Subscribe
Share
Share
Embed
Podcast series from the MRC/CSO Social and Public Health Sciences Unit, University of Glasgow.
Alastair Leyland:
Hello and welcome to a special podcast on 15 Minutes on Health Inequalities. My name's Alastair Leyland from the Social and Public Health Sciences Unit in Glasgow, and with me today is...
Mauricio Barreto:
I am Mauricio Barreto. I'm a friend of Alastair and I'm the head of CIDACS. That's the centre dedicated to data integration situated in Salvador, Brazil.
Alastair Leyland:
And also...
Phil Cooper:
Philip Cooper, I'm an epidemiologist based at St George's, University of London, and I've worked for many years in Latin America, particularly in Ecuador.
Alastair Leyland:
And also...
Natalia Romero:
Natalia Romero. I'm from Quito, Ecuador, and I am the head of the research department at University International Ecuador. And I am part of the team of the social inequalities project with Philip, Alastair and Mauricio.
Alastair Leyland:
Thanks. And also last but not least...
Gustavo Matta:
I am Gustavo Matta. I am a social scientist and a public health researcher at CIDACS-Fiocruz. I'm working with Mauricio and I am also the coordinator of interdisciplinary centre on health emergency from a social science perspective.
Alastair Leyland:
Thank you. And today we're going to talk about our NIHR-funded unit on the social and environmental determinants of health inequalities, which is working across Brazil and Ecuador. The first thing to think about is maybe why we should worry about health inequalities, why health inequalities as opposed to population health? Maybe, Mauricio, you have an answer for that?
Mauricio Barreto:
Yeah, I think it's clear there is a vast literature about that to one of the reasons. Now, the main factors will decrease or increase the population health is the reduction in inequality and that is really the reason that SEDHI gave a strong priority, you know, to observe how different kind of policies that affect health also affect inequality now, and to thinking more deeply the interrelationship among inequalities and health.
Alastair Leyland:
And you can see that health inequalities have started to increase in high income countries and this has caused a reduction in overall health measured by, for example, life expectancy. But Natalia, do you have anything to add to that about why we'd look at health inequalities?
Natalia Romero:
Yeah, I think it's very interesting to study these characteristics of the world, especially in countries as Brazil and Ecuador for instance, because we have population, very rich in terms of ethnicities, in terms of groups of age, in terms of the change between urban and rural population and all of these principal characteristics are producing, sadly, are producing still that inequalities and differences.
Alastair Leyland:
Yeah. What can be done to reduce health inequalities in Brazil and Ecuador? Gustavo?
Gustavo Matta:
Well, this is a very important point because there are many ways to understand health inequalities so we can measure health inequalities and there are many perspectives about this and this SEDHI is exactly focused on understanding health inequalities and also we can have other approaches or perspectives. As a social science for me and a collective health researcher in Brazil, we need to understand health inequalities in a more broader way, as well as a political dimension, a social dimensional economic dimension and also a democracy dimension. So for me it's crucial how to involve communities and society to think and to influence social policies, to respond to their needs. Sometimes, as we have a kind of a colonisation perspective of many ways to produce scientific knowledge, so it's important to say we are creating at CIDACS and colleagues in Ecuador and also with UK as well and the triangle perspective how to in certain ways decolonise a little bit this kind of idea. So it's a political issue, right? That's why we say in Brazil that health is democracy.
Mauricio Barreto:
Yeah, I think one point also, as I said that you need to discuss is the relationship among poverty and inequality. And that is one topic that sometimes is confused because in the public health literature, until certain point, yeah, the emphasis was on poverty. Later, it started to be on inequality. In context, like Latin America, you have the things together. But you have yet a lot of poverty and you have inequality, then this is a combination that need to be understood and how when so decreasing poverty, it affects inequality. The relation among poverty and inequality need to be also explored. Yeah, a bit more.
Alastair Leyland:
Then I'll turn to you Phil - what can be done to reduce health inequalities in Brazil and Ecuador?
