 2020. https://repositori.upf.edu/handle/10230/45975.

44.

Smith

. Evidence-informed policy in public health. Beyond Evidence-Based Policy Public Health: The Interplay of Ideas. 2013. Palgrave Macmillian. ISBN : 978-1-349-43926-3.

45.

Muntaner

Borrell

, et al. Politics, welfare regimes, and population health: Controversies and evidence. Sociol Health Illn. 2011;33(6):946–964. doi:https://doi.org/10.1111/J.1467-9566.2011.01339.X

46.

BMJ. Lies, damned lies, and suppressed statistics. Br Med J (Clin Res Ed). 1986;293(6543):349–350. doi:https://doi.org/10.1136/BMJ.293.6543.349

47.

Fernández

. GACETA SANITARIA: Nuestra revista para la salud pública local y global (GACETA SANITARIA: Our journal for local and global public health). Gac Sanit. 2004;18(4):257–259.

48.

Victora

Moreira

. North-South relations in scientific publications: Editorial racism? Rev Saude Publica. 2006;40(SPEC. ISS.):36–42. doi:https://doi.org/10.1590/s0034-89102006000400006

49.

Black

. Health inequalities. Published online 1980.

50.

Bartley

. Health inequality: an introduction to concepts, theories and methods. Published online 2016.

51.

Bartley

Blane

. Reflections on the legacy of British health inequalities research. Published online 2016:22–32.

52.

Navarro

. The “black report” of Spain-the commission on social inequalities in health. Am J Public Heal. 1997;87(3):334–335. doi:https://doi.org/10.2105/AJPH.87.3.334

53.

Navarro

Benach de Rovira

. Desigualdades sociales de salud en España. Informe de la Comisión Científica de Estudios de las Desigualdades Sociales de Salud en España [Social inequities of health in Spain. Report of the scientific commission for the study of social inequities in heal. Rev Esp Salud Publica. 1996;70(1):505–636. available: https://pubmed.ncbi.nlm.nih.gov/9011370/.

54.

Garthwaite

Smith

Bambra

Pearce

. Desperately seeking reductions in health inequalities: Perspectives of UK researchers on past, present and future directions in health inequalities research. Sociol Heal Illn. 2016;38(3):459–478. doi:https://doi.org/10.1111/1467-9566.12374

55.

Collyer

Smith

. An atlas of health inequalities and health disparities research: “How is this all getting done in silos, and why?”. Soc Sci Med. 2020;264(1):113330. doi:https://doi.org/10.1016/j.socscimed.2020.113330

56.

Bartley

. Authorities and partisans: the debate on unemployment and health. Published online 1992.

57.

Latour

. Science in action: how to follow scientists and engineers through society. Published online 1987.

58.

Musolino

Baum

Freeman

Labonté

Bodini

Sanders

. Global health activists’ lessons on building social movements for Health for All. Int J Equity Health. 2020;19(1):1–14. doi:https://doi.org/10.1186/S12939-020-01232-1/METRICS

59.

Renmans

Castellano Pleguezuelo

. Methods in realist evaluation: A mapping review. Eval Program Plann. 2023;97:102209. doi:https://doi.org/10.1016/J.EVALPROGPLAN.2022.102209

60.

Segovia-Saiz

Briones-Vozmediano

Pastells-Peiró

González-María

Gea-Sánchez

. Techo de cristal y desigualdades de género en la carrera profesional de las mujeres académicas e investigadoras en ciencias biomédicas. Gac Sanit. 2020;34(4):403–410. doi:https://doi.org/10.1016/J.GACETA.2018.10.008

61.

Bendels

Müller

Brueggmann

Groneberg

. Gender disparities in high-quality research revealed by Nature Index journals. PLoS One. 2018;13(1):0189136. doi:https://doi.org/10.1371/journal.pone.0189136

62.

Cash-Gibson

Guerra

Salgado-de-Snyder

. SDH-NET: A South-North-South collaboration to build sustainable research capacities on social determinants of health in low-and middle-income countries. Heal Res Policy Syst. 2015;13(1):1–9. doi:https://doi.org/10.1186/s12961-015-0048-1

63.

Hiam

Dorling

McKee

. When experts disagree: Interviews with public health experts on health outcomes in the UK 2010–2020. Public Health. 2023;214(4):96–105. doi:https://doi.org/10.1016/J.PUHE.2022.10.019

64.

Hinde

Howdon

Lomas

Franklin

. Health inequalities: To what extent are decision-makers and economic evaluations on the same page? An English case study. Appl Health Econ Health Policy. 2022;20(6):793–802. doi:https://doi.org/10.1007/S40258-022-00739-8/TABLES/2

65.

Petticrew

Whitehead

Macintyre

Graham

Egan

. Evidence for public health policy on inequalities: 1: The reality according to policymakers. J Epidemiol Community Health. 2004;58(10):811–816. doi:https://doi.org/10.1136/JECH.2003.015289

66.

Whitehead

Petticrew

Graham

Macintyre

Bambra

Egan

. Evidence for public health policy on inequalities: 2: Assembling the evidence jigsaw. J Epidemiol Community Heal. 2004;58(10):817–821. doi:https://doi.org/10.1136/JECH.2003.015297

67.

Smith

Bambra

Hill

. eds. Health Inequalities: Critical Perspectives. Oxford University Press; 2016, doi:https://doi.org/10.1093/ACPROF:OSO/9780198703358.001.0001.

68.

Thomson

Hillier-Brown

Todd

McNamara

Huijts

Bambra

. The effects of public health policies on health inequalities in high-income countries: An umbrella review. BMC Public Health. 2018;18(1):1–21. doi:https://doi.org/10.1186/S12889-018-5677-1/TABLES/7

69.

Pons-Vigués

Diez

Morrison

, et al. Social and health policies or interventions to tackle health inequalities in European cities: A scoping review. BMC Public Health. 2014;14(1):1–12. doi:https://doi.org/10.1186/1471-2458-14-198/TABLES/3

70.

Whitehead

. Diffusion of ideas on social inequalities in health: A European perspective. Milbank Q. 1998;76(3):469–492. doi:https://doi.org/10.1111/1468-0009.00099

71.

Buitendijk

Ward

Shimshon

Sharma

Harris

. COVID-19: An opportunity to rethink global cooperation in higher education and research. BMJ Glob Heal. 2020;5(2790):e002790. doi:https://doi.org/10.1136/bmjgh-2020-002790

72.

WHO. Achieving health equity in the Eastern Mediterranean Region. Published online 2020.

73.

Sibai

Rizk

Coutts

, et al. North–South inequities in research collaboration in humanitarian and conflict contexts. Lancet. 2019;394(10209):1597–1600. doi:https://doi.org/10.1016/S0140-6736(19)32482-1

74.

Olusanya

Opoka

. Obligations under global health partnerships in LMICs should be contractual. Lancet Glob Heal. 2017;5(9):e869. doi:https://doi.org/10.1016/S2214-109X(17)30260-7

75.

UK Research and Innovation (UKRI). Collaborative community research to tackle health inequalities. https://www.ukri.org/opportunity/collaborative-community-research-to-tackle-health-inequalities/.