The DOI matches its Crossref record; 51 of the 51 references it cites were found in a registry or an index; 17 of the 50 sources its claims cite were checked for support.
The COVID-19 pandemic and health inequalities
Open accessAbstract
This essay examines the implications of the COVID-19 pandemic for health inequalities. It outlines historical and contemporary evidence of inequalities in pandemics—drawing 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 syndemic pandemic . 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.
Overview
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Verification
Claims the paper makes
17 of 50 cited sources checked · 6 supported · 1 flagged · accuracy not yet measured
At least one cited source doesn’t support this claim or points to a different paper, and none confirmed it — see the verdicts below.
In the paper
“Similarly, access to healthcare is lower in disadvantaged and marginalised communities-even in universal healthcare systems.32”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Disputedcites [32] 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 sourceExperimental — accuracy not yet measured
The Conclusions (page unavailable) report the opposite pattern for the access this study measured: a higher proportion of people in England’s most deprived areas live within a 20-minute walk of a GP premises. The Discussion’s principal findings likewise say GP-premises accessibility was highest in the most deprived areas. The paper measures proximity to GP premises and pharmacies, not healthcare access in general or access among all marginalised communities. (LLM, conf=0.87)
Checked by a reasoning model — may be wrong.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Disputed
Every source the paper cites for this claim was checked and supports it.
In the paper
“and across Sweden, there were inequalities in mortality between the highest and lowest occupational classes -particularly among men.7”
§ The COVID-19 pandemic and health inequalities > PART 1. HISTORICAL AND CONTEMPORARY EVIDENCE OF INEQUALITIES IN PANDEMICS
What the sources say
- Supportedcites [7] source
The Discussion reports social-class differences in excess mortality during the July 1918–June 1919 pandemic and says they were larger among men than women. The Regression results likewise identify low-skilled men as having the highest excess mortality and farmers the lowest; the paper does not claim a uniform class gradient. (LLM, conf=0.91)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“In contrast, countries with smaller pre-existing social and economic inequalities, such as New Zealand, did not experience any socio-economic inequalities in mortality.8 9”
§ The COVID-19 pandemic and health inequalities > PART 1. HISTORICAL AND CONTEMPORARY EVIDENCE OF INEQUALITIES IN PANDEMICS
What the sources say
- Not matchedcites [8] Rice G , Bryder L . Black november: the 1918 influenza pandemic in New Zealand . Christchurch: Canterbury University Press, 2005.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Partly supportedcites [9] sourceExperimental — accuracy not yet measured
The Results (Univariate results, page unavailable) show no significant trend in mortality risk by occupational class among New Zealand military personnel; the paper also reports no significant occupational-class association in its fully adjusted model. But it does not establish that New Zealand had smaller pre-existing social and economic inequalities or that the country experienced no socioeconomic inequalities in pandemic mortality. The study was restricted to New Zealand military personnel in the Northern Hemisphere, so the claim generalizes beyond its population. (LLM, conf=0.87)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Not matched
Every source the paper cites for this claim was checked and supports it.
