III. The Evolution of Health Inequalities in the Time of COVID-19 International Journal of Health Services Health Inequalities in the Time of COVID-19: 2021, Vol. 51(3) 300–304 © The Author(s) 2021 The Globally Reinforcing Need to Strengthen Article reuse guidelines: Health Inequalities Research Capacities sagepub.com/journals-permissions DOI: 10.1177/0020731421993939 journals.sagepub.com/home/joh Lucinda Cash-Gibson1,2 , Juan M. Pericàs1,2,3,4, Eliana Martinez-Herrera1,5 and Joan Benach1,2,6 Abstract The full impact of coronavirus disease 2019 (COVID-19) is yet to be well established; however, as the pandemic spreads, and early results emerge, unmet needs are being revealed, and pressing questions are being asked about who is most affected, how, where, and in what ways government responses might be exacerbating inequalities. A number of scholars have called for more in-depth critical research on COVID-19 and health inequalities to produce a strong empirical evidence based on these issues. There are also justifiable concerns about the scarcity of health-equity actions oriented analyses of the situation and calls for more empirical evidence on COVID-19 and health inequalities. A preliminary condition to establish this type of information is strong capacity to conduct health inequalities research. Worldwide, however, this type of capacity is limited, which, alongside other challenges, will likely hinder capacities of many countries to develop comprehensive equity-oriented COVID-19 analyses, and adequate responses to present and future crises. The current pandemic reinforces the pending need to invest in and strengthen these research capacities. These capacities must be supported by widespread recognition and con- cern, cognitive social capital, and greater commitment to coordinated, transparent action, and responsibility. Otherwise, we will remain inadequately prepared to respond and meet our society’s unmet needs. Keywords COVID-19, health inequalities, research capacity strengthening, health policy While the full health, social, and economic impacts of coronavi- to determine how, and in which ways, government responses rus disease 2019 (COVID-19) are yet to be established, firstly, are impacting, and potentially exacerbating existing health evidence from past pandemics, nature diseases, and crises inequalities. A number of scholars have called for more show that the most “socially vulnerable” (ie, those with the in-depth critical research on COVID-19 and health inequal- lowest social positions and power due to structural factors and ities, to produce strong empirical evidence based on these systematic, unfair, and avoidable social hierarchies1) are often issues.3,8,11 To build a comprehensive and integrated disproportionately exposed, prior, during, and after such devas- picture of the causes, distribution, and impact of the pan- tating events.2–9 Also, early results from a number of countries demic on society, requires having a strong capacity to and cities have identified that social inequalities exist in the disease incidence and mortality from COVID-19.2,3,10–18 As the pandemic spreads, pressing new questions arise that need 1 Research Group on Health Inequalities, Environment and Employment to be understood, such as why do certain social groups Conditions, Pompeu Fabra University, Barcelona, Spain 2 appear to be more affected than others? What are the causes Pompeu Fabra University Public Policy Center, Johns Hopkins University, of these systematic differences? What is the effect and impact Barcelona, Spain 3 Hospital Clínic de Barcelona, Barcelona, Spain of current policy responses on preexisting health inequalities 4 Institute for Research, Vall d’Hebron Hospital Universitari, Barcelona, Spain between and within populations in different global contexts? 