Impacto de la crisis económica en la salud mental en España. Desigualdades y evidencias desde la Atención Primaria, 2006-2010 Destacadoeurpub.oxfordjournals.org
ANTECEDENTES: Casi todos los países europeos se han visto afectados por la crisis económica que comenzó en 2007, pero las consecuencias en España han sido de las peores . Se investigaron lasociaciones de la recesión en la frecuencia de estado de ánimo, ansiedad, somatomorfos, relacionados con el alcohol y los trastornos alimentarios entre las personas que visitan centros de atención primaria de España. MÉTODOS: Médicos de atención primaria seleccionaron muestras aleatorias de pacientes que acuden a centros de atención primaria que representan a poblaciones de España. Un total de 7.940 pacientes en 2006-07 y 5876 en 2010-11 se les administró la Evaluación de Atención Primaria de los trastornos mentales (PRIME-MD) instrumento para el diagnóstico de los trastornos mentales. Modelos de regresión logística multivariado se utilizaron para cuantificar los cambios globales en la frecuencia de los trastornos mentales, de ajustar por posibles diferencias socio-demográficas de las poblaciones consultadas, relacionados con factores económicos. RESULTADOS: En comparación con el período anterior a la crisis de 2006, la encuesta de 2010 reveló un aumento sustancial y significativo en la proporción de pacientes con estado de ánimo (19,4% en la depresión mayor), la ansiedad (8,4% en el trastorno de ansiedad generalizada), somatomorfo (7,3%) y los trastornos relacionados con el alcohol (4,6% en la dependencia del alcohol), todas significativas a P <0,001, pero no en los trastornos de la ali ...
Avanzando hacia la Equidad. Propuesta de Políticas e Intervenciones para reducir las Desigualdades Sociales en Salud en España Destacadowww.mspsi.es/profesionales/saludPublica/prevPromocion/promoc
En este informe la Comisión para Reducir las Desigualdades Sociales en Salud en España, tras un proceso de revisión de evidencia, experiencias, opinión de personas expertas y consenso de presenta un total de 27 recomendaciones principales y 166 específicas para reducir las desigualdades sociales en salud en España. Estas recomendaciones están ordenadas por prioridad y divididas en 5 apartados, cada uno de los cuales tiene varias áreas. Los apartados son los siguientes (constando las áreas entre paréntesis): I. La distribución del poder, la riqueza y los recursos (salud y equidad en todas las políticas; financiación justa y gasto público para la equidad; poder político y participación; buena gobernanza mundial); II. Condiciones de vida y trabajo cotidianas a lo largo del ciclo vital (infancia; empelo y trabajo; envejecimiento); III Entornos favorecedores de la salud (entorno físicos acogedores y accesibles; acceso a una vivienda digna; entornos favorecedores de hábitos saludables); IV Servicios sanitarios (un sistema sanitario que no causa desigualdad); V Información, vigilancia, investigación y docencia (información, vigilancia y evaluación; investigación, docencia)
Análisis de situación para la elaboración de una Propuesta de Políticas e Intervenciones para reducir las Desigualdades Sociales en España Destacadowww.mspsi.es/profesionales/saludPublica/prevPromocion/promoc
Este informe, realizado por la Comisión para Reducir las Desigualdades en Salud en España, analiza la situación de las desigualdades en salud en España y ha servido para desarrollar las recomendaciones de la propuesta de políticas e intervenciones para reducir las desigualdades sociales en salud en España. En el primer capítulo define las desigualdades en salud, y el modelo teórico utilizado por la Comisión para entender sus causas. El segundo capítulo describe el estado de la situación y ejemplos destacados de desigualdades en salud en España y de sus determinantes sociales. El tercer capítulo estudia las principales recomendaciones internacionales y experiencias de países europeos en el desarrollo de políticas para reducir las desigualdades. Y por último, el cuarto capítulo, analiza la incorporación de políticas de reducción de desigualdades en los Planes de salud de las Comunidades Autónomas, y algunas experiencias destacadas de intervenciones dentro y fuera del sector salud que pueden reducir las desigualdades.
Background:An economic crisis can widen health inequalities between individuals. The aim of this paper is to explore differences in the effect of socioeconomic characteristics on Spaniards' self-assessed health status, depending on the Spanish economic situation. Methods:Data from the 2006-2007 and 2011-2012 National Health Surveys were used and binary logit and probit models were estimated to approximate the effects of socioeconomic characteristics on the likelihood to report good health. Results:The difference between high and low education levels leads to differences in the likelihood to report good health of 16.00-16.25 and 18.15-18.22 percentage points in 2006-07 and 2011-12, respectively. In these two periods, the difference between employees and unemployed is 5.24-5.40 and 4.60-4.90 percentage points, respectively. Additionally, the difference between people who live in households with better socioeconomic conditions and those who are in worse situation reaches 5.37-5.46 and 3.63-3.74 percentage points for the same periods, respectively. Conclusions:The magnitude of the contribution of socioeconomic characteristics to health inequalities changes with the economic cycle; but this effect is different depending on the socioeconomic characteristics indicator that is being measured. In recessive periods, health inequalities due to education level increase, but those linked to individual professional status and household living conditions are attenuated. When the joint ef ...
