The unequal pandemic: investigating health equity and political responses to COVID-19

Countries’ political responses to COVID-19 share an outspoken goal to protect public health, but are highly diverse in both design and outcome. In a set of three integrated studies, the purpose of this project is to investigate the political determinants of health equity during the COVID-19 pandemic. In the first study, the project group aims to analyse the reciprocal relationship between political responses and the global burden of COVID-19 and how it has developed over time. In the second study, they will generate a typology of political responses in European countries, taking into consideration how they explicitly address, discursively frame, and implicitly affect health equity. In the third study, they will use Nordic registers to decompose inequalities in mortality and hospitalisations by their underlying causes and compare trends before and during the pandemic, using the results of the first two studies as an interpretative framework.

The project will use open data on political responses and the burden of COVID-19, written policy documents, and aggregated Nordic register data. The first study will combine the parametric g-formula with an empirical cluster analysis to analyse the relationships between political responses and the burden of COVID-19 on a global level. The second study will conduct a policy analysis with particular consideration of health equity in a European context. The third study will use a decomposition model and population registers to analyse health inequity trends in the Nordic countries during the pandemic.

The project follows an integrative approach, with the results of the individual studies feeding into each other. The project group consists of five researchers at the Department of Public Health Sciences, Stockholm University, combining their experiences in quantitative health research, policy analysis, and health equity studies.

The COVID-19 pandemic has been accompanied by a global political response that is unprecedented in magnitude. Understanding how pandemic policy deals with health inequities that emerge as a result of complex interactions between exposure, vulnerability, and social consequences of COVID-19 will be essential in preparing for future pandemics.

• Karl Gauffin, Principal Investigator
• Ylva B Almquist
• Agneta Cederström
• Can Liu
• Olof Östergren

1. Östergren, O. M., Counil, E., Karimi, A., Fall, T., Björk, J., & Gauffin, K. (2025). Who got tested and who got sick? Sociodemographic inequalities in COVID-19 testing and hospitalization among 1.48 million individuals in Sweden. European Journal of Epidemiology, 1-9.
2. Gauffin, K., Östergren, O., & Cederström, A. (2025). The global response to the pandemic: An empirical cluster analysis of policies targeting COVID-19. PLoS One, 20(5), e0322692.
3. Altmejd, A., Östergren, O., Björkegren, E., & Persson, T. (2023). Inequality and COVID-19 in Sweden: Relative risks of nine bad life events, by four social gradients, in pandemic vs. prepandemic years. Proceedings of the National Academy of Sciences, 120(46), e2303640120.
4. Gauffin, K., Östergren, O., & Cederström, A. (2023). Waves of inequality: income differences in intensive care due to Covid-19 in Sweden. European Journal of Public Health, 33(4), 574-579.