5 Research Group of Epidemiology, National School of Public Health What will appropriate, equitable responses look like? “Héctor Abad Gómez”, University of Antioquia, Medellín, Colombia 6 Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, Madrid, Spain Comprehensive Health-Equity Oriented Corresponding Author: Analyses: What? Where? How? Why? Lucinda Cash-Gibson, Political and Social Sciences Department, Universitat Pompeu Fabra, Campus de Ciutadella, Edifici Mercè Rodoreda – 24, Carrer Globally, there is a paucity of health-equity oriented analyses Ramón Trías Fargas, 25-27, 08005 Barcelona, Spain. and policy reactions to the pandemic, which limits the capacity Email: lucinda.cashgibson01@estudiant.upf.edu Cash-Gibson et al. 301 monitor, analyze, and conduct equity-oriented COVID-19 number of calls to gather much-needed disaggregated data research, which includes transparent collection of available by socio-demographic and socio-economic characteristics and reliable health data, disaggregated by social groups and of people infected and affected by COVID-19.2,32–34 Yet, geographical territories, and on environmental, social, eco- at the same time, to fully understand the causes of the sys- nomic, political, and labor determinants.2,8,19 Another impera- tematic social differences in COVID-19-related infection tive is a critical mass of motivated professionals, trained in and mortality (eg, by gender, race/ethnicity, socio-economic multiple disciplines, to recognize and conceptualize the health status, migrant status, social class, etc), will require a inequality problems, test and generate theories, map data balanced gathering of data on biomedical features, individ- sources, and capable of analyzing, interpreting, and reporting ual choices, and behaviors,2 and information on social deter- the results19; all of which should be supported by adequate minants of health, including unjust living situations, work stewardship, leadership, and resource provision.19–22 Within conditions, educational provisions, power relations, and social the city of Barcelona, for example, several institutions have mechanisms (eg, exploitation, discrimination, racism, and been able to rapidly identify that social inequalities exist in sexism) that shape material circumstances, behaviors, and the disease incidence and mortality from COVID-19 at the biology. As well as a better-contextualized understanding neighborhood level.10,12,13 This particularly strong capacity of the process of disease embodiment, that is the complex to generate evidence on health inequalities at the city level biological effects of the bio-psycho-social–environmental is partly due to a long tradition of social recognition and interplay to produce health inequalities,35 and the cumula- concern for public health and social injustice, and solid pre- tive impact of socio-economic adversity, political marginal- existing multidisciplinary research capacity at the individ- ization, in different settings.2,19,36 Furthermore, conducting ual, research infrastructure, and institutional level.23 Also, health inequalities research capacity assessments at the continuous access to available, reliable, and transparent local/national level could help identify pending challenges, data collection and reporting, and the more recent develop- barriers, and information gaps, and assist to guide future ment of an observatory for public health and inequalities, strategies that aim to address their specific capacities.19,37 and political prioritization to reduce health inequalities,24 We summarize some of the potential challenges that will amongst other things.23 likely need to be addressed in different contexts, in order to Worldwide, however, many countries still do not have a strengthen their capacity to generate health equity-oriented strong capacity to conduct scientific evidence on health COVID-19 research, which can be used to inform appropriate inequalities, to effectively inform efforts aiming to address and equitable responses23 (see Table 1). their population’s health and well-being needs.19,23,25,26 For example, a number of countries, particularly low- and The Ways Ahead middle-income ones, still face huge challenges in terms of health and geographical information and surveillance resour- Even in the absence of a comprehensive diagnosis, denial, ces, regarding their completeness and quality, as well as in the ignorance, and inaction are not options.7 Underlying the availability of reliable, disaggregated, and integrated health decision and actions taken, or neglected, to address socially and socio-demographic data, to support the measuring and relevant issues, such as social inequalities in health, are monitoring of health inequalities,19 as recently illustrated by divergent (political, social, and personal) values, ideological the cases of Ecuador26,27 and Mozambique.28 Although views, and tensions over what should be done, what is fair, census data collected in high-income countries, such as in and what is possible, as well as the type of research that the United States, are not necessarily free from problems.29 should be funded