{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,26]],"date-time":"2026-10-26T14:57:21Z","timestamp":1793026641994,"version":"4.5.0"},"reference-count":50,"publisher":"BMJ","issue":"11","license":[{"start":{"date-parts":[[2020,6,13]],"date-time":"2020-06-13T00:00:00Z","timestamp":1592006400000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/bmj.com\/coronavirus\/usage"}],"funder":[{"DOI":"10.13039\/501100000272","name":"National Institute for Health Research","doi-asserted-by":"publisher","award":["NIHR200173"],"award-info":[{"award-number":["NIHR200173"]}],"id":[{"id":"10.13039\/501100000272","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["J Epidemiol Community Health"],"accepted":{"date-parts":[[2020,5,18]]},"published-print":{"date-parts":[[2020,11]]},"abstract":"<jats:p>\n                    This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics\u2014drawing on international research into the Spanish influenza pandemic of 1918, the H1N1 outbreak of 2009 and the emerging international estimates of socio-economic, ethnic and geographical inequalities in COVID-19 infection and mortality rates. It then examines how these inequalities in COVID-19 are related to existing inequalities in chronic diseases and the social determinants of health, arguing that we are experiencing a\n                    <jats:italic>syndemic<\/jats:italic>\n                    <jats:italic>pandemic<\/jats:italic>\n                    . It then explores the potential consequences for health inequalities of the lockdown measures implemented internationally as a response to the COVID-19 pandemic, focusing on the likely unequal impacts of the economic crisis. The essay concludes by reflecting on the longer-term public health policy responses needed to ensure that the COVID-19 pandemic does not increase health inequalities for future generations.\n                  <\/jats:p>","DOI":"10.1136\/jech-2020-214401","type":"journal-article","created":{"date-parts":[[2020,6,13]],"date-time":"2020-06-13T17:15:14Z","timestamp":1592068514000},"page":"964-968","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":1647,"title":["The COVID-19 pandemic and health inequalities"],"prefix":"10.1136","volume":"74","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-1294-6851","authenticated-orcid":false,"given":"Clare","family":"Bambra","sequence":"first","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ryan","family":"Riordan","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Cambridge University, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"John","family":"Ford","sequence":"additional","affiliation":[{"name":"School of Clinical Medicine, Cambridge University, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fiona","family":"Matthews","sequence":"additional","affiliation":[{"name":"Population Health Sciences Institute, Newcastle University Institute for Health and Society, Newcastle upon Tyne, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2020,6,13]]},"reference":[{"key":"2025100302524807000_74.11.964.1","first-page":"191","article-title":"The incidence of in\ufb02uenza among persons of different economic status during the epidemic of 1918","volume":"121","author":"Sydenstricker","year":"2006","journal-title":"Public Health Rep"},{"key":"2025100302524807000_74.11.964.2","unstructured":"Lawrence AJ . The incidence of in\ufb02uenza among persons of different economic status during the epidemic of 1918 (1931): commentary. Public Health Rep 2006;121:190. doi: 10.1177\/00333549061210S122"},{"key":"2025100302524807000_74.11.964.3","unstructured":"SkyNews (27\/03\/20) \u2018virus does not discriminate claims Gove [Conservative government Minister for the Cabinet Office, UK]. Available https:\/\/news.sky.com\/video\/coronavirus-virus-does-not-discriminate-gove-11964771 (accessed 22 04 2020)."