How could differences in "control over destiny" lead to socio-economic inequalities in health? A synthesis of theories and pathways in the living environment
We conducted the first synthesis of theories on causal associations and pathways connecting degree of control in the living environment to socio-economic inequalities in health-related outcomes. We identified the main theories about how differences in 'control over destiny' could lead to socio-economic inequalities in health, and conceptualised these at three distinct explanatory levels: micro/personal; meso/community; and macro/societal. These levels are interrelated but have rarely been considered together in the disparate literatures in which they are located. This synthesis of theories provides new conceptual frameworks to contribute to the design and conduct of theory-led evaluations of actions to tackle inequalities in health.
BACKGROUND:Socioeconomic inequalities in injury morbidity are an important yet understudied issue in Southern Europe. This study analysed the injuries treated in primary care in the Community of Madrid, Spain, by socioeconomic status (SES), sex and age.METHODS: This was a cross-sectional study of injuries registered in the primary care electronic medical records of the Madrid Health Service in 2012. Incidence stratified by sex, SES and type of injury were calculated. Poisson regression was performed.RESULTS: A statistically significant upward trend in global injury incidence was observed with decreasing SES in all age groups. By type of injury, the largest differences were observed in injuries by foreign body in men aged 15-44 and in poisonings in girls under 15 years of age. Burns risk also stood out in the group of girls under 15 years of age with the lowest SES. In the group above 74 years of age, wounds, bruises and sprains had the lowest SES differences in both sexes, and the risk of fractures was lower in the most socioeconomically advantaged group.CONCLUSION: People with lower SES were at a greater risk of injury. The relationship between SES and injury varies by type of injury and age.
Impact of tobacco prices and smoke-free policy on smoking cessation, by gender and educational group: Spain, 1993-2012
BACKGROUND:To evaluate the effect of tobacco prices and the implementation of smoke-free legislation on smoking cessation in Spain, by educational level, across the period 1993-2012.METHODS:National Health Surveys data for the above two decades were used to calculate smoking cessation in people aged 25-64 years. The relationship between tobacco prices and smoking quit-ratio was estimated using multiple linear regression adjusted for time and the presence of smoke-free legislation. The immediate as well as the longer-term impact of the 2006 smoke-free law on quit-ratio was estimated using segmented linear regression analysis. The analyses were performed separately in men and women with high and low education, respectively.RESULTS:No relationship was observed between tobacco prices and smoking quit-ratio, except in women having a low educational level, among whom a rise in price was associated with a decrease in quit-ratio. The smoke-free law altered the smoking quit-ratio in the short term and altered also pre-existing trends. Smoking quit-ratio increased immediately after the ban - though this increase was significant only among women with a low educational level - and then decreased in subsequent years except among men with a high educational level.CONCLUSION:A clear relationship between tobacco prices and smoking quit-ratio was not observed in a recent period. After the implementation of smoke-free legislation the trend in the quit ratio in most of the socio-economic groups ...
Socioeconomic inequalities in smoking in The Netherlands before and during the Global Financial Crisis: a repeated cross-sectional study
Background:The Global Financial Crisis (GFC) increased levels of financial strain, especially in those of low socioeconomic status (SES). Financial strain can affect smoking behaviour.This study examines socioeconomic inequalities in current smoking and smoking cessation in The Netherlands before and during the Global Financial Crisis (GFC). Methods:Participants were 66,960 Dutch adults (?18 years) who took part in the annual national Health Survey (2004–2011). Period was dichotomised: ‘pre-’ and ‘during-GFC’. SES measures used were income, education and neighbourhood deprivation. Outcomes were current smoking rates (smokers/total population) and smoking cessation ratios (former smokers/ever smokers). Multilevel logistic regression models controlled for individual characteristics and tested for interaction between period and SES. Results:In both periods, high SES respondents (in all indicators) had lower current smoking levels and higher cessation ratios than those of middle or low SES. Inequalities in current smoking increased significantly in poorly educated adults of 45–64 years of age (Odds Ratio (OR) low educational level compared with high: 2.00[1.79-2.23] compared to pre-GFC 1.67[1.50-1.86], p for interaction?=?0.02). Smoking cessation inequalities by income in 18–30 year olds increased with borderline significance during the GFC (OR low income compared to high income: 0.73[0.58-0.91]) compared to pre-GFC (OR: 0.98[0.80-1.20]), p for interaction?=?0.051). Conclusion ...
