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Session 3

Health Inequalities Across Space and Time: A Historical Demographic Perspective from the 19th Century to the Present

Organisers: Pavlos Baltas (National Centre for Social Research)

  • Friday, 27 November 2026 · 09:30–11:00

    Room I.2, National Centre for Social Research (EKKE)

About this session
Spatial inequalities in health and mortality constitute one of the most persistent and deeply rooted challenges faced by societies over the long term. From the nineteenth century to the present, differences in exposure to disease, vulnerability, and survival have been closely linked to place, social conditions, and unequal access to resources. Recent experiences, including the COVID 19 pandemic, have again shown that health crises do not affect populations uniformly but tend to amplify pre existing spatial and social inequalities. This session is situated at the intersection of historical demography and historical geography, focusing on the spatial dimensions of health inequalities from the early nineteenth century to the present. It treats mortality, causes of death, and health outcomes as historically embedded and spatially differentiated processes, shaped by social structure, urbanisation, environmental conditions, and institutional arrangements. Rather than viewing epidemics as exceptional moments, the session considers them as critical episodes that reveal longer term patterns of inequality across space. Particular emphasis is placed on the analysis of health inequalities across multiple geographical scales. Contributions may examine differences between countries and regions, contrasts within cities and between neighbourhoods, as well as spatial variations observed during epidemic outbreaks. The session welcomes studies that explore how inequalities in health and mortality have evolved over time, how they have been reproduced or transformed across places, and how spatial context has influenced demographic outcomes. The session invites empirically and theoretically informed contributions drawing on a wide range of sources and methods, including historical mortality data, causes of death records (at aggregate or individual level), archival material, historical GIS, and comparative approaches. Papers combining quantitative and qualitative perspectives, or linking historical analysis with contemporary debates on health inequalities, are particularly encouraged.

Presentations are listed in the order set by the session organisers.

Presentations3

Slot 1 · Fri 27 Nov · 09:30–11:00

  1. 1.Sick of Waiting: Historical Disease and the Demographic Transition Dynamics

    Evi Antonopoulou

    • PhD (c) Athens University of Economics and Business
    Abstract
    This paper examines whether the historical disease environment shaped the timing and structure of the First Demographic Transition and the accumulation of human capital. Drawing on Unified Growth Theory, we test whether historical pathogen prevalence acted as a structural constraint on education, fertility behavior, and demographic takeoff. Using a three-tiered cross-country empirical strategy, we first assess the relationship between pathogen stress and pre-transition human capital and fertility (1870–1930). We then analyze its effect on the timing of demographic transition onset across distinct transition waves. Finally, we examine whether historical morbidity influenced the stock of human capital at the moment of transition onset. We find that higher historical pathogen prevalence is associated with lower educational attainment and higher fertility prior to the transition. For early-transitioning countries, pathogen stress significantly delayed demographic takeoff. In contrast, for later transition waves, this effect is partially reversed, consistent with the role of post-war international health interventions that compressed demographic change. Countries with heavier historical disease burdens also entered the transition with lower human capital stocks. These findings suggest that the epidemiological environment constituted a deep structural factor shaping demographic timing and long-run development trajectories.

  2. 2.Implementation of Health Policy and Contemporary Inequality

    Nadiia Demikhova1, Oleksii Demikhov1, Iya Dehtyarova2

    • 1Sumy State University
    • 2Dnipro Institute of Medicine and Public Health, Ukraine
    Abstract
    Globally, healthcare constitutes a central domain of human development and remains embedded in patterns of systemic social inequality. The healthcare sector performs a critical social function by shaping population health outcomes. Key determinants include socioeconomic status, environmental conditions, education, spatial organization (urban versus rural), and housing quality. At these levels, a robust scholarly debate has emerged concerning both the persistence and expansion of inequality. Disparities are evident in access to high-quality healthcare services, including prevention and treatment; to adequate nutrition; and to the broader capacity to maintain a healthy lifestyle - particularly in urban areas, which tend to be most vulnerable. In response to unequal access to healthcare, national and regional authorities in the European Union and Ukraine have initiated the development and implementation of public health strategies and programs at multiple governance levels. The objective of this study is to examine the public health sector within the EU and compare it with Ukraine to formulate policy recommendations aimed at mitigating inequalities in access to healthcare services. The study also seeks to contribute to the development of new standards and a comprehensive framework for effective public health policymaking. A crucial component involves the synthesis of information regarding public policy instruments designed to improve population health, extend life expectancy, enhance quality of life, prevent disease, and promote healthy lifestyles. The study adopts an interdisciplinary and systemic approach, employing methods of analysis, synthesis, generalization, comparison, and economic-statistical evaluation. The empirical basis includes survey data from Ukrainian and international scholars, as well as statistics from national agencies in the EU and Ukraine. Key indicators include urbanization levels, gross domestic product, environmental pollution, mortality rates, and other relevant economic, social, and health-related variables.

  3. 3.Pandemic crisis from epicenter to periphery: territorial inequalities and mortality during covid-19 in northern Portugal.

    António Gonçalves

    • University of Minho / INDEPENDENT RESEARCHER (Portugal)
    Abstract
    Territorial inequalities in health and mortality constitute a structural feature of long-term demographic regimes. From the nineteenth century to the present, differences in exposure to disease, vulnerability, and survival have been closely associated with place, socio-economic conditions, and unequal access to healthcare. The COVID-19 pandemic once again demonstrated that health crises tend to amplify pre-existing inequalities, as was also observed during the 1918 influenza pandemic. This study examines the territorial impact of COVID-19 in Northern Portugal, focusing on the regions of Tâmega e Sousa and the Ave Valley, with particular attention to the municipality of Vizela during the initial phase of the pandemic. At the national level, in March 2020, 143 out of 308 municipalities recorded a number of deaths above the reference period, corresponding to approximately 46% of the total, highlighting differentiated territorial patterns in mortality. At the regional level, significant inequalities in access to healthcare are observed. While municipalities such as Vizela show average travel times to hospital care of less than ten minutes, more peripheral areas, such as Mondim de Basto, exceed thirty minutes. At the same time, asymmetries in the distribution of medical resources persist, reflecting structural inequalities in access to care. Through an approach combining demographic and spatial analysis, this study demonstrates that factors such as healthcare accessibility, age structure, and territorial organization contributed to differentiated pandemic outcomes. Rather than representing an exceptional rupture, COVID-19 is interpreted as a critical episode that reveals and reinforces persistent patterns of health inequality. By linking contemporary evidence with a historical-demographic perspective, this study contributes to understanding the relationships between territory, population vulnerability, and access to healthcare, highlighting the importance of long-term and spatial approaches in shaping more equitable public policies.