New Methods to Study Health Inequalities Require Investments in Data Infrastructures, European Academies Report Says

A new generation of scientific methods are helping to better understand health inequalities in Europe, but investments in data infrastructures are required to make use of its full potential for informing policymaking, European academies say in a new report.

The COVID-19 pandemic has struck disadvantaged groups in society much more severely than others. As a result, the health gap between socio-economic groups has widened, exacerbating inequalities long known to researchers. A better understanding of these inequalities is therefore more important than ever.

In the Health Inequalities Research: New methods, better insights? report published today, experts from the European Federation of Academies of Sciences and Humanities (ALLEA) and the Federation of European Academies of Medicine (FEAM) evaluate scientific methods to study health inequalities with the aim of helping to narrow the health gap across Europe.

“In many European countries, differences in average life expectancy at birth between people with a lower and a higher level of education, occupation, or income amount to between 5 and more than 10 years, and differences in healthy life expectancy often amount to even more than 15 years”, the document says.

Issues in the field of health inequalities are not new to policymakers and have, over the past four decades, been studied extensively by researchers from various disciplines. However, there is still substantial uncertainty about several important issues, such as the extent to which socioeconomic disadvantage causally affects health, and the effectiveness of interventions to reduce health inequalities.

In the newly published report, experts on the scientific committee, chaired by the Royal Netherlands Academy of Arts and Sciences (KNAW), conclude that a range of new analytic methods are a “valuable addition to health inequalities researchers’ tool-box” and should be used as a complement to conventional research methods to resolve these issues and reduce the uncertainties.

Examples of such new methods include “counterfactual” approaches to assess the causal effect of socio-economic conditions on health, and “natural experiments” to evaluate the effect of interventions on health inequalities.

Research using these new methods can play an important role in informing policies to narrow the health gap but requires investments in data infrastructures which allow these methods to be applied, the experts highlight.

The experts therefore call on the European Commission and on national governments to support research on health inequalities, including research that takes advantage of variation in socioeconomic conditions, health outcomes and policies between European countries.

Final conference “Health inequalities: new methods, better insights?” on 8 December

The debate on health inequalities research methods began in 2018 and had as its starting point a discussion paper prepared by the ALLEA-FEAM interdisciplinary scientific committee. Under the chairmanship of Johan Mackenbach of the KNAW, the experts on the committee developed this work further over the last few years and as a result, produced the report.

The official presentation of the Health Inequalities Research: New methods, better insights? report will take place at a symposium to be held on 8 December 2021, 13:30 – 17:30 CET. The event, hosted by KNAW, will be organised in Amsterdam in a hybrid format.

Under the theme How can new research methods help address COVID-related health inequalities?, researchers and policymakers will discuss how to capitalise on new research methods in the field of health inequalities.

Registration and Conference Programme

Download publication (short version, full report)

Expert Workshop on Causality of Health Inequalities Held Online

On 2 December, the Scientific Committee of the ALLEA-FEAM-KNAW project on Health Inequalities in Europe welcomed external experts to its second workshop, which was held online. Dedicated to exploring causality of socioeconomic inequalities in healthover 50 participants analysed and debated new approaches to assessing causality in an interdisciplinary dialogue. 

Recent quasi-experimental studies have pointed out that a direct relationship between socioeconomic position and health could not be confirmed, and that factors such as education or income may not always lead to the assumption that there is a causal effect of such factors on health. Meanwhile, novel findings in genetics suggest a stronger role of genetic predisposition in ‘confounding’ as opposed to the causal effect of the indicators such as socioeconomic position and physical and mental wellbeing. This and other related perspectives were introduced and discussed by leading European experts in the field, who were joined by their North American counterparts despite the early hour across the pond.  

Moderated by Axel Börsch-Supan, member of the National Academy of Leopoldina and Johan Mackenbach, Chair of the Scientific Committee of this tripartite project, workshop attendees emphasized the importance of causation both in the scientific as well as policy context. As such, they called for the need to adequately address socioeconomic disadvantages vis-à-vis policymakers in a unified voice from scientists. 

Initially set to take place in March 2020 at the Leopoldina Academy in Berlin, this meeting was shifted to an online format due to the restrictions brought on by the current pandemic. In a next step, the Committee will start preparing the final workshop of this project, which will aim at evaluating current policies and interventions to reduce health inequalities. 

Read more about ALLEA’s Health Inequalities activities

Migrants need better access to healthcare, European Academies say

EU and national authorities need to act now to support the health of migrants, according to European academy networks ALLEA and FEAM.

In a joint statement published today, European academy networks ALLEA and FEAM call on EU and national authorities to undertake crucial actions to support the health of migrants. This situation has become more critical as the lack of basic services and overcrowded conditions in refugee camps start to sound alarms all over Europe, especially during the coronavirus crisis.

The statement reviewed evidence showing that, in contrast to previous concerns, the transmission of communicable diseases from migrants does not appear to be a substantial problem. However, evidence also shows that migrants and other vulnerable populations are at high risk for several non-communicable and communicable diseases, including COVID-19.

“During this terrible crisis the issue of migrant health has been almost completely forgotten in Europe,” says Professor Luciano Saso, Vice-Rector for European University Networks of Sapienza University of Rome. “Forcibly displaced migrants are still struggling to reach Europe, exposing themselves to COVID-19. The incipient economic crisis threatens to further reduce the resources allocated by the EU to face migrant health issues.”