},{"key":"2025100302524807000_74.11.964.4","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(06)69895-4"},{"key":"2025100302524807000_74.11.964.5","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2005.06.051"},{"key":"2025100302524807000_74.11.964.6","unstructured":"Grantz KH , Rane MS , Salje H , et al. Disparities in in\ufb02uenza mortality and transmission related to sociodemographic factors within Chicago in the pandemic of 1918. PNAS 2016. doi: 10.1073\/pnas.1612838113"},{"key":"2025100302524807000_74.11.964.7","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwy151"},{"key":"2025100302524807000_74.11.964.8","unstructured":"Rice G , Bryder L . Black november: the 1918 influenza pandemic in New Zealand . Christchurch: Canterbury University Press, 2005."},{"key":"2025100302524807000_74.11.964.9","doi-asserted-by":"publisher","DOI":"10.1111\/irv.12228"},{"key":"2025100302524807000_74.11.964.10","doi-asserted-by":"publisher","DOI":"10.1098\/rspb.2007.1477"},{"key":"2025100302524807000_74.11.964.11","doi-asserted-by":"publisher","DOI":"10.1086\/507154"},{"key":"2025100302524807000_74.11.964.12","doi-asserted-by":"publisher","DOI":"10.1093\/cid\/cir644"},{"key":"2025100302524807000_74.11.964.13","doi-asserted-by":"publisher","DOI":"10.1007\/s00038-012-0337-1"},{"key":"2025100302524807000_74.11.964.14","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2012.300814"},{"key":"2025100302524807000_74.11.964.15","doi-asserted-by":"publisher","DOI":"10.1017\/S0950268813000654"},{"key":"2025100302524807000_74.11.964.16","doi-asserted-by":"publisher","DOI":"10.1111\/irv.12231"},{"key":"2025100302524807000_74.11.964.17","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2006.12.001"},{"key":"2025100302524807000_74.11.964.18","unstructured":"Catalan Agency for Health Quality and Assessment (AQuAS) . Coronavirus SARS-Cov-2 interactive map. Available http:\/\/aquas.gencat.cat\/.content\/IntegradorServeis\/mapa_covid\/atlas.html (accessed 22 Apr 2020)."},{"key":"2025100302524807000_74.11.964.19","unstructured":"Chen JT , Krieger N . Revealing the unequal burden of COVID-19 by income, race\/ ethnicity,and household crowding: US county vs ZIP code analyses. Harvard Center for Population and Development Studies Working Paper Series 21 Apr 2020. Volume 19, Number 1. Available https:\/\/tinyurl.com\/ya44we2r"},{"key":"2025100302524807000_74.11.964.20","unstructured":"Intensive Care National Audit and Research Centre . Report on COVID-19 in critical care 17 April 2020 . London: Intensive Care National Audit and Research Centre, 2020."},{"key":"2025100302524807000_74.11.964.21","unstructured":"Chicago Department of Public Health . COVID-19 death characteristics for Chicago residents. 2020. Available https:\/\/www.chicago.gov\/city\/en\/sites\/covid-19\/home\/latest-data.html (accessed 18 Apr 2020)."},{"key":"2025100302524807000_74.11.964.22","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2018.01.025"},{"key":"2025100302524807000_74.11.964.23","unstructured":"Singer M . Introduction to syndemics: a systems approach to public and community health . San Francisco, CA: Jossey-Bass, 2009."},{"key":"2025100302524807000_74.11.964.24","first-page":"13","article-title":"A dose of drugs, a touch of violence, a case of AIDS: conceptualizing the SAVA syndemic","volume":"28","author":"Singer","year":"2000","journal-title":"Free Inq Creat Sociol"},{"key":"2025100302524807000_74.11.964.25","unstructured":"Dahlgren G , Whitehead M . Policies and strategies to promote social 9. Equity in health . Stockholm: Institute for Future Studies, 1991."},{"key":"2025100302524807000_74.11.964.26","unstructured":"Guo L , Wei D , Zhang X , et al. Clinical features predicting mortality risk in patients with viral pneumonia: the MuLBSTA score. Front Microbiol 2019;10:2752. doi: 10.3389\/fmicb.2019.02752"},{"key":"2025100302524807000_74.11.964.27","unstructured":"Bambra C . Health divides: where you live can kill you . Bristol: Policy Press, 2016."},{"key":"2025100302524807000_74.11.964.28","unstructured":"Public health England . Local action on health inequalities understanding and reducing ethnic inequalities in health . London: Public Health England, 2018."},{"key":"2025100302524807000_74.11.964.29","unstructured":"European commission . Roma health report: health status of the Roma population in the member states of the European union . Brussels: European Commission, 2014."