and generated.7,19,23,29,38,39 These diverse Collectively, these challenges will hinder many countries’ perspectives become even more visible during times of capacities to comprehensively prevent, analyze, and manage crises and pandemics. Subsequently, the socio-political current and future problems, such as racial inequalities, partic- context in which public health and health inequalities ularly during the pandemic, as recently highlighted in the case research, and political priorities are planned and implemented, of Brazil,26 as well to design and implement effective and also need to be evaluated to better understand the causal equitable responses to address them, and to monitor and eval- forces and dynamics operating at different (macro-to-micro) uate their impact on the (entire) population. This is on top of levels, which influence and determine the capacity to act in the fact that many countries, particularly lower-income ones, an equitable manner.19,23,37 face resource shortages which will also inhibit effective The increase in social inequalities in health, infectious COVID-19 preparedness.30,31 disease outbreaks, and ecological changes over the past few decades are arguably symptoms of systemic dysfunctions, and incompatibilities with our decisions and choices in Research Capacity Needs and Challenges pursuit of progress and prosperity,8,42 which are adversely The current pandemic reinforces the unmet need to invest in shaping and influencing our opportunities to lead healthy and strengthen health inequalities research capacity in many lives in the process.7 Going forward, widespread recognition, local and global settings. We agree with the increasing sensitivity, and concern for these problems need to be instilled, 302 International Journal of Health Services 51(3) Table 1. Potential Health Inequalities Research Capacity Challenges to Consider in Different Contexts. Level Potential health inequality research capacity challenges to address Global Limited stewardship, governance, and lack of human and financial and technical resources19,21; limited demand for, and prioritization of, locally relevant health equity-oriented COVID-19 research19,21; conflicting socio-political value judgments, ideology, and interests around health inequalities, and fair and inequitable responses between countries and institutions.19,23,38,39 National, regional, or city Limited stewardship, governance, and limited provision of health inequalities related human and financial and technical resources19,21,37; limited tradition of public health and health inequalities research37; conflicting socio-political value judgments, ideology and interests around health inequalities, and fair and inequitable responses between institutions and stakeholders19,37; limited demand for, and prioritization of locally relevant health equity-oriented COVID-19 research19,21,28; limited demand for available, transparent and reliable, disaggregated and integrated health and socio-demographic data12,13,37; limited academic freedom or creative autonomy to reflect, propose and pursue critical research on global-societal-health issues, such as health inequalities, particularly during pandemics.19 Institutional Limited stewardship, limited provision of human, financial and technical resources, facilities, and infrastructure19,21,40; conflicting social-political value judgments, ideology and interests19,38,39; limited demand for, and prioritization of, locally relevant health equity-oriented COVID-19 research19,21; limited academic freedom or creative autonomy to reflect, propose, and pursue critical research on global-societal-health issues such as health inequalities, particularly during pandemics.19 Research infrastructure: Limited stewardship, governance, and limited provision of human, financial, and information Information systems resources19,21,40; limitations in the completeness and quality of geographical information and surveillance resources, with a health equity lens27,28,37; limitations in the available, reliable, disaggregated and integrated health and socio-demographic data, to support the measuring and monitoring of health inequalities.2,19,27,28,32,37,40 Research infrastructure: Human Limited access to available training in integrating transdisciplinary perspectives to be able to understand, resources analyze, and monitor health inequalities19,21,37,40; “brain-drain”19,21; lack of a local critical mass of transdisciplinary professionals, trained