Academies recommend wider and easier access to healthcare services for forced migrants, and at least basic and emergency healthcare for irregular or undocumented migrants. Early access to healthcare may also lead to cost-savings for host countries.

According to Professor Alfred Spira, a member of the French Academy of Medicine,

All international and European legal instruments recognise the right of everyone to the enjoyment of the highest attainable standard of physical and mental health, and all EU Member States should act to allow access to these basic human rights for everyone, including migrants and refugees.”

The coronavirus crisis has provided a global opportunity to enhance the integration of migrants while addressing shortages of healthcare workers. The recommendations within this statement, though drafted before the COVID-19 outbreak began, have acquired new relevance as several countries such as Germany, the UK, the US and Australia are incorporating refugees with foreign qualifications to address shortages in their health workforce.

The document concludes that reliable, validated and comparable data across countries and regions is the key element that will inform policies and confront myths around migration and health. Academies offer their support to lead the dialogue and scientific work to guide policies in this complex area.

This statement has been published at a time when developing evidence-based policies is particularly important. These recommendations, if transformed into policy, will enhance the protection of migrant health and of public health overall.

The recommendations from the academies include:

  • More scientifically validated data and frequent updates on migrant health should be produced and reflected in evidenced-based policies.
  • Increased cross-sectorial collaboration is needed to address current challenges in migrant health, also with a view towards tackling shortages of healthcare workers.
  • The health sector should be actively involved in policy discussions and actions on migration.
  • National health systems should allow for personal health information to be easily transportable and accessible while ensuring the protection of personal data.

The statement and the full set of recommendations is available in the publications section.  

This statement came about as the result of a joint ALLEA-FEAM conference on Migration, Health and Medicine held on 22 November 2019 in Brussels. Attended by stakeholders from research, policy and the civil society, this event strove to approach the topic of migrant health from a multidisciplinary, cross-sectoral point of view and in a coordinated fashion transcending national boundaries. This places the Academies of Sciences and Medicine in a critical position as they offer impartial scientific advice to policymakers for taking informed decisions.

Academic community calls for multidisciplinary approach to reduce health inequalities

Inequalities in health may have different causes, yet the most persistent and man-made are linked to the social factor. Socio-economic position, education or access to healthcare are likely to have considerable impact on our physical and mental wellbeing, as they do on the susceptibility to diseases. So what can societies and especially lawmakers do to reduce the inequalities caused by these factors?

Around 200 researchers, civil society representatives, and members of the public discussed these and further questions at the “Social Inequalities in Health Symposium“. The event was organised by Académie nationale de médecine in partnership with ALLEA and FEAM, the Federation of European Academies of Medecine, and took place on 22 January 2020 in Paris.

Sadly, health inequalities in all European countries are increasing even though we know many of the causes. It was stressed at the symposium that with so much evidence at our disposal we need to act decisively and bring stakeholders from research, civil society, policy and the wider society together to develop policies concerning inequalities.‘, says Professor Graham Caie, Vice President of ALLEA, who chaired the session on health systems, education and mental health. ‘Medical, social and educational factors of health inequalities are closely interlineked and require a multidisciplinary approach. Our networks of academies can assist with finding the best experts to investigate this vitally important topic.’

The recent symposium in Paris followed a successful joint conference of ALLEA and FEAM in November 2019 in Brussels. This event looked further into exploring how vulnerable groups such as migrants often find themselves challenged for various reasons, from language barriers to adaptability of healthcare systems in receiving countries.

The following day, invited experts from across Europe and North America attended a workshop focusing on key methodologies of health inequalities research. This meeting emerged from a joint ALLEA-FEAM-KNAW (the Royal Netherlands Academy of Arts and Sciences) project that seeks to synthesise the evidence-base and identify consensus among the various disciplines involved in the subject of health inequalities. A subsequent expert workshop will address causalities and socioeconomic inequalities in health will take place on 18 March in Berlin.

Conference report ‘Migration, Health and Medicine’ released

The ALLEA-FEAM report of the conference ‘Migration, Health and Medicine’ is now available. The publication summarises the discussions of the event held in Brussels on 22 November 2019. It provides the basis for a scientifically sound analysis on migrant health and, among other topics, addresses the methods and strategies to collect valid and comparable data on this issue.

The conference was organised by ALLEA and the Federation of European Academies of Medicine (FEAM), and hosted by the Royal Academies of Medicine of Belgium (ARMB and KAGB) in collaboration with the French Academy of Medicine (ANM).

Migrant health from a scientific perspective

Migrant health is determined by multiple factors, from socio-economic aspects of health to biological and environmental interactions influencing the health of migrant populations. However, the generalisation of research findings from one community or from one country to the regional or global levels faces considerable hurdles.

From the policy side in Europe, the complexity increases due to the various levels of governance at the EU. Whereas many aspects of migration and health can be dealt with an EU approach, the provision of healthcare services is managed by Member States.

The report seeks to inform policy debates on this pressing issue from a scientific perspective. It also underlines the need for academia, policymakers, civil society and international organisations to join forces to provide scientifically validated data on the health of refugees and migrants across Europe and the world.