In the paper
“Another study found positive associations between people with financial issues (eg, financial barriers to healthcare access) and influenza-like illnesses during the 2009 H1N1 pandemic in the USA.15”
§ The COVID-19 pandemic and health inequalities > PART 1. HISTORICAL AND CONTEMPORARY EVIDENCE OF INEQUALITIES IN PANDEMICS
What the sources say
- Supportedcites [15] source
The COMMENT section (page not provided) reports that respondents with financial barriers to healthcare were more likely to report influenza-like illness, even after adjustment for age, medical conditions, and employment. This directly supports the cited association in the US pandemic study. (LLM, conf=0.94)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“For example, globally, Mexico experienced a higher mortality rate than that in higher-income countries.12”
§ The COVID-19 pandemic and health inequalities > PART 1. HISTORICAL AND CONTEMPORARY EVIDENCE OF INEQUALITIES IN PANDEMICS
What the sources say
- Supportedcites [12] source
The Discussion states that Mexico had higher 2009 pandemic-related mortality rates than the United States, Europe, or Australia. It also compares an estimated 11.1 deaths per 100,000 in Mexico with 4 per 100,000 in the United States. (LLM, conf=0.91)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Various studies on cyclical winter influenza in North America have also found associations between mortality, morbidity and symptom severity and socio-economic status among adults and children.16 17”
§ The COVID-19 pandemic and health inequalities > PART 1. HISTORICAL AND CONTEMPORARY EVIDENCE OF INEQUALITIES IN PANDEMICS
What the sources say
- Partly supportedcites [16] sourceExperimental — accuracy not yet measured
The Discussion reports that influenza-related hospitalizations increased as neighborhood socioeconomic status decreased among adults in New Haven County across four seasons. The Introduction also reports an earlier Connecticut finding for children. These passages support an association with hospitalization, but not the claimed associations with mortality or symptom severity across North America. (LLM, conf=0.88)
- Not checked — no full text of the sourcecites [17] source
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Similarly, old-age pensions in the UK were protected from austerity cuts after the GFC and research has suggested that this prevented health inequalities increasing amongst the older population.45”
§ The COVID-19 pandemic and health inequalities > PART 3. THE GREAT LOCKDOWN: THE COVID-19 ECONOMIC CRISIS AND HEALTH INEQUALITIES
What the sources say
- Partly supportedcites [45] sourceExperimental — accuracy not yet measured
The Background and Discussion say UK pensioners were largely protected from austerity and suggest that maintaining these benefits may explain why the mental-health gap did not widen in the study’s older cohort. The Conclusion limits that finding to an 18-month study of the most and least deprived neighbourhoods of Stockton-on-Tees; it does not establish that pension protection prevented health inequalities from increasing among the UK’s older population generally. (LLM, conf=0.85)
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Housing is also an important factor in driving health inequalities.34”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Supportedcites [34] source
The Introduction describes housing and neighbourhood conditions as an upstream determinant that plays a role in health inequalities. The Abstract also calls them important social determinants of health. Together, these passages support the citing sentence's broad claim. (LLM, conf=0.93)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Decades of research into the psychosocial determinants of health have found that the chronic stress of material and psychological deprivation is associated with immunosuppression.36”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Partly supportedcites [36] sourceExperimental — accuracy not yet measured
The Results report that chronic stressors, including unemployment and caregiving, were associated with reduced function on almost all immune measures examined. The Discussion describes the most chronic stressors as associated with broad immunosuppression. The paper does not establish material and psychological deprivation as distinct categories of stressor, so that specificity goes beyond its findings. (LLM, conf=0.82)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passes- Partly supported
Every source the paper cites for this claim was checked and supports it.
In the paper
“Likewise, there is increasing evidence that living in disadvantaged environments may produce a sense of powerlessness and collective threat among residents, leading to chronic stressors that, in time, damage health.39”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Supportedcites [39] source
Section 3.3 (Meso/community level theories; page not provided) states that disadvantaged living environments may produce collective threat and powerlessness, which act as chronic stressors damaging health over time. This directly supports the attributed claim. (LLM, conf=0.95)
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes- Supported
- It may state two separate claims as one. 21
- Probably not a substantial claim. 2
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“Housing also impacts health inequalities materially through costs (eg, as a result of high rents) and psychosocially through insecurity (eg, short-term leases).34”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Partly supportedcites [34] sourceExperimental — accuracy not yet measured
The Introduction (page unavailable) says housing tenure may affect health psychosocially: home ownership may provide greater security than renting, while debt may cause anxiety. It does not identify high rents as a material pathway or short-term leases as the source of insecurity, and it qualifies the tenure effect rather than asserting it outright. (LLM, conf=0.84)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Partly supported
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“For example, exposure to poor quality housing is associated with certain health outcomes, for example, damp housing can lead to respiratory diseases such as asthma while overcrowding can result in higher infection rates and increased risk of injury from household accidents.34”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Partly supportedcites [34] sourceExperimental — accuracy not yet measured
The Introduction says cold and damp housing may cause or exacerbate respiratory conditions, and that some housing-related hazards can cause injuries. The Results identify overcrowding as a housing-risk category, but the passages do not link it specifically to higher infection rates or household-accident injuries. The paper also does not specifically identify asthma as an outcome of damp housing. (LLM, conf=0.87)
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Partly supported
The cited sources that could be checked couldn’t confirm or dispute this claim.