OBJECTIVES: To examine the patterning of four behavior-related health risk factors (tobacco smoking, risky alcohol drinking, overweight, and physical inactivity) among job-seekers and to investigate socio-demographic and health-related predictors of patterning.METHODS:The sample of 3,684 female and 4,221 male job-seekers was proactively recruited at three job agencies in northeastern Germany in 2008/09. Participants provided data on socio-demographics, substance use, body mass index, physical activity and self-rated health. Latent class analyses (LCA) and multinomial logistic regression analyses were applied to identify health risk patterns and possible predictors of patterning, respectively.RESULTS:Forty-three percent of the female and 58% of the male participants had two or more health risk factors. LCA revealed three similar patterns for women and men: Substance use (tobacco smoking, risky drinking), Non-exercising overweight (physical inactivity, overweight/obesity) and Health-conscious (non-smoking, low-risk drinking, under-/normal weight, physical activity). Age, education, marital status, life-time unemployment and self-rated health were significantly associated with patterning in both genders.CONCLUSIONS:Our results may help to define target populations for improving health behaviors among job-seekers.
The impact of economic austerity and prosperity events on suicide in Greece: a 30-year interrupted time-series analysis
Objectives:To complete a 30-year interrupted time-series analysis of the impact of austerity-related and prosperity-related events on the occurrence of suicide across Greece. Setting: Greece from 1 January 1983 to 31 December 2012. Participants: A total of 11?505 suicides, 9079 by men and 2426 by women, occurring in Greece over the study period. Primary and secondary outcomes: National data from the Hellenic Statistical Authority assembled as 360 monthly counts of: all suicides, male suicides, female suicides and all suicides plus potentially misclassified suicides. Results: In 30?years, the highest months of suicide in Greece occurred in 2012. The passage of new austerity measures in June 2011 marked the beginning of significant, abrupt and sustained increases in total suicides (+35.7%, p<0.001) and male suicides (+18.5%, p<0.01). Sensitivity analyses that figured in undercounting of suicides also found a significant, abrupt and sustained increase in June 2011 (+20.5%, p<0.001). Suicides by men in Greece also underwent a significant, abrupt and sustained increase in October 2008 when the Greek recession began (+13.1%, p<0.01), and an abrupt but temporary increase in April 2012 following a public suicide committed in response to austerity conditions (+29.7%, p<0.05). Suicides by women in Greece also underwent an abrupt and sustained increase in May 2011 following austerity-related events (+35.8%, p<0.05). One prosperity-related event, the January 2002 la ...
In this final scientific report of research accomplished within Work Package 3 of DRIVERS (‘Work and Health Inequities, including Policy Recommendations’) we demonstrate how the three main project aims have been accomplished. These aims are: (1) to establish an updated knowledge base on associations of work, social inequality, and health; (2) to synthesise current evidence on feasibility and outcomes of work and health-related interventions at different levels, by critically evaluating applied methodologies and by comparing the methods of improving intervention effectiveness; and (3)to develop and apply a theoretical model linking national labour and social policies to the quality of work and their effects on unequal health. With findings drawn from systematic reviews, and from secondary data analyses performed on the basis of newly available data from selected European surveys, we update and extend the knowledge base on associations of social inequalities, work and health in several respects.
Background:Almost all studies on the effect on health from unemployment have concluded that unemployment is bad for your health. However, only a few review articles have dealt with this relation in recent years, and none of them have focused on the analysis of subgroups such as age, gender, and marital status. The objective of our article is to review how unemployment relates to self-assessed health with a focus on its effect on subgroups. Methods:A search was performed in Web of Science to find articles that measured the effect on health from unemployment. The selection of articles was limited to those written in English, consisting of original data, and published in 2003 or later. Our definition of health was restricted to self-assessed health. Mortality- and morbidity-related measurements were therefore not included in our analysis. For the 41 articles included, information about health measurements, employment status definitions, other factors included in the statistical analysis, study design (including study population), and statistical method were collected with the aim of analysing the results on both the population and factor level. Results:Most of the studies in our review showed a negative effect on health from unemployment on a population basis. Results at the factor levels were most common for gender (25 articles), age (11 articles), geographic location (8 articles), and education level (5 articles). The analysis showed that there was a health effect for gender ...