Phil Cooper:
Well, the first thing to do is to understand what the inequalities are and how they affect health outcomes. And so when we talk about health inequality, about inequalities, we talk about differences in health outcomes according to for example age, could be ethnicity, it could be educational level. And we know these factors, whether, for example, if you are born in, in an indigenous family, the risks of of dying in the first five years of life are much greater than if you're born in a mestiza family. So we know that there are important outcomes related to these axes of inequality as we call them. And so the first thing to do is actually to try and understand these inequalities. Try to measure them and in the project we're currently involved in called SEDHI or social and environmental determinants of health inequalities, we're using publicly available data to try and understand how health inequalities impact health outcomes and also how various policies in terms of social policies such as conditional cash transfers, environmental policies relating to the care of the environment, for example, in Ecuador they have a programme called Socio Bosque, which is a programme providing cash incentives to people to maintain the forest environment and we're trying to understand how these, how these policies can impact health outcomes. So you know, if you live in a place where there's a lot of environmental degradation, where there's deforestation does this affect health outcomes such as your risk of cardiovascular disease, your risk of dying of cardiovascular disease. So the project is trying to understand these health inequalities, how they impact health, and also whether these policies might in the future be modified in the way that might benefit health outcomes. So can we provide data to show that biodiversity is beneficial to health and that would be additional evidence to provide support to preserving biodiversity, for example.
Alastair Leyland:
And Natalia, these policies - social and environmental policies certainly, won't have been designed principally with health in mind. So do you think we stand a chance of changing policy development in the future?
Natalia Romero:
Yes, of course. I think it is possible and I can say this is one of the goals of the SEDHI project because we want to analyse some issues and if we are able to analyse the impact or the effect of these current policies in our countries, for example in Ecuador or in Brazil, Brazil and Ecuador and other countries in Latin America, have very interesting characteristics. For example, we have in the small territories we have very natural regions and we have many different ethnic groups and the policies in general terms has been designed considering us whole people as homogeneous people. And with our proposal, with our analysis, I think we are able to present details to understand or to achieve a better understanding about how the policies having impact in these small groups in these small, not only small groups of people, small areas, which is one of our goal and based on this information, our perspective is to discuss with the policymakers and to create new policies because we don't define a future if we don't have current data or if we don't understand the trends of the data. We nowadays we have the, the humanity, recognise the climate change but we don't know enough evidence or enough data or enough outcomes that relate the that changes with the health outcomes in the different human beings.
Alastair Leyland:
Good. Thank you. Now this sort of policy evaluation obviously needs good quality data, but the data we've got are very different in Ecuador and Brazil. Mauricio, do you want to say something about the data sources in Brazil?
Mauricio Barreto:
Yeah, Brazil have a system of registers that have been developed for decades and this system of registers is improving and then is affected all the quality of the data, in particular health data. The register of events like mortality, births and the others infectious disease register have improved a lot the quality. Then the problem is how to access this data. This data is processed in the in different ministries and they keep this data in silos, separate silos. Brazil have one long tradition to put this data after disidentification open. You have a lot of individual data open in Brazil, but when go to identify data then it's a more complicated mechanism related to data protection and what for example you try to do in CIDACS and in SEDHI is using the maximum potential of this data, not only using disidentified data but also use the identified data to combine to link the disidentified data yeah form mega structure that make possible to go deeply in evaluation and the other studies to show included to show the levels of inequalities inside the Brazilian society. In this process of data linkage have been possible. CIDACS have done that with some, developed some expertise to do that. And the access some important database in Brazil, but not all. There is a limitation. There is a lot of control in some of this data not yet accessible, but there is important data that have been accessible and then you try to work as much as possible to link this data and creating the cohorts and doing study in large scale that cover all Brazil that because the cohorts that exist in CIDACS they include the population from a lot of Brazil.
Alastair Leyland:
OK, Natalia, do you want to say something about the data in Ecuador?