to understand, analyze, monitor, and evaluate health inequalities, and other complex global-societal issues such as pandemics19,21,37; conflicting socio-political value judgments, ideology, and interests among research groups and individual researchers.19,23,37–39 Research networks Limited pooling and mobilizing of (local and international) resources and cognitive social capital to co-develop effective solutions to address health inequalities during complex global–societal times19,21,23,37; conflicting socio-political value judgments, ideology and interests among research groups and individual researchers.19,23,37–39 Research output Limited volume of health equity-oriented COVID-19 analyses, and transparent reporting of locally relevant findings, published in peer-review academic international journals.12,13,19,21,25,37 Research usage Challenges in communicating and disseminating these research findings to different audiences in an accurate, appropriate, and timely manner.5,31 at the political, social, institutional, and individual level.23,43,44 provide direct financial support for the research, authorship, and/ Also, strong cognitive social capital (e.g., social norms related or publication of this article. to solidarity, trust, and social participation45–49) must be fostered to co-produce innovative, effective, and equitable Declaration of Conflicting Interests solutions for health to our increasingly globalized prob- The authors declared no potential conflicts of interest with respect to lems; both of which need to be supported by greater the research, authorship, and/or publication of this article. responsibility, cooperation, and commitment to coordi- nated, transparent action.23 Otherwise, we will continue Funding to remain inadequately prepared to respond, manage, and The author(s) received no financial support for the research, author- address our society’s unmet needs. ship, and/or publication of this article. Acknowledgments ORCID iDs JB gratefully acknowledges the financial support by ICREA under Lucinda Cash-Gibson https://orcid.org/0000-0003-3292-5684 the ICREA Academia programme. However, ICREA did not Joan Benach https://orcid.org/0000-0003-2285-742X Cash-Gibson et al. 303 References 15. Burström B, Tao W. Social determinants of health and inequal- 1. Katz AS, Hardy BJ, Firestone M, Lofters A, Morton-Ninomiya ities in COVID-19. Eur J Public Health. 2020;30:617–618. ME. Vagueness, power and public health: Use of ‘vulnerable’ doi:10.1093/eurpub/ckaa095 in public health literature. Crit Public Health. 2020;30:601– 16. Abedi V, Olulana O, Avula V, Chaudhary D, Khan A, 611. doi:10.1080/09581596.2019.1656800 Shahjouei S. Racial, Economic and Health Inequality and 2. Chowkwanyun M, Reed AL Jr. Racial health disparities and COVID-19 Infection in the United States. medRxiv Prepr COVID-19 – Caution and context. N Engl J Med. Serv Heal Sci. 2020 [cited 25 Sep 2020]. doi:10.1101/2020. 2020;383(3):201–203. doi:10.1056/NEJMp2012910 04.26.20079756 3. Bambra C, Riordan R, Ford J, Matthews F. The COVID-19 17. Rollston R, Galea S. COVID-19 and the social determinants of pandemic and health inequalities. J Epidemiol Community health. Am J Health Promot. 2020;34:687–689. doi:10.1177/ Health. 2020;74:964–968. doi:10.1136/jech-2020-214401 0890117120930536b 4. Benach J, Díaz MR, Muñoz NJ, Martínez-Herrera E, Pericàs 18. Blundell R, Costa Dias M, Joyce R, Xu X. COVID-19 and JM. What the Puerto Rican hurricanes make visible: inequalities*. Fisc Stud. 2020;41:291–319. doi:10.1111/ Chronicle of a public health disaster foretold. Soc Sci Med. 1475-5890.12232 2019;238:112367. doi:10.1016/j.socscimed.2019.112367 19. Cash-Gibson L, Harris M, Guerra G, Benach J. A novel concep- 5. Mesa Vieira C, Franco OH, Gómez Restrepo C, Abel T. tual model and heuristic tool to strengthen understanding and COVID-19: The forgotten priorities of the pandemic. capacities for health inequalities research. Health Res Policy Maturitas. 2020;136:38–41. doi:10.1016/j.maturitas.2020.04. Syst. 2020;18:42. doi:10.1186/s12961-020-00559-z 004 20. Hanney SR, Kanya L, Pokhrel S, Jones TH, Boaz A. How to 6. White AIR. Historical linkages: Epidemic threat, economic strengthen a health research system: WHO’s review, whose lit- risk, and xenophobia. The Lancet. 