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Tanja A.J. Houweling

Assistant Professor
Tanja A.J. Houweling

Research group

Social Epidemiology
Tanja A.J. Houweling

I am assistant professor at the Department of Public Health, Erasmus MC. My research focuses on socioeconomic inequalities in health and development in the first two decades of life, and the intergenerational transmission of inequalities and disadvantage, worldwide. My work on the linkages between society and health builds on my backgrounds in the medical sciences (PhD public health, MSc epidemiology) and the social sciences (MA cultural & medical anthropology (cum laude) and non-western sociology (cum laude)). I lead cross-disciplinary research consortia, including an NWO funded consortium on a Promising Start in the First 1000 Days of Life in the Netherlands (€1.3m) and internationally collaborative research on health equity and universal health coverage (€2.5m). I also supervise a ZonMW funded project on inequalities in early child development using Generation R birth cohort data (€400k).

Previously, I was senior research associate at the UCL Institute for Global Health and scientific coordinator of a £5 million project on maternal and newborn health in Asia and Africa. Together with partners in India and Bangladesh, we ran large intervention studies, including cluster randomised trials, to improve maternal health and newborn survival. I was also PI of an ESRC-funded multi-country project on socioeconomic inequalities in newborn health (£450k). Between 2005 and 2008, I worked for the WHO Commission on the Social Determinants of Health, and its international Knowledge Network on Early Child Development. I am lead author of four chapters of the Commission’s final report, including the chapters on Early Child Development and Social Protection.

P.O. Box 2040
3000 CA Rotterdam
The Netherlands

Visitor address:

Dr.Molewaterplein 40, 3015 GD Rotterdam, The Netherlands

Most recent grants and work I lead, in the following areas:

EARLY LIFE INEQUALITIES – socioeconomic inequalities in health and development in the first two decades of life

In this multidisciplinary project, we study how registration data, among others of Statistics Netherlands, can be used to support children and (expectant) parents in vulnerable circumstances. By ensuring more timely referral to services that meet their needs. And by tailoring municipal polities to the needs of vulnerable children and (expectant) parents. Stakeholder collaboration is a core component of our work to ensure our research meets the needs of parents, practitioners and policy makers.

  • Understanding socioeconomic inequalities in educational achievement, mental health and risk taking behaviour from birth to adolescence (Co-Investigator, €400k, funded by The Netherlands Organisation for Health Research and Development (ZonMW), 2018-2022)

This project aims to improve the understanding of the complex factors and mechanisms that explain the inter-generational transmission of health inequalities. We examine factors at multiple levels, including conditions at the family, neigbourhood, school and peers-level, which in turn are embedded in multiple societal sectors (environment, social works, education, economy, health). Data for this project come from two large cohorts (the Generation R Study in Rotterdam, and the Happy Children, Happy Adolescents study).

  •  Socioeconomic inequalities and the MDGs: building evidence to support equitable improvement in maternal and newborn health in Asia & Africa (Principal Investigator, £450k, funded by the Economic and Social Research Council (ESRC), 2011-2014)

This project aimed to build evidence to support an equitable improvement in newborn and maternal health in Asia and Africa. The work involved intensive collaboration between the UCL Institute for Global Health and six demographic surveillance sites in India, Nepal, Bangladesh and Malawi. We used data from the six surveillance sites, with a combined population of over 2 million people, to describe and explain inequalities in newborn mortality, health care use and home care practices. We used data from randomized controlled trials of women’s group interventions to evaluate the equity impact of community mobilisation on neonatal mortality. We also actively learned from and engaging with stakeholders, drawing on their experiential evidence regarding what works to ensure an equitable improvement in newborn and maternal health.

 

EARLY LIFE INTERVENTIONS – participatory interventions, equity impact of newborn, child and adolescent health intervention

  • Research for Health Impact in Africa (Co-Principal Investigator,€2.5 million, Stichting Erasmus Trustfonds, 2018 – 2027)

This is a collaborative research program across partners at Erasmus MC (Department of Public Health), Erasmus University (International Institute for Social Studies, Erasmus School of Health Policy and Management) and partners in several African countries. The work I supervise, focuses on interventions to support child and adolescent health and development. Among others, we have evaluated, with partners from UNICEF and in Tanzania, the effects of the government-run conditional cash transfer program on adolescent mental health.

  • Universal Health Coverage: what works? The Frontiers of Global Health Research into Equitable Access to Health Care (Co-Principal Investigator, funded by Erasmus University Rotterdam Research Excellence Initiative, €1 million, 2015-2019)

The work I supervised for this collaborative research program across partners at Erasmus MC (Department of Public Health) and Erasmus University (International Institute for Social Studies, Erasmus School of Health Policy and Management) included, among others, an equity impact evaluation of the JSY conditional cash transfer program in India for maternity care, and an evaluation of the national health insurance program in Colombia with respect to neonatal mortality and caesarean sections.