Natalia Romero:
In Ecuador, we are experimenting the same process that mentioned Mauricio. I mean, Ecuador has been improving the quality of data of some events, some indicators. For example, birth mortality, hospital discharge, but we have a big difference with Brazil because we don't have the capacity to linkage data in a nominal base. Yeah, because we have some characteristics. One of them, the regulations. I think this project and this cooperation between the research group is a nice opportunity to give our authorities to give the governmental institutions in Ecuador to learn from other countries, from other groups and to know the experience and to know the values or the opportunities to get that linkage. I'd like to say that, as a group, as researchers, we are the first group that we are defending the rights of the participants in research or the rights of the patients. Obviously we are the first, we defined that. But nowadays the research field has a very interesting opportunity to analyse in this from a perspective, an integrated perspective. And to achieve that goal is necessary to access the data. And the current authorities, the current researchers we have, we have this obligation to think how to get how to achieve that goal, how to get the linkage data to analyse and to try to understand in the best way how happens with our territories and how to with data how to fight against the inequalities.
Alastair Leyland:
Yeah. Thank you. Part of the work of SEDHI is creating or updating some area based measures; a measure of deprivation and the measure of urbanisation. Mauricio, I was wondering, you've had the experience of the IBP, I was wondering if you wanted to say something about the value of having a measure of deprivation.
Mauricio Barreto:
Yeah, I think it is very valuable in terms of make it visible now in the space now or make more visible in the space difference or inequalities in the special perspective. This IBP has been very much successful in doing that. Is an instrument to improve other studies into multicultural other studies on inequality using this resource. As a planning instrument, I would not have it yet so much experience. Yeah. How much it is influence policy and how much the policymakers are using this information to policy. The question of inequality is not yet deeply go in the great part of politician and policymakers in Brazil. I believe in Ecuador, in other countries. They see this as a one question to be solved, but not central in their policy. Then this is a a big question for us researchers to discuss - what, what the effectiveness of what we produce like area-based intervention. I think it's a very powerful instrument but need yet to be tested and to be put in action. You have to use the potential that it has.
Alastair Leyland:
OK. And what about the measure of urbanisation, Phil?
Phil Cooper:
The plan is for the team in Ecuador is also to develop, as in Brazil, is to use to to build on the expertise in Brazil to build up an indices of deprivation, but also of urbanicity. So to have some kind of - have a measure which could be used to measure urbanicity. And and see how this might affect health outcomes. And the idea is to make these two indices eventually available to researchers through some kind of open accessible platform.
Alastair Leyland:
Great. We normally finish these podcasts by asking what the impact is for health inequalities. Our whole unit is about having an impact on health inequalities, but I would be interested to know how soon you think we're going to have an impact on health inequalities. Natalia, I'll start with you...
Natalia Romero:
I think it is a process. For instance, as researchers, we have the opportunity to learn about this process. I mean thinking in inequalities, thinking in the impact of the policies to fight against the inequalities. The effect of the consequences of this proposal, could be to learn in details what happened with marginalised population, what happened with no, not only with minority ethnics as well as marginalised population, because in Latin America or in other countries or cities we are living daily with marginalised population and we think that this is a big opportunity to learn how the relationship between the policies and that population. Based on that understanding to propose, to create the thing and how to fight against that inequalities.
Alastair Leyland:
Mauricio?
Mauricio Barreto:
Yeah, I think one important thing that you need to look at an impact of the work. Is to show that the measures and policies that are not direct to to health affect health then can be a nice important booster to reinforce these policies, and maybe to give the policymaker more instruments, not only to defend that specific policy, yeah to find the other stakeholders that supports it. And to maybe to make change in the policies to orient them more towards the inequalities and toward the health. Yeah, I think this could be that as a unit you can contribute to the in our context and in other contexts which are studies going deep in, in understanding the mechanism how policies that are not direct to health but affect health, because these policies are among the other things, decrease inequalities and this is an important point that we can contribute.
Alastair Leyland:
Thanks very much all of you. I'm going to wrap it up here. For anyone listening who wants to find out more information, there will be some in the show notes. And if you want to find other podcasts in this series, just search for 15 Minutes on Health Inequalities. Thanks very much.