In the paper
“For example, inequalities in premature mortality and infant mortality by income and ethnicity in the USA decreased during the period of welfare expansion in the USA ('war on poverty' era 1966 to 1980), but they increased again during the Reagan-Bush period (1980-2002) when welfare services and healthcare coverage were cut.46”
§ The COVID-19 pandemic and health inequalities > PART 3. THE GREAT LOCKDOWN: THE COVID-19 ECONOMIC CRISIS AND HEALTH INEQUALITIES
What the sources say
- Could not verifycites [46] sourceExperimental — accuracy not yet measured
The ‘Post-treatment reduction of clinical risk’ and ‘Duration of Follow-Up’ sections discuss antimalarial treatment trials, not US mortality inequalities. Searches for premature and infant mortality by income and ethnicity, the war on poverty, and the Reagan–Bush period found no passage addressing the claimed trends. (LLM, conf=0.78)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Could not verify
The cited sources support only part of this claim — read each source’s verdict below.
In the paper
“COVID-19 has laid bare our longstanding social, economic and political inequalities -even before the COVID-19 pandemic, life expectancy amongst the poorest groups was already declining in the UK and the USA and health inequalities in some European countries have been increasing over the last decade.50”
§ The COVID-19 pandemic and health inequalities > CONCLUSION
What the sources say
- Partly supportedcites [50] 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 sourceExperimental — accuracy not yet measured
The “Healthier but Still Unequal” section (page not provided) reports widening life-expectancy gaps in Denmark and in England between 2010 and 2015, supporting the claim that health inequalities increased in some European countries before COVID-19. It does not establish that life expectancy itself declined among the poorest groups in the UK or USA; the search for that claim found no such passage. (LLM, conf=0.88)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Partly supported
None of the sources cited for this claim have been checked yet.
In the paper
“The international literature demonstrates that there were inequalities in prevalence and mortality rates: between high-income and low-income countries, more and less affluent neighbourhoods, higher and lower socio-economic groups, and urban and rural areas.”
§ The COVID-19 pandemic and health inequalities > PART 1. HISTORICAL AND CONTEMPORARY EVIDENCE OF INEQUALITIES IN PANDEMICS
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“These health impacts were not shared equally though-areas of the UK with higher unemployment rates had greater increases in suicide rates and inequalities in mental health increased with people living in the most deprived areas experiencing the largest increases in psychiatric morbidity and self-harm.43”
§ The COVID-19 pandemic and health inequalities > PART 3. THE GREAT LOCKDOWN: THE COVID-19 ECONOMIC CRISIS AND HEALTH INEQUALITIES
What the sources say
- Not checked — no full text of the sourcecites [43] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The COVID-19 pandemic is occurring against a backdrop of social and economic inequalities in existing non-communicable diseases (NCDs) as well as inequalities in the social determinants of health.”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes? Based: unclearIt may state two separate claims as one.
In the paper
“With regard to ethnic inequalities in COVID-19, data from England and Wales have found that people who are black, Asian and minority ethnic (BAME) accounted for 34.5% of 4873 critically ill COVID-19 patients (in the period ending April 16, 2020) and much higher than the 11.5% seen for viral pneumonia between 2017 and 2019.20”
§ The COVID-19 pandemic and health inequalities > PART 1. HISTORICAL AND CONTEMPORARY EVIDENCE OF INEQUALITIES IN PANDEMICS
What the sources say
- Not matchedcites [20] 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.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: 14% of the population of England and Wales are from BAME backgrounds.
- Not matched
In the paper
“For example, in Chicago (in the period ending April 17, 2020), 59.2% of COVID-19 deaths were among black residents and the COVID-19 mortality rate for black Chicagoans was 34.8 per 100 000 population compared to 8.2 per 100 000 population among white residents.21”
§ The COVID-19 pandemic and health inequalities > PART 1. HISTORICAL AND CONTEMPORARY EVIDENCE OF INEQUALITIES IN PANDEMICS
What the sources say
- Not matchedcites [21] 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).
