NIHR Global Health Research Unit on Social and Environmental Determinants of Health Inequalities Brazil and Ecuador are Latin American countries that show marked inequalities in health. Although there are many potential causes of health differences between different social groups, it is reasonable to assume that these are largely due to the social determinants of health – the conditions in which people are born, grow, work, live, age and die. At the same time, there are many environmental factors that can impact individual and population health, including the built environment and climate change. Such environmental considerations tend to have the most harmful impacts on the most deprived in society.

In an attempt to reduce the impact of social conditions such as poverty, governments sometimes have introduced policies such as providing small cash payments to or building houses for the very poor. Similarly, in an attempt to protect the environment and to mitigate their harmful effects on the conditions in which people live, governments may introduce environmental policies. While such policies may have health improvement as the primary target, they may still have a notable influence on health. Our Unit will focus on discovering whether these policies, when implemented, had any impact on health, whether they had a bigger impact on disadvantaged groups (defined by income, ethnicity, sex, geography, migrant status and deprivation), and the extent to which the health impacts have been modified by the provision and organisation of health services, particularly regarding coverage, access and quality.

Over the next five years, we plan to lead globally, with particular reference to Latin America, in terms of using the full potential of existing databases by combining them to find out whether social and environmental policies have had an impact on health and health inequalities, and the extent to which these can be affected by health service provision. 1. Building, developing and linking national databases covering health, social (e.g. welfare) and environmental registers in Brazil and Ecuador;
2. Studying the impacts of social and environmental policies, and the effects of large scale population movement on health and health inequalities;
3. Creating indicators of deprivation for small areas covering the whole of Brazil and Ecuador;
4. Determining how best to organise health services to improve health for all social groups and to respond to social and environmental threats in a way that minimises the damage they do to health;
5. Focusing on health outcomes that are considered priorities in Brazil, Ecuador and the Latin American region, in which our research team has particular expertise: non-communicable diseases including mental health and asthma; maternal and child health; reproductive and sexual health; COVID-19, infectious diseases and emerging health threats; neglected tropical diseases; and violence;
6. Monitoring progress towards the United Nations’ 2030 Agenda for Sustainable Development (particularly Goal 3: Ensure healthy lives and promote well-being for all at all ages);
7. Working with stakeholders, communities and the public to decide which policies we should evaluate, set priorities for our research, and tell different audiences about our results, particularly those who are making policies; and
8. Training researchers from Brazil, Ecuador and other low and middle-income countries in global health research methods by developing a research hub in Ecuador, and providing training programmes and mechanisms to share researchers’ experiences.