Martin Mckee

London School of Hygiene and Tropical Medicine | LSHTM · European Centre on Health of Societies in Transition

There is a rich body of literature on the distribution of cancer incidence and mortality in socioeconomically different world regions, but none of the studies has compared the spatial distribution of mortality and incidence to see if they are consistent with each other. All malignant neoplasms combined and cervical, colorectal, breast, pancreatic,...

Background Eastern Europe witnessed substantial life expectancy losses in 2021. COVID-19 vaccination coverage was lower, and mortality was higher than in Western Europe. Research suggests an important factor behind lower vaccination coverage is vaccine hesitancy. Our studies aimed to explore spatial inequalities in COVID-19 morbidity, mortality, an...

Background Cervical cancer is a preventable and inequitably distributed disease. Screening plays a vital role in prevention, but many women face barriers to participation. The aims of this scoping review, undertaken to inform the co-design of interventions to equitably increase screening uptake, were to: (1) identify barriers and facilitators to ce...

Background: Primary health centres (PHCs) in Nigeria suffer critical shortages of health workers, aggravated by chronic absenteeism that has been attributed to insufficient resources to govern the system and adequately meet their welfare needs. However, the political drivers of this phenomenon are rarely considered. We have asked how political powe...

The current economic crisis in Europe has challenged the basis of the economic model that currently prevails in much of the industrialised world. It has revealed a system that is managed not for the benefit of the people but rather for the corporations and the small elite who lead them, and which is clearly unsustainable in its present form. Yet, t...

Background During the first wave of the COVID-19 pandemic, the United Kingdom experienced one of the highest per-capita death tolls worldwide. It is debated whether this may partly be explained by the relatively late initiation of voluntary social distancing and mandatory lockdown measures. In this study, we used simulations to estimate the number...

The current Opinion explores the concept of solidarity from both theoretical and implementation perspectives with a focus on health emergencies. Focusing on how the principle of solidarity is enshrined in European Union (EU) law, it critically examines relevant implemented and proposed actions of solidarity towards EU Member States and towards...

In this article, we argue that the design and timing of regulatory responses, as well as the adherence of the population to the relevant rules, have a critical impact on the progression and public health consequences of the COVID-19 pandemic. This hypothesis is empirically tested using the example of Poland, a country that experienced, compared to...

Objective To offer a quantitative risk–benefit analysis of two doses of SARS-CoV-2 vaccination among adolescents in England. Setting England. Design Following the risk–benefit analysis methodology carried out by the US Centers for Disease Control, we calculated historical rates of hospital admission, Intensive Care Unit admission and death for as...

Introduction We describe COVID-19 morbidity, mortality, case fatality and excess death in a country-wide study of municipalities in Hungary, exploring the association with socioeconomic status. Methods The spatial distribution of morbidity, mortality and case fatality was mapped using hierarchical Bayesian smoothed indirectly standardised ratios....

Background Job loss is a well-established social determinant of health. Recent research has taken an ‘institutional turn’, asking whether unemployment support could buffer the health consequences of job loss. Here, we exploit a quasi-natural experiment based on the Fornero reforms in Italy, which increased wage replacement rates from 60% to 75% on...

When the Fun Stops, Stop, is a prominent ‘responsible gambling’ campaign in the UK, originally funded and delivered by the industry-initiated and funded Senet Group. Since the Senet Group’s dissolution in 2020, the campaign has been overseen by the Betting and Gambling Council (BGC), the main gambling industry trade body. There has been no prior an...

Background All-cause excess mortality is a comprehensive measure of the combined direct and indirect effects of COVID-19 on mortality. Estimates are usually derived from Civil Registration and Vital Statistics (CRVS) systems, but these do not include non-registered deaths, which may be affected by changes in vital registration coverage over time....

The UK JCVI committee recently announced that vaccines would not be offered to all 12-17 year olds, as the potential risks were not outweighed by the benefits. Here, we offer a quantitative risk-benefit analysis of vaccines among 12-17 year olds in England, showing that the benefits of vaccination greatly outweigh risks among 12-17 year olds in Eng...

