Ulikhet dreper. Fattige barn og familier fra alle deler av verden vil med større sannsynlighet leve med dårligere helse og under dårligere kår sammenlignet med de som har mer ressurser. Det er dette vi kaller sosioøkonomiske ulikheter i helse, og de har blitt observert i alle land med tilgjengelig data. Sosioøkonomiske ulikheter i helse er også urettferdige, unødvendige og unngåelige. De begynner å manifestere seg tidlig i livet og tross massive forbedringer i vår evne til å forebygge og behandle sykdom, så fortsetter de bare å vokse.
Prosjektet CHAIN er et akronym for Centre for Global Health Inequalities Research (Senter for Global Helseulikhetsforskning). Sammen med ledende akademikere og internasjonale organisasjoner, som FN, Institute for Health Metrix and Evaluation (IHME) som leder den globale helsebyrdestudien (Global Burden of Disease) og WHO, har vi jobbet mot et felles mål: å finne ut av hvordan vi best kan bruke verdens ressurser for å redusere sosial ulikhet i helse.
God helse er en menneskerettighet, men den bestemmes av hvordan våre samfunn er organisert og hvilken politikk vi er utsatte for. Dette gjelder særlig i krisetider, som under pandemier, økonomisk nedgang, og ekstreme værendringer.
Å kjempe for sosial rettferdighet er motivasjon, drivkraft, og ambisjon for forskningen. Ett av målene er å bidra til politiske endringsprosesser som kan redusere sosial ulikhet, barnedødelighet, og forbedre helsen for alle sosiale grupper.
I løpet av prosjektet har vi for eksempel funnet en global og universell forbindelse mellom foreldreutdannelse og barnedødelighet. Når det gjelder hvilke mekanismer som gir gode levekår og lange liv i god helse, har forskningen hatt et bredt fokus: fra klima, pandemi, vaksinenasjonalisme, teknologi, velferdspolitikk, og helsesystemer til migrasjon, utdanning, inntekt, boforhold, arbeidsmiljø, kreftscreening, formell og uformell helsetjenestebruk, røyking, alkohol, fysisk aktivitet og kosthold.
CHAINs arbeider har kombinerert forskningsfelt (fra sosiologi og sosialpolitikk til epidemiologi, nevrovitenskap, medisin, og teknologi), sektorer (akademia, nasjonale myndigheter, frivillige organisasjoner, EU-kommisjonen, UNESCO, UNICEF og WHO), forskningsaktiviteter (fra etablering av ny datainfrastruktur og teoriutvikling til årsaksanalyser og intervensjoner), og metoder (kantitativt, kvalitativt, samt kombinasjoner av dem).
CHAIN-prosjektet har identifisert en rekke nasjonale og globale tiltak som har størst potensiale til å redusere ulikheter i og mellom land. En fellesnever for mange av tiltakene er at vi må investere i tidlig i livene, at vi må tenke tverrsektorielt (også utenfor helsesystemet) og universelt.
The CHAIN project has achieved remarkable progress in advancing health equity through its research and collaborations. During the project period, CHAIN has established itself as a global leader in understanding and addressing health inequalities.
The project has published around 200 scientific articles in the project period (2019 – 2025), we have frequently engaged in high-level dissemination events in governments and organizations and influenced policy and practice worldwide. Our interdisciplinary approach has allowed us to produce actionable knowledge aimed at reducing socioeconomic disparities in health, both on the national and global level. This synergy has resulted in significant achievements such as the development of new monitoring tools—like the health inequalities module integrated into the European Social Survey—and comprehensive analyses demonstrating how social risk factors influence mortality. Notably, our systematic reviews and meta-analyses have contributed to recognizing low education as a critical global risk factor.
A key groundbreaking discovery in 2023 revealed a universal global association between parental education and child mortality, underscoring the profound impact of social determinants on health outcomes worldwide. Our research also shows that societal changes—both positive (technological advances) and negative (pandemics, pollution, climate change)—tend to widen health gaps, as those with greater resources benefit more during good times and are better protected during crises.
CHAIN has actively partnered with international organizations to translate research into action. We provided vital evidence to the WHO Technical Advisory Group on COVID-19 mortality, highlighting how the pandemic disproportionately affected vulnerable populations. Our collaboration with WHO’s IARC on cancer screening identified effective interventions to increase participation, directly informing public health strategies. Our alliance with UNICEF has been particularly impactful: we contributed to the Child Health Report Card series, highlighted that around 800 million children (one in three worldwide) suffer from lead poisoning, and co-developed frameworks for implementation research to improve child health interventions. These efforts demonstrate that combining data, analytical capacity, and collaborative frameworks can produce actionable insights that influence policies and lead to meaningful health improvements.
Looking ahead, CHAIN aims to maintain its leadership role in advocating for health equity on a global scale. We will continue to prioritize socioeconomic determinants of health, expand our sophisticated data infrastructure, and develop new frameworks for evaluating interventions through an equity lens. Our goal is to ensure that our research not only advances scientific understanding but also drives policies and programs that effectively reduce health disparities and protect vulnerable populations worldwide.
The CHAIN project will provide a better understanding of socioeconomic inequalities in health and identify specific public health policy interventions that are effective in reducing such inequalities in global regions, with a focus on children.
More specifically, CHAIN will (1) monitor international variations in health inequalities between and within countries, (2) identify and analyse the causal drivers of health inequalities in different countries, (3) identify and evaluate interventions that have the potential to reduce health inequalities, and (4) propose evidence-based policy and practice guidelines for health equity.
This will be done by bringing together Norwegian and international public health groups and international organisations to establish a novel approach to the better determination of the causes of health inequalities, their impacts on groups such as children and their families, and the identification of ‘best practice’ ways of reducing health inequalities in different regions of the world. The CHAIN project will involve leaders from UNICEF, the Norwegian Institute of Public Health (NIPH), the International Agency for Research on Cancer (IARC), EuroHealthNet, and the Institute for Health Metrix and Evaluation (IHME), which leads the Global Burden of Disease (GBD) Study.
The CHAIN project will introduce socioeconomic position as a risk factor in the GBD Study, we will analyse the most important determinants of health inequalities in different contexts, and the policy and programme responses that are most effective in reducing them. Through CHAIN`s partnerships with international academic institutions, UNICEF, IARC, public health experts, and civil society agencies, we further expect to 1) obtain global visibility, 2) reduce the distance between research, policy and practice, and 3) create a national and global arena to attract and advance research talents within health inequalities research.