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“For example, lower-paid workers (where BAME groups are disproportionately represented)-particularly in the service sector (eg, food, cleaning or delivery services)-are much more likely to be designated as key workers and thereby are still required to go to work and rely on public transport for doing so.All these increase their exposure to the virus.”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Lower socio-economic groups have a higher exposure to poor quality or unaffordable, insecure housing and therefore have a higher rate of negative health consequences.35”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Not checked — no full text of the sourcecites [35] source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“People with existing chronic conditions (eg, cancer or cardiovascular disease (CVD)) are less likely to receive treatment and diagnosis as health services are overwhelmed by dealing with the pandemic.”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Just like the 1918 influenza pandemic (which had severe impacts on economic performance and increased poverty rates), the COVID-19 crisis will have huge economic, social and-ultimately-health consequences.”
§ The COVID-19 pandemic and health inequalities > PART 3. THE GREAT LOCKDOWN: THE COVID-19 ECONOMIC CRISIS AND HEALTH INEQUALITIES
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Minority ethnic groups, people living in areas of higher socioeconomic deprivation, those in poverty and other marginalised groups (such as homeless people, prisoners and street-based sex workers) generally have a greater number of coexisting NCDs, which are more severe and experienced at at a younger age.”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“For example, deprived neighbourhoods are more likely to contain houses of multiple occupation and smaller houses with a lack of outside space, as well as have higher population densities (particularly in deprived urban areas) and lower access to communal green space.27”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Not matchedcites [27] Bambra C . Health divides: where you live can kill you . Bristol: Policy Press, 2016.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“Previous research has found that sudden economic shocks (like the collapse of communism in the early 1990s and the global financial crisis (GFC) of 2008 41 ) lead to increases in morbidity, mental ill health, suicide and death from alcohol and substance use.”
§ The COVID-19 pandemic and health inequalities > PART 3. THE GREAT LOCKDOWN: THE COVID-19 ECONOMIC CRISIS AND HEALTH INEQUALITIES
What the sources say
- Not matchedcites [41] Stuckler D , Basu S . The body economic. why austerity kills . London: Thomas Allen, 2013.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Not matched
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“So, the health consequences of the COVID-19 economic crisis are likely to be similarly unequally distributed-exacerbating heath inequalities.”
§ The COVID-19 pandemic and health inequalities > PART 3. THE GREAT LOCKDOWN: THE COVID-19 ECONOMIC CRISIS AND HEALTH INEQUALITIES
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The prevalence and severity of the COVID-19 pandemic is magnified because of the pre-existing epidemics of chronic disease-which are themselves socially patterned and associated with the social determinants of health.”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Similarly, the Gypsy/Roma community-one of the most marginalised minority groups in Europe-has a smoking rate that is two to three times the European average and increased rates of respiratory diseases (such as COPD) and other COVID-19 risk factors.29”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Not matchedcites [29] European commission . Roma health report: health status of the Roma population in the member states of the European union . Brussels: European Commission, 2014.
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Not matched
In the paper
“These will likely increase COVID-19 transmission rates-as was the case with H1N1 where strong associations were found with urbanity.13”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
What the sources say
- Not checked — no full text of the sourcecites [13] source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“These state-imposed restrictionsusually requiring the government to take on emergency powershave been implemented to varying levels of severity, but all have in common a significant increase in social isolation and confinement within the home and immediate neighbourhood.”
§ The COVID-19 pandemic and health inequalities > PART 3. THE GREAT LOCKDOWN: THE COVID-19 ECONOMIC CRISIS AND HEALTH INEQUALITIES
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✗ Based: failsProbably not a substantial claim. The paper may give no reason why it holds.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This reduced access to healthcare-before and during the outbreak -contributes to inequalities in chronic disease and is also likely to lead to worse outcomes from COVID-19 in more disadvantaged areas and marginalised communities.”
§ The COVID-19 pandemic and health inequalities > PART 2. THE SYNDEMIC OF COVID-19, CHRONIC DISEASE AND THE SOCIAL DETERMINANTS OF HEALTH
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“It seems likely that there will be a post-COVID-19 global economic slumpwhich could make the health equity situation even worse, particularly if health-damaging policies of austerity are implemented again.”