Background: The differences in cancer survival across countries and over time are well recognised, with progress varying even among high-income countries with comparable health systems. Previous research has examined several possible explanations, but the role of leadership in systems providing cancer care has attracted little attention. As part o...

Objective: Doctor absenteeism is widespread in Bangladesh, and the perspectives of the actors involved are insufficiently understood. This paper sought to elicit preferences of doctors over aspects of jobs in rural areas in Bangladesh that can help to inform the development of packages of policy interventions that may persuade them to stay at thei...

Background: Mental health problems increased during the COVID-19 pandemic. Knowledge that one is less at risk after being vaccinated may alleviate distress but this hypothesis remains unexplored. Here we test whether psychological distress declined in those vaccinated against COVID-19 in the US and whether changes in perceived risk mediated any ass...

Industrialised countries have varied in their early response to the Covid-19 pandemic, and how they have adapted to new situations and knowledge since the pandemic began. These variations in preparedness and policy may lead to different death tolls from Covid-19 as well as from other diseases. We applied an ensemble of 16 Bayesian probabilistic mod...

Context: Regional international organizations, from the South African Development Community (SADC) to the European Union (EU), are organizations that promote cooperation among countries in a specific region of the world. Asking what RIOs do to health and health policy by looking only at their formal health policies can understate their effects (e....

Most countries have implemented restrictions on mobility to prevent the spread of Coronavirus disease-19 (COVID-19), entailing considerable societal costs but, at least initially, based on limited evidence of effectiveness. We asked whether mobility restrictions were associated with changes in the occurrence of COVID-19 in 34 OECD countries plus Si...

Background Food insecurity concerns have featured prominently in the UK response to the COVID-19 pandemic. We assess changes in the prevalence of food-related hardships in the UK population from April to July 2020. Method We analysed longitudinal data on food-related hardships for 11,104 respondents from the April-July 2020 waves of the Understand...

Objective To systematically learn lessons from the experiences of countries implementing find, test, trace, isolate, support (FTTIS) in the first wave of the COVID-19 pandemic. Design, data sources and eligibility criteria We searched MEDLINE (PubMed), Cochrane Library, SCOPUS and JSTOR, initially between 31 May 2019 and 21 January 2021. Research...

Background: Variation in the approaches taken to contain the SARS-CoV-2 (COVID-19) pandemic at country level has been shaped by economic and political considerations, technical capacity, and assumptions about public behaviours. To address the limited application of learning from previous pandemics, this study aimed to analyse perceived facilitator...

Background Drug-related mortality in the UK rose markedly after 2012. Here we test the hypothesis that cuts to disability-related spending were associated with increased drug-related mortality across local governments in Great Britain. Methods We regressed changes in drug-related death rates (years 2010–12 versus 2015–17) on local government disab...

How will the coronavirus disease 2019 (COVID-19) pandemic develop in the coming months and years? Based on an expert survey, we examine key aspects that are likely to influence the COVID-19 pandemic in Europe. The challenges and developments will strongly depend on the progress of national and global vaccination programs, the emergence and spread o...

Background There is an extensive body of research demonstrating that trade and globalisation can have wide-ranging implications for health. Robust governance is key to ensuring that health, social justice and sustainability are key considerations within trade policy, and that health risks from trade are effectively mitigated and benefits are maximi...

The rise of digital mobile communications has made possible novel research methods that can provide a better understanding of patients’ experience of non-communicable diseases. This study explores the opportunities and challenges in employing “digital diaries” via mobile phones to track the lived experiences of people with hypertension in the Phili...

The ongoing COVID-19 pandemic has spotlighted the role of America's overcrowded prisons as vectors of ill health, but robust analyses of the degree to which high rates of incarceration impact population-level health outcomes remain scarce. In this paper, we use county-level panel data from 2927 counties across 43 states between 1983 and 2014 and a...

Background: People with disabilities (PWD) are at increased risk of poor mental health. However, this association and the pathways involved remain under-researched in many parts of the world. This study examined the association between disability and psychological distress in nine countries of the former Soviet Union (FSU). Methods: Data were analy...

Often portrayed as a harmless leisure activity in the UK, gambling is being increasingly recognised as a public health concern. However, a gambling policy system that explicitly tackles public health concerns and confronts the dependencies and conflicts of interest that undermine the public good is absent in the UK. Although there is a window of op...

