Over the past century, health inequalities have shifted from being driven mainly by infectious diseases, poor sanitation, and hazardous working conditions to being shaped by chronic diseases, lifestyle factors, and unequal access to modern healthcare. While historical health disparities, like those today, were deeply rooted in socioeconomic inequalities such as poverty, industrialisation, and war, modern disparities are driven by these persistent structural factors alongside differences in education, environmental risks, and the prevalence of chronic diseases.
Despite overall improvements in life expectancy and medical advancements, these inequalities remain deeply rooted, continuing to affect vulnerable populations across and within countries.

The Need for Long-Term Data and Historical Insights

The COVID-19 pandemic has revealed structural inequalities in health, both within and between nations. These disparities serve as reminders of the persistent challenges that continue to undermine equitable access to healthcare.
The crisis has disproportionately affected vulnerable communities, reinforcing the urgent need for policies that address systemic health inequities and ensure fair access to medical resources and care.
However, two pressing research challenges remain unresolved. First, both historically and in the present, health improvements have not been shared equally. Europe today continues to grapple with significant social and regional disparities in health outcomes. The European Commission counts health inequalities, including access to health and care, among the four main healthcare challenges Europe is facing. Despite this, there is still a surprising lack of understanding regarding the historical origins of these modern health inequalities.
Second, the social, economic, and environmental factors driving the divergences in health and life expectancy across Europe in the early 19th and 20th centuries remain unclear.

Challenges

Understanding the scale of the challenges requires first identifying their origins. Most historical studies rely on inadequate sources, such as national-level mortality figures that lack details on underlying causes of death. These classifications often include broad and ambiguous disease categories with little information on how they were determined. This has created a lack of accurate and comparable data.
Research in the historical background of human health and life expectancy remains divided, with research confined within strict disciplinary boundaries. Although historians, demographers, economists, and epidemiologists share common interests, their work is often limited by the perspectives and methodologies of their respective fields. The effects of changing disease environments are neglected, which can lead to inaccurate conclusions about the role of socioeconomic factors or human interventions in health changes. Another factor that prevents a pan-European understanding of health changes and health inequalities concerns the uneven access to digital research innovations concerning sources, data, and analytical strategies. Innovations are mainly concentrated in north-western European countries, where researchers have been able to create large-scale databases containing thousands or even millions of individuals. In many cases, these databases are constructed based on citizen science approaches.

Introducing GREATLEAP COST Action

A collaborative multidisciplinary network was set in 2023, GREATLEAP COST Action, to look at historical perspectives to gain a greater understanding of the roots and drivers of health inequalities across regions and countries in Europe and beyond. The network currently has 258 members spread across 35 countries.

The network brings together expertise, data, and advanced analytical tools to create the first internationally comparable dataset on historical causes of death at the individual level. GREATLEAP COST Action will develop innovative methods to analyse the data and provide valuable insights for improving current public health policies and practices.
“By unravelling the historical drivers of health inequalities, GREATLEAP COST Action is bridging the past and present to reveal how deeply rooted socioeconomic factors have shaped health outcomes across Europe for centuries. This multidisciplinary collaboration not only uncovers the origins of these disparities but also equips us with the insights needed to design fairer, more effective health policies for the future,” says Dr Tim Riswick, chairing the Action.
GREATLEAP COST Action will play a crucial role in uncovering the drivers of health disparities. Tackling these disparities must remain a top priority to safeguard the health and well-being of all citizens, regardless of socioeconomic status or geographic location. To create a lasting impact, it is essential to establish additional long-term, population-based cohorts that provide comprehensive data for informed policy decisions and equitable healthcare solutions.
This collaborative and multidisciplinary network will enhance our understanding of the past while shaping how we view modern health inequalities.

Additional Information

View the Action website

View the network website: https://greatleap.eu/

Follow GREATLEAP on social media: BlueSky; LinkedIn & X @GREATLEAPCost
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