§ The COVID-19 pandemic and health inequalities > CONCLUSION
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
14% of the population of England and Wales are from BAME backgrounds.
“Only 14% of the population of England and Wales are from BAME backgrounds.”
The paper relies on this without support.
Most countries failed to pursue traditional public health surveillance measures and were forced to implement lockdowns.
“While traditional public health surveillance measures of contact tracing and individual quarantine were successfully pursued by some countries (most notably by South Korea and Germany) as a way of tackling the virus in the early stages, most other countries failed to do so, and governments worldwide were eventually forced to implement mass quarantine measures -in the form of lockdowns.”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
In the citing paper
“What we do know with more certainty is that times of crisis or periods of austerity are likely to disadvantage entire cohorts/generations [60], but that this will amplify prior forms of exclusion and marginalisation [3].”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conclusion attributes 1918 inequalities to COVID-19
MinorThe conclusion says inequalities both then and now arose through COVID-19. Earlier, the paper identifies the historical inequalities as occurring during the 1918 Spanish influenza pandemic, not the COVID-19 pandemic.
“Both then and now, these inequalities have emerged through the syndemic nature of COVID-19-as it interacts with and exacerbates existing social inequalities in chronic disease and the social determinants of health.”
“More recent studies have confirmed Sydenstricker's early findings: there were significant inequalities in the 1918 Spanish influenza pandemic.”
Citations
Cites
Closing the gap in a generation: health equity through action on the social determinants of health
Marmot, M. G., Friel, S., Bell, R., Houweling, T. A. J., & Taylor, S. A. J. (2008) · The Lancet · doi:10.1016/s0140-6736(08)61690-6 · Cited by 8,473
Psychological stress and the human immune system: a meta-analytic study of 30 Years of inquiry
Segerstrom, S. C., & Miller, G. E. (2004) · Psychological Bulletin · doi:10.1037/0033-2909.130.4.601 · Cited by 3,334 · cited 1×
“Decades of research into the psychosocial determinants of health have found that the chronic stresses of material and psychological deprivation is associated with immunosuppression [36].”
BackgroundAlmond, D. (2006) · Journal of Political Economy · doi:10.1086/507154 · Cited by 1,190 · cited 1×
“There is also some evidence from the USA that the pandemic had long term impacts on child health and development [11].”
BackgroundMurray, C. J., Lopez, A. D., Chin, B., Feehan, D., & Hill, K. H. (2006) · The Lancet · doi:10.1016/s0140-6736(06)69895-4 · Cited by 605 · cited 4×
“For example, India had a mortality rate 40 times higher than Denmark and the mortality rate was 20 times higher in some South American countries than in Europe.4 In Norway, mortality rates were highest among the working-class districts of Oslo5; in the USA, they were highest among the unemployed and the urban poor in…”
BackgroundInfluentialGibson, M., Petticrew, M., Bambra, C., Sowden, A. J., Wright, K. E., & Whitehead, M. (2011) · Health & Place · doi:10.1016/j.healthplace.2010.09.011 · Cited by 539 · cited 2×
“Housing is also an important factor in driving health inequalities [34].”
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Work, Worklessness, and the Political Economy of Health
Bambra, C. L. (2011) · Oxford University Press eBooks · doi:10.1093/acprof:oso/9780199588299.001.0001 · Cited by 278
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“respiratory diseases like COVID-19 [40].”
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“These health impacts were not shared equally though – areas of the UK with higher unemployment rates had greater increases in suicide rates and inequalities in mental health increased with people living in the most deprived areas experiencing the largest increases in poor mental health and self-harm [43].”
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“observed in the 1918 influenza pandemic whereby, for example, in England and Wales, mortality was 30–40% higher in urban areas [10].”