},{"key":"2025100302524807000_74.11.964.30","unstructured":"WHO - World Health. Organisation . Commission on the social determinants of health: closing the gap in a generation . Geneva, 2008."},{"key":"2025100302524807000_74.11.964.31","doi-asserted-by":"publisher","DOI":"10.1136\/jech.2009.102103"},{"key":"2025100302524807000_74.11.964.32","unstructured":"Todd A , Copeland A , Kasim A , et al. Access all areas? An area-level analysis of the relationship between community pharmacy and primary care distribution, urbanity and social deprivation in England. BMJ Open 2015;5:e007328. doi: 10.1136\/bmjopen-2014-007328"},{"key":"2025100302524807000_74.11.964.33","unstructured":"Lacobucci G . GPs in deprived areas face severest pressures. BMJ . 2019;365:l2104."},{"key":"2025100302524807000_74.11.964.34","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2010.09.011"},{"key":"2025100302524807000_74.11.964.35","doi-asserted-by":"publisher","DOI":"10.1093\/eurpub\/ckw224"},{"key":"2025100302524807000_74.11.964.36","doi-asserted-by":"publisher","DOI":"10.1037\/0033-2909.130.4.601"},{"key":"2025100302524807000_74.11.964.37","unstructured":"Bartley M . Health inequality: an introduction to concepts, theories and methods . 2nd edn. London: Polity, 2016."},{"key":"2025100302524807000_74.11.964.38","unstructured":"Bambra C . Work, worklessness and the political economy of health . Oxford: Oxford University Press, 2011."},{"key":"2025100302524807000_74.11.964.39","doi-asserted-by":"publisher","DOI":"10.1016\/j.healthplace.2016.02.002"},{"key":"2025100302524807000_74.11.964.40","doi-asserted-by":"publisher","DOI":"10.1159\/000289101"},{"key":"2025100302524807000_74.11.964.41","unstructured":"Stuckler D , Basu S . The body economic. why austerity kills . London: Thomas Allen, 2013."},{"key":"2025100302524807000_74.11.964.42","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyv058"},{"key":"2025100302524807000_74.11.964.43","doi-asserted-by":"publisher","DOI":"10.1016\/j.socscimed.2015.11.009"},{"key":"2025100302524807000_74.11.964.44","doi-asserted-by":"publisher","DOI":"10.2190\/HS.45.1.b"},{"key":"2025100302524807000_74.11.964.45","doi-asserted-by":"publisher","DOI":"10.1016\/j.ssmph.2018.08.004"},{"key":"2025100302524807000_74.11.964.46","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.0050227"},{"key":"2025100302524807000_74.11.964.47","doi-asserted-by":"publisher","DOI":"10.1136\/jech-2018-211679"},{"key":"2025100302524807000_74.11.964.48","unstructured":"Taylor-Robinson D , Lai E , Wickham S , et al. (2019) Assessing the impact of rising child poverty on the unprecedented rise in infant mortality in England, 2000\u20132017: time trend analysis. BMJ Open 2019;9:e029424. doi: 10.1136\/bmjopen-2019-029424"},{"key":"2025100302524807000_74.11.964.49","unstructured":"Beckfield J , Bambra C . Shorter lives in stingier states: social policy shortcomings help explain the US mortality disadvantage. Soc Sci Med . 2016;171:30\u20138."},{"key":"2025100302524807000_74.11.964.50","unstructured":"Forster T , Kentikelenis A , Bambra C . Health inequalities in Europe: setting the stage for progressive policy action, Foundation for European Progressive Studies and the Think Tank for Action on Social Change (TASC). 2018. Available https:\/\/www.feps-europe.eu\/component\/attachments\/attachments.html?task=attachment&id=168"}],"container-title":["Journal of Epidemiology and Community Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/jech-2020-214401","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,3]],"date-time":"2025-10-03T09:52:53Z","timestamp":1759485173000},"score":1,"resource":{"primary":{"URL":"https:\/\/jech.bmj.com\/lookup\/doi\/10.1136\/jech-2020-214401"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2020,6,13]]},"references-count":50,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2020,10,7]]},"published-print":{"date-parts":[[2020,11]]}},"alternative-id":["10.1136\/jech-2020-214401"],"URL":"https:\/\/doi.org\/10.1136\/jech-2020-214401","relation":{},"ISSN":["0143-005X","1470-2738"],"issn-type":[{"value":"0143-005X","type":"print"},{"value":"1470-2738","type":"electronic"}],"subject":[],"published":{"date-parts":[[2020,6,13]]}}}