  • The Equity Impact of Performance-based Financing in Cameroon (Principal Investigator, €124k, funded by Cordaid, 2013-14)

We evaluated a system of targeting the poorest of society in a PBF programme in Cameroon, examining (under)coverage, leakage and perceived positive and negative effects using qualitative research methods.

  •  Improving maternal, newborn and child health in low-income countries (Scientific Coordinator, £5 million, funded by Big Lottery Fund UK, 2009-2010).

With a consortium of partners in India, Bangladesh, and at the UCL Institute for Global Health, we ran large intervention studies, including cluster randomised trials, to improve maternal health and newborn survival. We worked with consortium partners to mobilise communities to address their maternal, newborn and child health challenges, and evaluated the effectiveness of women’s groups implementing a participatory learning and action intervention.

 

SOCIAL DETERMINANTS OF HEALTH

  • WHO Commission on the Social Determinants of Health (2005-2008). The Commission, chaired by Prof. Sir Michael Marmot, was established to support countries to address the social determinants of ill-health and health inequalities. As one of the four members of the scientific secretariat (University College London), I was responsible for scientific interaction between the Knowledge Networks, the high-level Commissioners, and the Chair. As such, I collaborated intensively with the Commission‘s international Early Child Development Knowledge Network, Measurement and Evidence Knowledge Network, and Knowledge Network on Women and Gender Equity. I led the writing of four chapters of the Final Report (Chapter 5: Equity from the Start; Chapter 8: Social Protection Across the Life-course; Chapter 13: Gender Equity; and Chapter 16: The Social Determinants of Health: Monitoring, Research, and Training).

I am involved in teaching in the NIHES Master’s program and in teaching of medical students at Erasmus MC.

In the NIHES program, I teach on early child development and life course epidemiology (NIHES elective “Public Health across the life course”, and NIHES course “Determinants of Population Health”).

For medical students, I teach “Theme 3c, Physicians and Public Health” (‘Arts en Volksgezondheid’) and I teach in the minor Global Health. I also supervise 3rd year medical students for their public health community projects.

I supervise Master thesis projects of, among others, medical students and NIHES students. Several of these students have been able to publish their work in international peer reviewed journals:

  • Busch SLP, Houweling TAJ, Pradhan H, Gope R, Rath S, Kumar A, Nath V, Prost A, Nair N: Socioeconomic inequalities in stillbirth and neonatal mortality rates: evidence on Particularly Vulnerable Tribal Groups in eastern India. Int J Equity Health 2022, 21:61. https://doi.org/10.1186/s12939-022-01655-y
  • van der Spek L., Sanglier S., Mabeya H.M., Mertens PLJM, Houweling TAJ.  Socioeconomic differences in caesarean section – are they explained by medical need? An analysis of patient record data of a large Kenyan hospital. Int J Equity Health 19, 117 (2020). https://doi.org/10.1186/s12939-020-01215-2
  • Thongkong N, Van de Poel E, Houweling TA. (2017) How equitable is the uptake of conditional cash transfers for maternity care in India? Evidence from the Janani Suraksha Yojana scheme in Odisha and Jharkhand. Int. J Eq. Health.  16:48. https://doi.org/10.1186/s12939-017-0539-5
  • Gonzalez C, Houweling TA, Marmot MG, Brunner EJ. Comparison of physical, public and human assets as determinants of socioeconomic inequalities in contraceptive use in Colombia – moving beyond the household wealth index. Int J Equity Health. 2010;9:10. https://doi.org/10.1186/1475-9276-9-10

Publications list

Most relevant publications

How to reach every newborn: three key messages

Houweling, T. A., J. Morrison, K. Azad, D. S. Manandhar, G. Alcock, S. Shende, P. Tripathy, and A. Costello

Lancet Global Health

Closing the gap in a generation: health equity through action on the social determinants of health

Marmot, M., S. Friel, R. Bell, T. A. Houweling, and S. Taylor

Lancet

Bucking the inequality gradient through early child development

Hertzman, C., A. Siddiqi, E. Hertzman, L. G. Irwin, Z. Vaghri, T. A. Houweling, R. Bell, A. Tinajero, and M. Marmot

BMJ

A prediction model for neonatal mortality in low- and middle-income countries: an analysis of data from population surveillance sites in India, Nepal and Bangladesh

Houweling, T. A. J., D. van Klaveren, S. Das, K. Azad, P. Tripathy, D. Manandhar, M. Neuman, E. de Jonge, J. V. Been, E. Steyerberg, and A. Costello

