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The need for global social epidemiology in the polycrisis era
  1. Davide Rasella1,2,
  2. Ivalda Macicame3,
  3. Aliya Naheed4,
  4. Megan Naidoo1,5,
  5. Elisa Landin-Basterra1,
  6. Natanael Silva1,
  7. Ana L Moncayo6,
  8. Andrés Trotta7,
  9. Luis Eugenio Portela Fernandes de Souza2
  1. 1ISGlobal, Hospital Clínic – Universitat de Barcelona, Barcelona, Spain
  2. 2Instituto de Saúde Coletiva, Universidade Federal da Bahia, Salvador, Brazil
  3. 3National Institutes of Health, Maputo, Mozambique
  4. 4International Centre for Diarrhoeal Disease Research, Dhaka, Bangladesh
  5. 5University of Cape Town, Rondebosch, South Africa
  6. 6Pontificia Universidad Catolica del Ecuador, Quito, Ecuador
  7. 7Universidad Nacional de Lanus, Lanus, Argentina
  1. Correspondence to Dr Davide Rasella; davide.rasella{at}gmail.com

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Summary box

  • Polycrisis era: the convergence of the COVID-19 pandemic, escalating global conflicts, economic instability and climate change has created one of the most uncertain and unpredictable periods in recent history. These crises interact and amplify each other’s impact, disproportionately affecting vulnerable populations and exacerbating poverty and inequalities globally.

  • Call for global social epidemiology (GSE): there is a need for a renewal in social epidemiology to address the challenges of the polycrisis era. GSE prioritises interventions that mitigate crisis impacts, focuses on global relations between countries, particularly in low-income and middle-income countries, and promotes a decolonised approach.

  • Multifaceted approach: GSE advocates for multimethodological and multidisciplinary approaches to generate data, involve various experts and ensure comprehensive evaluations. This includes leveraging existing datasets, employing diverse study designs and engaging stakeholders from different sectors. The aim is to bridge the research-to-policy gap and promote evidence-informed decision-making to mitigate the health-related burden of the polycrisis era and achieve the health-related sustainable development goals.

The world is facing one of the most uncertain and unpredictable periods of its recent history. The compounding effects of the COVID-19 pandemic, escalating global conflicts, economic instability and climate change have converged into the polycrisis era: concurrent crises interacting and amplifying their global impact beyond the sum of their individual parts.1

While these crises differ in nature, dynamics and causes, they share a common denominator: they all disproportionately affect the most vulnerable and exacerbate poverty and inequalities at the local and global level.2 From a public health perspective, the dramatic decline in key social determinants of health (SDH) is significantly increasing morbidity and mortality among the poorest, leading to heightened health disparities.2 3

The branch of epidemiology that focuses on the effects of SDH is known as social epidemiology. Although social epidemiology has generated an abundance of evidence regarding the influence of social vulnerabilities and inequalities on various diseases and health conditions, its largest scientific production has been focused on descriptive studies within high-income countries.4

Through this commentary, we advocate for a renewal in the field of social epidemiology. We call for the creation of global social epidemiology (GSE), a new and potentially more effective approach to address the challenges of the current polycrisis era.

A comprehensive GSE approach should prioritise:

  1. Interventions which mitigate adverse impacts of crises and develop resilience: it is crucial to identify interventions that can be rapidly deployed and which safeguard the most vulnerable, thereby alleviating the health-related burden from the polycrisis and creating resilience. An example is the 2014–16 Brazilian economic recession: social protection was able to mitigate its detrimental health effects, especially among the most vulnerable populations.5

  2. Global relations between countries: the interconnected nature of globalisation plays a pivotal role in the socioeconomic health and wellness of populations across the world. Local crises could create a domino effect, where a localised shock has the potential to resonate across neighbouring countries, regions and, in some cases, escalate to a global scale, as exemplified by the 2008 crash in the US housing market.6

  3. Low-income and middle-income countries (LMICs): global inequality and poverty have risen dramatically, with LMICs facing a disproportionate burden. There is insufficient cross-country social epidemiological research to develop solution-oriented action for LMICs.4 Furthermore, a decolonised approach should be promoted, whereby LMIC researchers are elevated within the field of social epidemiology and beyond.

  4. Multimethodological approaches to generate data and knowledge: social epidemiology has historically suffered from data scarcity, primarily because socioeconomic determinants are challenging to define and are underrepresented in most health-related studies or surveys.7 As a result, GSE should leverage linkages between existing socioeconomic and health-related datasets.8 Furthermore, given randomised control trials are often unfeasible, GSE studies can harness the potential of quasi-experimental evaluation designs, simulation and forecasting models to help identify the most impactful and cost-effective interventions.9 Additionally, qualitative studies should complement and support the development and interpretation of quantitative studies.4

  5. Multidisciplinary approaches for comprehensive evaluations: it is vital to involve in GSE studies not only epidemiologists and public health professionals but also a diverse array of experts, such as economists, sociologists and anthropologists, among others, to ensure all inequality dimensions and context-specific vulnerabilities are comprehensively addressed.4

  6. Multisectoral approaches for evidence-informed decision-making (EIDM)10: projects and studies should be designed using a multisectoral approach, including not only the ministries and departments of health but also economics, education and social protection, among others.

  7. Closing the research-to-policy gap: communication, advocacy and dissemination play a fundamental role in promoting EIDM.10 The production of evidence must align with policy windows, necessitating the use of not just peer-reviewed articles, which can be time-consuming and unpredictable in their publication but also preprints, policy briefs and concise one-pagers. It is also necessary to establish effective mechanisms for the active participation of all relevant stakeholders in all stages of the research process.

Understanding and mitigating the impact of the polycrisis era on global health require a paradigm shift in the approach to conducting epidemiological research. An initiative to catalyse the field of GSE has been the recent creation of the Global Social Epidemiology Network: an alliance of international and multidisciplinary researchers committed to tackling the global structural determinants of health and health inequities through a GSE approach.11

Global social epidemiology has the potential to provide crucial evidence to mitigate the health-related burden of the polycrisis by addressing root causes of inequality, building resilience and ultimately contributing to the achievement of the health-related sustainable development goals.

Data availability statement

There are no data in this work.

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References

Footnotes

  • Contributors Conceptualisation of the manuscript: DR. Drafting of the manuscript: DR, EL-B, MN and NS. Revision of the manuscript: DR, IM, AN, MN, EL-B, NS, ALM, AT and LEPFdS. Approval of the final version: DR, IM, AN, MN, EL-B, NS, ALM, AT and LEPFdS.

  • Funding Authors thank the funder MCIN/AEI/10.13039/501100011033: award number CEX2018-000806-S, and the funder Generalitat de Catalunya: CERCA Programme: N/A.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; internally peer reviewed.