Historical research on urban epidemics has focused on the interaction of diseases with social and spatial gradients, such as class, ethnicity, or neighborhood. Even sophisticated historical studies usually lack data on health-related behavior or health-related perceptions, which modern analysts tend to emphasize. With detailed source material from the Finnish city of Tampere during a typhoid epidemic in 1916, we are able to combine both dimensions and look at how material and social constraints interacted with behavior and knowledge to produce unequal outcomes. We use data on socioeconomic status, location, and physical habitat as well as the self-reported behavior and expressed understandings of transmission mechanisms of the infected people to identify the determinants of some falling ill earlier or later than others. Applying survival analysis to approximately 2,500 cases, we show that disease avoidance behavior was deficient and constrained by physical habitat, regardless of considerable public health campaigning. Behavioral guidelines issued by authorities were sub-optimally communicated, unrealistic, and inadequately followed. Boiling water was hampered by shared kitchens, and access to laundry houses for additional hygiene was uneven. Centralized chemical water purification finally leveled the playing field by socializing the cost of prevention and eliminating key sources of unequal risk.

By 2050 the number of adults living with obesity in the UK will rise with approximately one in four in the adult population. This rising trend is not equitable, with higher prevalence in socially disadvantaged groups. There is an apparent paradox of not being able to provide food for the family to eat, a feature of food insecurity and living with obesity. With the current cost-of-living crisis, there is a challenge to afford both food and fuel bills. Environmentally sustainable and healthy diets are proposed to improve public health and reduce the impact of the food system on the environment, while also improving diet quality. However, healthier foods tend to be nearly three times more expensive than unhealthy foods, and this provides a challenge for citizens on low incomes. In this review, we explore some of the evidence for solutions in the retail food environment to support the UK food system to be safe, nutritious, environmentally friendly and fair for all. We highlight the value of co-production in research, to give value and power to the lived experience to address these inequalities. Our multidisciplinary research approach within the FIO Food research grant will generate new insights into modifiable and potentially impactful changes to the UK food system, specifically for the retail food sector. We believe that the co-creation, design and delivery of research with those living with obesity and food insecurity will help to transform the UK food system for health and the environment in this vulnerable group.

Ultra-processed food (UPF) intake is associated with increased non-communicable disease risks. However, systematic reports on sociodemographic predictors of UPF intake are lacking. This review aimed to understand UPF consumption based on sociodemographic factors, using nationally representative cohorts. The systematic review was pre-registered (PROSPERO:CRD42022360199), following PRISMA guidelines. PubMed/MEDLINE searches (‘ultra-processed/ultraprocessed’ and ‘ultra-processing/ultraprocessing’) until 7 September 2022 retrieved 1131 results. Inclusion criteria included: observational, nationally representative adult samples, in English, in peer-reviewed journals, assessing the association between sociodemographics and individual-level UPF intake defined by the NOVA classification. Exclusion criteria included: not nationally representative, no assessment of sociodemographics and individual-level UPF intake defined by NOVA. Risk of bias was assessed using the Newcastle–Ottawa Scale (NOS). Fifty-five papers were included, spanning thirty-two countries. All thirteen sociodemographic variables identified were significantly associated with UPF intake in one or more studies. Significant differences in UPF intake were seen across age, race/ethnicity, rural/urbanisation, food insecurity, income and region, with up to 10–20% differences in UPF intake (% total energy). Higher UPF intakes were associated with younger age, urbanisation and being unmarried, single, separated or divorced. Education, income and socioeconomic status showed varying associations, depending on country. Multivariate analyses indicated that associations were independent of other sociodemographics. Household status and gender were generally not associated with UPF intake. NOS averaged 5·7/10. Several characteristics are independently associated with high UPF intake, indicating large sociodemographic variation in non-communicable disease risk. These findings highlight significant public health inequalities associated with UPF intake, and the urgent need for policy action to minimise social injustice-related health inequalities.

Exposure to (a liberal) democracy can have an impact on both the political attention and visibility of the needs of marginalized populations, as well as the design of health policies that can influence the distribution of population health. This paper investigates the effect of exposure to democracy, that is, the number of years spent in a democracy as measured by democracy indexes, on various measures of inequality in self-reported health across European countries. We use an instrumental variable strategy to leverage the potential endogeneity of a country’s exposure to democracy, drawing on both bivariate (socioeconomic) and univariate health inequality measures. Our estimates provide evidence that an additional year in a democracy reduces both bivariate (income-related) health inequality and overall (univariate) health inequality. Our preferred specification suggests a two-point rank reduction in inequality with an additional year under a democracy. The effect is mainly driven by a reduction of “health poverty” alongside other effects.

Rural-urban migrants, though facing unique social and institutional constraints, remain a largely overlooked population in research on health inequality in China. This study applies the inequality of opportunity (IOp) framework to investigate health inequality among children in China. Instead of comparing only urban and rural children, we include rural-urban migrants. Drawing upon three waves of a nation-wide survey, we find that migrant children in China remain disadvantaged in terms of health when compared to urban and rural children. The decomposition of the determinants indicates that while the direct influence of hukou, China’s household registration system, on IOp in health is low and has decreased, particularly between 2007 and 2013, one’s province of residence still matters. Parental health contributes substantially to IOp in health, which likely is an indirect effect of hukou that creates barriers for migrant parents in regard to accessing healthcare. The policy implication of these findings is that although the direct influence of hukou has decreased, when coupled with the continued lack of local government support for the welfare of migrant workers, it perpetuates health inequalities.

Already home to 23% of the global elderly population, China will experience further demographic change in the coming decades. To address the consequences of population ageing, the Chinese government is implementing major social insurance reforms and promotes the development of private insurance markets. We aim to inform these initiatives by developing a new method to project healthy life expectancy (HLE) in different regions. HLE is an important population health measure which is increasingly used in the actuarial literature. Our new approach relies on publicly available data from the Global Burden of Disease Study for life expectancy and HLE for 139 countries. We use the model to estimate HLE at birth in 2015 for 31 province-level regions in China for both males and females. We discuss the implications of our results for planned increases in the retirement age in China and for long-term care insurance pricing.

This paper develops a theory of human capital to investigate the role of early childhood health in explaining the large and persistent schooling gaps observed within and across countries. Quantitative analysis using the theory and data from 98 countries shows that early health inequalities within developingcountries strongly amplify later schooling gaps— counterfactually eliminating inequalities reduces schooling Ginis by an average of 18% in developing economies but has only mild effects in richer countries. Moreover, early health inequalities are found to be an important source of schooling variation across countries— universally equating early health to the average US level reduces the cross-country standard deviation of average schooling attainment by over 40%. Additional policy experiments reveal that the gains from early health interventions tend to be amplified by later educational investments in developing economies, while those targeting school-aged children may be limited if early health conditions are ignored.