Summary

This research focuses on understanding the role health systems have in improving health and health inequalities. This includes evaluating routine services and health system interventions, such as the contribution of primary health care can make to population health and overall health system efficiency. We also have a large international programme of work which includes evaluating health system performance in Latin America

Research topics

• The Brazilian health system and the impact of interventions such as the Brazilian Family Health Programme (Estratégia Saúde da Família) and the More Doctors (Mais Medicos) programme on health and health inequalities
• Health system fragmentation in Latin America and its impact on health system functioning
• Collaborative work with the United Nations Relief and Works Agency (UNRWA) focusing on growing burden of chronic disease in the Palestinian population
• The impact of economic shocks on population health in middle-income countries, and the role of health and social protection systems

Country focus: England, India, Brazil, China, UNWRA

Project example

This study set out to understand the impact of the 2014-2016 economic crisis in Brazil on adult mortality, and the role health and social welfare programmes in the country played during recession. We used data from routine public datasets and used unemployment rates as a proxy for the depth of the economic recession. Increases in unemployment were associated with increases in adult mortality - a one percentage point increase in the state unemployment rate was associated with a 0.50 per 100,000 population increase in all-cause mortality. We estimated that between 2012 and 2017, higher unemployment due to the recession led to 31,415 excess deaths. We also found that unemployment-related increases in mortality were primarily seen in black or mixed race (pardo) Brazilians and individuals aged between 30-59 years. However, there were no significant increases in mortality in municipalities where expenditure on health and social protection programmes was high, suggesting that they may have offer a protective effect against unemployment-related mortality.