Addressing the silent pandemic of antimicrobial resistance (AMR) is a focus of the 2021 G7 meeting. A major driver of AMR and poor clinical outcomes is suboptimal antimicrobial use. Current research in AMR is inequitably focused on new drug development. To achieve antimicrobial security we need to balance AMR research efforts between development of...

Informal payments for healthcare are widespread in sub-Saharan Africa. They are often regressive, potentially limiting access to quality healthcare, particularly for the most vulnerable, and can have catastrophic consequences for households. Yet there is little empirical research that uses theory-driven hypotheses to explore what influences informa...

The Covid-19 pandemic has been associated with worsening mental health but it is unclear whether this is a direct consequence of containment measures, like ‘Stay at Home’ orders, or due to other considerations such as fear and uncertainty about becoming infected. It is also unclear how responsive mental health is to a changing situation. Exploiting...

Objectives: In most countries, life expectancy at birth (e0) has improved for many decades. Recently, however, progress has stalled in the UK and Canada, and reversed in the USA. Lifespan variation, a complementary measure of mortality, increased a few years before the reversal in the USA. To assess whether this measure offers additional meaningfu...

The UK's response to the pandemic The UK has recorded one of the highest death rates associated with COVID-19 globally, whether measured as deaths that are directly attributable to COVID-19 or by excess mortality. The reasons for this high rate are complex and not yet fully understood, but elements of the UK Government response have been criticised...

The health and care sector plays a valuable role in improving population health and societal wellbeing, protecting people from the financial consequences of illness, reducing health and income inequalities, and supporting economic growth. However, there is much debate regarding the appropriate level of funding for health and care in the UK. In this...

The demographics of the UK population are changing and so is the need for health care. In this Health Policy, we explore the current health of the population, the changing health needs, and future threats to health. Relative to other high-income countries, the UK is lagging on many health outcomes, such as life expectancy and infant mortality, and...

A B S T R A C T Background People with disabilities (PWD) often face structural and other barriers to community involvement and may therefore be at risk of loneliness. Yet, so far, this issue has received little attention. Objective This cross-sectional study aimed to examine the association between disability and loneliness in nine countries of...

The resilience of health systems has received considerable attention as of late, yet little is known about what a resilience test might look like. We develop a resilience test concept and methodology. We describe key components of a toolkit and a 5-phased approach to implementation of resilience testing that can be adapted to individual health syst...

COVID-19 can cause persistent ill-health. Around a quarter of people who have had the virus experience symptoms that continue for at least a month but one in 10 are still unwell after 12 weeks. This has been described by patient groups as “Long COVID”. Our understanding of how to diagnose and manage Long COVID is still evolving but the condition ca...

An unprecedented mortality crisis struck Eastern Europe during the transition from socialism to capitalism. Working-class men without a college degree suffered the most. Some argue that economic dislocation caused stress and despair, leading to adverse health behavior and ill health (dislocation-despair approach). Others suggest that hazardous drin...

Objective: To estimate the impact of the 2015-2018 economic crisis on tobacco consumption in Brazil. Methods: This is an interrupted time series analysis conducted with data from 27 cities collected by VIGITEL, using linear regression models to account for first-order autocorrelation. Analyses were conducted based on gender, age group, and educa...

Policy Points • Despite the pandemic's ongoing devastating impacts, it also offers the opportunity and lessons for building a better, fairer, and sustainable world. • Transformational change will require new ways of working, challenging powerful individuals and industries who worsened the crisis, will act to exploit it for personal gain, and will...

Objective Patients with a combination of long-term physical health problems can face barriers in obtaining appropriate treatment for co-existing mental health problems. This paper evaluates the impact of integrating the improving access to psychological therapies services (IAPT) model with services addressing physical health problems. We ask whethe...

Objective: To elicit preferences of doctors over interventions to address doctor absenteeism in rural facilities in Bangladesh, a pervasive form of corruption across the country. Methods: We conducted a discrete choice experiment with 308 doctors across four tertiary hospitals in Dhaka, Bangladesh. Four attributes of rural postings were included ba...