Int J Epidemiol

The equity impact of community women's groups to reduce neonatal mortality: a meta-analysis of four cluster randomized trials

Houweling, T. A. J., C. W. N. Looman, K. Azad, S. Das, C. King, A. Kuddus, S. Lewycka, D. S. Manandhar, N. Sah More, J. Morrison, T. Phiri, S. Rath, M. Rosato, A. Sen, P. Tripathy, A. Prost, D. Osrin, and A. Costello

Int J Epidemiol

Reaching the poor with health interventions: programme-incidence analysis of seven randomised trials of women's groups to reduce newborn mortality in Asia and Africa

Houweling, T. A., J. Morrison, G. Alcock, K. Azad, S. Das, M. Hossen, A. Kuddus, S. Lewycka, C. W. Looman, B. B. Magar, D. S. Manandhar, M. Akter, A. L. Dube, S. Rath, N. Saville, A. Sen, P. Tripathy, A. Costello, and EquiNaM group

JECH

World Health Report 2000: inequality index and socioeconomic inequalities in mortality

Houweling, T. A., A. E. Kunst, and J. P. Mackenbach

Lancet

Do Conditional Cash Transfers Improve Mental Health? Evidence From Tanzania's Governmental Social Protection Program

Prencipe, L., T. A. J. Houweling, F. J. van Lenthe, T. Palermo, and Pssn Youth Evaluation Team

J Adolesc Health

The Effect of Increased Coverage of Participatory Women's Groups on Neonatal Mortality in Bangladesh: A Cluster Randomized Trial

Fottrell, E., K. Azad, A. Kuddus, L. Younes, S. Shaha, T. Nahar, B. H. Aumon, M. Hossen, J. Beard, T. Hossain, A. M. Pulkki-Brannstrom, J. Skordis-Worrall, A. Prost, A. Costello, and T. A. Houweling

JAMA Pediatr

New measure of neighborhood socioeconomic position

Member of Expert Advisory Group for Statistics Netherlands (2021-2022). The group, consisting of 10 external advisors, was installed by the Netherlands Ministry of Health, Welfare and Sport and Statistics Netherlands to advise on the development of a new measure of socioeconomic position at the neighbourhood level by Statistics Netherlands (https://www.cbs.nl/nl-nl/achtergrond/2022/14/statusscore-per-wijk-en-buurt-o-b-v-welvaart-opleidingsniveau-en-arbeid; https://www.cbs.nl/-/media/_pdf/2021/45/berekenwijze-sociaal-economische-statusscores.pdf; https://opendata.cbs.nl/statline/#/CBS/nl/dataset/85163NED/table?ts=1651764834909; https://vng.nl/nieuws/cbs-publiceert-nieuwe-sociaaleconomische-score-van-wijken

 

Scale-up of participatory women’s groups across Jharkhand (India) to reduce neonatal mortality – nearly 12000 newborn lives saved

Collaboration in the scale-up of participatory women’s groups across Jharkhand state (24 milion population) and it’s evaluation, led by Ekjut, India, and Prof. Audrey Prost (UCL). I was responsible for the equity impact analyses of the scale-up. We found that the participatory women’s reduced neonatal mortality equitably. We estimated that the intervention saved 11,803 neonatal lives across 20 districts with adequate coverage over 42 months of scale up.  http://dx.doi.org/10.1136/bmjgh-2021-005066

 

Commission on the Social Determinants of Health

The WHO Commission on the Social Determinants of Health, chaired by Prof. Sir Michael Marmot, has been instrumental in putting the social determinants of health higher up on the political and research agenda. As one of the four-member scientific secretariat, I was responsible for scientific interaction between international Knowledge Networks (Women and Gender Equity; Measurement and Evidence; Early Child Development), the high-level Commissioners, and the Chair, and for leading the writing of four chapters of the Commission’s Final Report:

  • Chapter 5: Equity from the Start, pp 50-59
  • Chapter 8: Social Protection Across the Lifecourse, pp 84-91
  • Chapter 13: Gender Equity, pp145-153
  • Chapter 16: The Social Determinants of Health: Monitoring, Research, and Training, pp 178-188

Final report: Commission on Social Determinants of Health. Closing the Gap in a Generation: Health Equity through Action on the Social Determinants of Health. Final Report of the Commission on Social Determinants of Health.  Geneva: World Health Organisation; 2008. [member of writing team] https://www.who.int/social_determinants/final_report/en/

Can women talking save lives? Reducing inequalities in newborn mortality in India, Nepal, Bangladesh and Malawi

International Journal of Epidemiology - BLOG