2020;395:1250–1251. erature and who is providing leadership? Health Res Policy doi:10.1016/S0140-6736(20)30737-6 Syst. 2020;18:72. doi:10.1186/s12961-020-00581-1 7. Benach J. We must take advantage of this pandemic to make a 21. Ghaffar A, Ijsselmuiden C, Zicker F. Changing mindsets: radical social change: The coronavirus as a global health, Research capacity strengthening in low- and middle-income inequality, and eco-social problem. Int J Health Serv. countries, Geneva, COHRED, Global Forum for Health 2020;51(1):50–54. doi:10.1177/0020731420946594 Research and UNICEF/UNDP/World Bank/WHO Special 8. Ali S, Asaria M, Stranges S. COVID-19 and inequality: Are we Programme for Research and Training in Tropical Diseases all in this together? Can J Public Health. 2020;111:415–416. (TDR) 2008. ISBN: 92-9226-028-6. http://www.cohred. doi:10.17269/s41997-020-00351-0 org/downloads/cohred_publications/Changing_Mindsets.pdf. 9. Ahmed F, Ahmed N, Pissarides C, Stiglitz J. Why inequality Counc Health Res Dev. 2008. could spread COVID-19. Lancet Public Health. 2020;5:e240. 22. Pang T, Sadana R, Hanney S, Bhutta ZA, Hyder AA, Simon J. doi:10.1016/S2468-2667(20)30085-2 Knowledge for better health: A conceptual framework and 10. Amengual-Moreno M, Calafat-Caules M, Carot A, Rita Rosa foundation for health research systems. Bull World Health Correia A, Río-Bergé C, Rovira Plujà J. Determinantes sociales Org. 2003;81:815–820. de la incidencia de la COVID-19 en Barcelona: Un estudio 23. Cash-Gibson L. Where, Why and How Scientific Knowledge on ecológico preliminar usando datos públicos./[Social determi- Health Inequalities is Generated?: An Integrated Perspective to nants of the incidence of COVID-19 in Barcelona: a prelimi- Strengthen Understanding of Health Inequalities Research nary ecological study using public data.]. Rev Esp Salud Capacities: Key Insights from the United Kingdom and the Pública. 2020;94:16–17. https://www.mscbs.es/resp City of Barcelona. Universitat Pompeu Fabra. 2020. https:// 11. Shadmi E, Chen Y, Dourado I, Faran-Perach I, Furler J, repositori.upf.edu/handle/10230/45975 Hangoma P. Health equity and COVID-19: Global perspec- 24. Borrell C, Pasarín MI, Díez E, Pérez K et al. Health inequalities tives. Int J Equity Health. 2020;19:104. doi:10.1186/s12939- as a political priority in Barcelona. Gac Sanit. 2019;34:69–76. 020-01218-z doi:10.1016/j.gaceta.2019.04.004 12. Marí-Dell’Olmo M, Gotsensa M, Pasarína M-I, García de 25. Cash-Gibson L, Rojas-Gualdrón DF, Pericàs JM, Benach J. Olalla P, Riusa C, Rodríguez-Sanza M. Desigualtats socials i Inequalities in global health inequalities research: A 50-year COVID-19 at Barcelona; May 2020. https://ajuntament. bibliometric analysis (1966-2015). PLoS One. 2018;13: barcelona.cat/dretssocials/sites/default/files/revista/08_op_aspb_ e0191901. doi:10.1371/journal.pone.0191901 bcn26.pdf 26. Pilecco FB, Leite L, Góes EF, Diele-Viegas LM, Aquino EML. 13. Observatori de les Desigualtats en Salut (AQuAS). Informe De Addressing racial inequalities in a pandemic: Data limitations L’Observatori: Desigualtats socioeconomiques en el nombre de and a call for critical analyses. Lancet Glob Health. casos i la mortalitat per COVD-19 a Catalunya, Barcelona; 2020;8(12): e1461–e1462. doi:10.1016/S2214-109X(20) 2020. http://aquas.gencat.cat 30360-0 14. Chen JT, Krieger N. Working paper series: Revealing the unequal 27. Peralta A, Benach J, Borrell C, et al. Evaluation of the mortality burden of COVID-19 by income, race/ethnicity, and household registry in Ecuador (2001-2013) – Social and geographical crowding: US county vs. ZIP code analyses. J Public Health inequalities in completeness and quality. Popul Health Metr. Manag Pract. 2021;27 Suppl 1, COVID-19 and Public 2019;17:3. Health: Looking Back, Moving Forward:S43-S56. doi:10. 28. Llop-Gironés A, Cash-Gibson L, Chicumbe S et al. Health 1097/PHH.0000000000001263. PMID: 32956299. equity monitoring is essential in public health: Lessons from 304 International Journal of Health Services 51(3) Mozambique. Global Health. 2019;15:67. doi:10.1186/ 44. Whitehead M. Diffusion of ideas on social inequalities in health: s12992-019-0508-4 A European perspective. Milbank Q. 1998;76:469–492,306. http:// 29. Krieger N. The US census and the People’s Health: Public www.ncbi.nlm.nih.gov/pubmed/9738171 Health engagement from enslavement and “Indians Not 45. Putnam RD, Leonardi R, Nanetti R. Making Democracy Work: Taxed” to census tracts and health equity (1790-2018). Am J Civic Traditions in Modern Italy. Princeton University Press; Public Health. 2019;109:1092–1100. doi:10.2105/AJPH. 1993. 