Mobile phones have been used to monitor mobility changes during the COVID-19 pandemic but surprisingly few studies addressed in detail the implementation of practical applications involving whole populations. We report a method of generating a “mobility-index” and a “stay-at-home/resting-index” based on aggregated anonymous Call Detail Records of a...

Multi-layered mitigations can substantially reduce the risk of transmission within schools and into households. We summarise a set of recommendations that are in line with guidelines from the US Centers for Disease Control and Prevention (CDC) and practised in many countries to reduce the risk of transmission in schools and mitigate the impact of C...

On 22nd February, the UK government announced schools in England would fully reopen on the 8th March 2021. While returning to school as soon as possible is imperative for the education, social development, and mental and physical welfare of children, not enough has been done to make schools safer for students and staff. Multi-layered mitigations ca...

In 1935, the United States introduced the old-age assistance (OAA) program, a means-tested program to help the elderly poor. The OAA improved retirement conditions and aimed to enable older persons to live independently. We use the transition from early elderly plans to OAA and the large differences in payments and eligibility across states to show...

PurposeThe war in Syria has created the greatest refugee crisis in the twenty-first century. Turkey hosts the highest number of registered Syrian refugees, who are at increased risk of common mental disorders because of their exposure to war, violence and post-displacement stressors. The aim of this paper is to examine the prevalence and predictors...

A Correction to this paper has been published: https://doi.org/10.1038/s41591-021-01254-4.

Objective To examine the association between social isolation and mortality and incident diseases in middle-aged adults in urban and rural communities from high-income, middle-income and low-income countries. Design Population-based prospective observational study. Setting Urban and rural communities in 20 high income, middle income and low incom...

Background: Cardiovascular diseases (CVDs) are the leading cause of premature mortality in the world and are a growing public health concern in low- and middle-income countries (LMICs), including those in South East Asia. Their management requires coordinated responses by a range of healthcare providers, which should preferably be based on knowledg...

Could there be a symbiotic relationship between COVID-19 and conflict? On the one hand, circumstances associated with armed conflicts may give rise to greater spread of the virus, while, on the other hand, the COVID-19 pandemic may create conditions for violence through heightened xenophobia and nationalism or may change the dynamics of existing co...

Eva Turk and colleagues believe that there is much to learn from the experiences of low and middle income countries in co-producing knowledge and working with communities to find feasible and acceptable solutions to healthcare concerns

The scale of the COVID-19 pandemic is a consequence of international trade and globalisation, with the virus spreading along established trade and travel routes. However, the pandemic also affects international trade through reductions in both supply and demand. In this Viewpoint we describe the many implications for health and propose ways to miti...

Background There are concerns that the response to the COVID-19 pandemic in the UK might have worsened physical and mental health, and reduced use of health services. However, the scale of the problem is unquantified, impeding development of effective mitigations. We aimed to ascertain what has happened to general practice contacts for acute physic...

Key messages The Global Health Security Index predicted that the world in general was not well prepared for the pandemic but did not predict individual country preparedness Ten factors seem to have contributed to the index failing to predict country responses, including overlooking political, economic, and social contexts and the role of civil so...

In this article we argue that the design and timing of regulatory responses, as well as the adherence of the population to the relevant rules, have a critical impact on the progression and public health consequences of the pandemic. This hypothesis is empirically tested using the example of Poland, a country which experienced, compared to its Weste...

We study the link between fiscal austerity and Nazi electoral success. Voting data from a thousand districts and a hundred cities for four elections between 1930 and 1933 show that areas more affected by austerity (spending cuts and tax increases) had relatively higher vote shares for the Nazi Party. We also find that the localities with relatively...

Background The choices that policymakers make are shaped by how their problems are framed. At last, non-communicable diseases (NCDs) have risen high on the global policy agenda, but there are many disputed issues. First, what are they? Their name refers not to what they are but what they are not. Second, where do their boundaries lie? What diseases...

Background Inpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission. Methods We conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual,...

Israel has led the world in rolling out its COVID-19 vaccination program. This experience provides lessons that others can learn from. It is, however, necessary to consider some national specificities, including the small size of the country, its young population, and the political imperative to drive this program forward. Israel also has a number...