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“For example, India had a mortality rate 40 times higher than Denmark and the mortality rate was 20 times higher in some South American countries than in Europe.4 In Norway, mortality rates were highest among the working-class districts of Oslo5; in the USA, they were highest among the unemployed and the urban poor in…”
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“For example, India had a mortality rate 40 times higher than Denmark and the mortality rate was 20 times higher in some South American countries than in Europe.4 In Norway, mortality rates were highest among the working-class districts of Oslo5; in the USA, they were highest among the unemployed and the urban poor in…”
BackgroundWork, worklessness and the political economy of health inequalities: Figure 1
Bambra, C. (2011) · Journal of Epidemiology and Community Health · doi:10.1136/jech.2009.102103 · Cited by 152 · cited 1×
“These working conditions are associated with increased risks of respiratory diseases, certain cancers, musculoskeletal disease, hypertension, stress and anxiety [31].”
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Self-citationThe Social Determinants of Health and Pandemic H1N1 2009 Influenza Severity
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“Similarly, a Canadian study in Ontario, found that hospitalisation rates for H1N1 were associated with lower educational attainment and living in a high deprivation neighbourhood [14].”
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“For example, following the GFC, worldwide an excess of suicides were observed in the USA, England, Spain and Ireland.42 There is also evidence of other increases in poor mental health after the GFC including self-harm and psychiatric morbidity.41 42 These health impacts were not shared equally though—areas of the UK w…”
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“This challenged the widely held popular and scientific consensus of the time that held ‘‘the flu hit the rich and the poor alike’’ [2] In the 2020 COVID-19 pandemic, there have been similar claims made by politicians and the media that we are ‘all in it together’ and that the COVID-19 virus ‘does not”
BackgroundSocio-economic disparities in mortality due to pandemic influenza in England
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“These will likely increase COVID-19 transmission rates - as was the case with H1N1 where strong associations were found with urbanity [13].”
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“mortality between the highest and lowest occupational classes – particularly amongst men [7].”
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Health Divides: Where You Live Can Kill You
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GPs in deprived areas face severest pressures, analysis shows
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“Indeed, research has found that countries with higher rates of social protection (such as Sweden) do not experience increases in health inequalities during economic recessions [44].”
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Flagged first, then by citations
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Cited by
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Predictors of COVID-19 vaccine hesitancy in the UK household longitudinal study
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“It is also worth noting that the COVID-19 burden may be coupled with existing non-communicable diseases among marginalized social groups, particularly those in minority ethnic groups, socioeconomic deprivation, and poverty, aggravating the populations’ overall vulnerability [23, 29, 30].”
BackgroundGlobal developments in social prescribing
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Covid-19 vaccination hesitancy
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Metadata
- Authors
- Bambra, C., Riordan, R., Ford, J., & Matthews, F.
- Affiliations
- Newcastle University (GB)
- University of Cambridge (GB)
- Corresponding author
- Bambra, Clare
- Venue
- Journal of Epidemiology and Community Health
- Publisher
- BMJ
- Published
- 2020-06-13
- Volume
- 74
- Issue
- 11
- Pages
- 964-968
- ISSN
- 0141-7681 (ISSN-L)
- 0143-005X
- 1470-2738
- PMC
- PMC7298201
- OpenAlex
- W3034285292
- Cited by
- 2,118
- References
- 48
- Citations by year
- 2026: 216 · 2025: 196 · 2024: 298 · 2023: 364 · 2022: 508 · 2021: 454 · 2020: 80
- FWCI
- 174.72
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- Journal of Epidemiology & Community Health (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Repository@Hull (Worktribe) (University of Hull) (submittedVersion, cc-by)
- HighWire Press Open Archive (submittedVersion)
- Newcastle University ePrints (Newcastle Univesity)
- Funders
- National Institute for Health Research (NIHR200173)
- Topics
- Social Sciences › Health › Public Health and Social Inequalities
- Social Sciences › Health › Health disparities and outcomes
- Health Sciences › Health Professions › General Health Professions › Healthcare Systems and Challenges
- Keywords
- COVID-19 pandemic, health disparities, syndemic, social determinants of health, socioeconomic disparities, ethnic inequality, regional disparities, economic impact of lockdown, public health policy
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Humans, Pneumonia, Viral, Socioeconomic Factors, Coronavirus Infections, Health Status Disparities, Healthcare Disparities, Pandemics, Social Determinants of Health
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-10-11, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-10-11 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Cited sources are checked with a language model’s help (gpt-6-sol).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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