2019.305017 46. Islam MK, Merlo J, Kawachi I, Lindström M, Gerdtham UG. 30. McMahon DE, Peters GA, Ivers LC, Freeman EE. Global Social capital and health: Does egalitarianism matter? A litera- resource shortages during COVID-19: Bad news for low- ture review. Int J Equity Health. 2006;5:3. doi:10.1186/ income countries. PLoS Negl Trop Dis. 2020;14:e0008412. 1475-9276-5-3 doi:10.1371/journal.pntd.0008412 47. Siisiäinen M. Two concepts of social capital: Bourdieu vs. 31. Ataguba OA, Ataguba JE. Social determinants of health: The Putnam. Int J Contemp Sociol. 2003;40:183–204. role of effective communication in the COVID-19 pandemic 48. Putnam R, Leonardi R, Nanetti R. Making Democracy Work: in developing countries. Glob Health Action. 2020;13. doi:10. Civic Tradition in Modern Italy. Princeton University Press; 1080/16549716.2020.1788263 1993. 32. The Lancet. The gendered dimensions of COVID-19. Lancet. 49. Lochner K, Kawachi I, Kennedy BP. Social capital: A guide to 2020;395(10231):1168. doi:10.1016/S0140-6736(20)30823-0 its measurement. Health Place. 1999;5:259–270. doi:10.1016/ 33. Laurencin CT, McClinton A. The COVID-19 pandemic: A call S1353-8292(99)00016-7 to action to identify and address racial and ethnic disparities. J Racial Ethn Health Disparities. 2020;7:398–402. doi:10.1007/ Author Biographies s40615-020-00756-0 Lucinda Cash-Gibson, BSc, MSc, MRes, PhD, is a 34. Khalatbari-Soltani S, Cumming RC, Delpierre C, Kelly-Irving M. Importance of collecting data on socioeconomic determi- Collaborative Researcher at the Research Group on Health nants from the early stage of the COVID-19 outbreak Inequalities, Environment, Employment Conditions onwards. J Epidemiol Community Health. 2020;74:620–623. Knowledge Network (GREDS-EMCONET) at Universitat doi:10.1136/jech-2020-214297 Pompeu Fabra (UPF), and the Johns Hopkins University – 35. Krieger N. A glossary for social epidemiology. J Epidemiol Pompeu Fabra University Public Policy Center, Barcelona, Community Health. 2001;55:693–700. Spain. 36. Geronimus AT, Hicken M, Keene D, Bound J. “Weathering” and age patterns of allostatic load scores among blacks and whites in Juan M Pericàs, MD, MPH, PhD, is a Medical Doctor at the United States. Am J Public Health. 2006;96:826–833. doi:10. Vall d’Hebron University Hospital and Hospital Clinic, 2105/AJPH.2004.060749 Barcelona, and Collaborative Researcher at the Research 37. Cash-Gibson L, Benach J. Health inequalities research capacity in Group on Health Inequalities, Environment, Employment the UK: Preliminary findings from a realist explanatory case study. Conditions Knowledge Network (GREDS-EMCONET) at The Lancet. 2019;394:S29. doi:10.1016/s0140-6736(19)32826-0 UPF, and the Johns Hopkins University – Pompeu Fabra 38. Muntaner C, Chung H, Murphy K, Ng E. Barriers to knowl- University Public Policy Center, Barcelona. edge production, knowledge translation, and urban health policy change: Ideological, economic, and political consider- Eliana Martinez-Herrera, MDM, MSc, PhD, is a Professor ations. J Urban Health. 2012;89:915–924. doi:10.1007/s11524- at National School of Public Health “Héctor Abad Gómez”, 012-9699-1 University of Antioquia, Medellín, Colombia, and Collaborative 39. Navarro V. The politics of health inequalities research in the Researcher at the Research Group on Health Inequalities, United States. Int J Health Serv. 2004;34:87–99. doi:10.2190/ Environment, Employment Conditions Knowledge Network 0KT0-AQ1G-5MHA-9H7R (GREDS-EMCONET) at UPF, Barcelona, Spain. 40. Mayor A, Martínez-Pérez G, Tarr-Attia CK, et al. Training through malaria research: Building capacity in good clinical and laboratory practice in Liberia. Malar J. 2019;18:136. Joan Benach, MD, MPH, PhD, is the Director of the doi:10.1186/s12936-019-2767-1 Research Group on Health Inequalities, Environment, 41. Wenham C, Smith J, Morgan R. COVID-19: The gendered Employment Conditions Network (GREDS-EMCONET), impacts of the outbreak. The Lancet. 2020;395:846–848. the Co-Director of the Johns Hopkins – UPF Public Policy doi:10.1016/S0140-6736(20)30526-2 Center, and a Professor of Sociology in the Department of 42. The Lancet. No more normal. Lancet. 2020;396:143. doi:10. Political and Social Sciences at UPF, Barcelona. He served 1016/S0140-6736(20)31591-9 as co-chair of the Employment Conditions Knowledge 43. Recognition (Stanford Encyclopedia of Philosophy). [cited Network of the World Health Organization’s Commission May 9, 2020]. https://plato.stanford.edu/entries/recognition/ on Social Determinants of Health.