El presente informe revela que las perspectivas laborales en el mundo empeorarán durante los próximos cinco años. En 2014 más de 201 millones de personas estaban desempleadas, 31 millones más que antes de que irrumpiese la crisis global. Se prevé asimismo que el desempleo mundial aumente en 3 millones de personas en 2015 y en 8 millones durante los siguientes cuatro años. La brecha mundial de empleo, que mide el número de puestos de trabajo perdidos desde elinicio de la crisis, se sitúa, hoy, en 61 millones de personas. Si se incluye a las personas que se incorporarán al mercado de trabajo durante los próximos cinco años, para colmar la brecha en el empleo que ha generado la crisis será preciso crear 280 millones de empleos nuevos para 2019.Los jóvenes, en particular las mujeres jóvenes, siguen viéndose afectadas por el desempleo de manera desproporcionada. En 2014, cerca de 74 millones de personas (de entre 15 y 24 años) buscaban trabajo. La tasa de desempleo de los jóvenes casi triplica la de los adultos. El aumento del desempleo de los jóvenes es común a todas las regiones y prevalece a pesar de la mejora del nivel de educación, lo que fomenta el malestar social.
Employment precariousness is a social determinant that affects the health of workers, families, and communities. Its recent popularity has been spearheaded by three main developments: the surge in “flexible employment” and its associated erosion of workers' employment and working conditions since the mid-1970s; the growing interest in social determinants of health, including employment conditions; and the availability of new data and information systems. This article identifies the historical, economic, and political factors that link precarious employment to health and health equity; reviews concepts, models, instruments, and findings on precarious employment and health inequalities; summarizes the strengths and weaknesses of this literature; and highlights substantive and methodological challenges that need to be addressed. We identify two crucial future aims: to provide a compelling research program that expands our understanding of employment precariousness and to develop and evaluate policy programs that effectively put an end to its health-related impacts.
Neo-Marxian social class inequalities in the mental well-being of employed men and women: The role of European welfare regimes
The relation between "neo-Marxian" social class (NMSC) and health in the working population has received considerable attention in public health research. However, less is known about the distribution of mental well-being according to NMSC in a European context. The objectives of this study are (i) to analyse the association of mental well-being and NMSC among employees in Europe (using a welfare regime typology), (ii) to investigate whether the relation between NMSC and mental well-being is the same in women compared to men within each welfare regime, and (ii) to examine within each welfare regime the role of the gender division of labour and job quality as potential mediating factors in explaining this association. Data from the European Social Survey Round 5 (2010) were analysed. Mental well-being was assessed by the WHO Well-being Index. Social class was measured through E.O. Wright's social class scheme. Models separated by sex were generated using Poisson regression with a robust error variance. The associations were presented as prevalence ratios with 95% confidence intervals. Women reported NMSC differences in mental well-being in State corporatist/family support and Southern welfare regimes. Men reported NMSC differences in mental well-being in all but the Basic security/market-oriented welfare regimes. Gender inequalities were more marked and widespread in Basic security/market-oriented welfare regimes. In all welfare regimes job quality (partly) explained NMSC in ...
There is a very large literature examining income inequality in relation to health. Early reviews came to different interpretations of the evidence, though a large majority of studies reported that health tended to be worse in more unequal societies. More recent studies, not included in those reviews, provide substantial new evidence. Our purpose in this paper is to assess whether or not wider income differences play a causal role leading to worse health. We conducted a literature review within an epidemiological causal framework and inferred the likelihood of a causal relationship between income inequality and health (including violence) by considering the evidence as a whole. The body of evidence strongly suggests that income inequality affects population health and wellbeing. The major causal criteria of temporality, biological plausibility, consistency and lack of alternative explanations are well supported. Of the small minority of studies which find no association, most can be explained by income inequality being measured at an inappropriate scale, the inclusion of mediating variables as controls, the use of subjective rather than objective measures of health, or follow up periods which are too short. The evidence that large income differences have damaging health and social consequences is strong and in most countries inequality is increasing. Narrowing the gap will improve the health and wellbeing of populations.
Assessing the short term health impact of the Great Recession in the European Union: A cross-country panel analysis
Background:There are great concerns and some initial country-specific, descriptive evidence about potential adverse health consequences of the recent Great Recession. Methods:Using data for 23 European Union countries we examine the short-term impact of macroeconomic decline during the Great Recession on a range of health and health behaviour indicators. We also examine whether the effect differed between countries according to the level of social protection provided. Results:Overall, during the recent recession, an increase of one percentage point in the standardised unemployment rate has been associated with a statistically significant decrease in the following mortality rates: all-cause-mortality (3.4%), cardiovascular diseases (3.7%), cirrhosis- and chronic liver disease-related mortality (9.2%), motor vehicle accident-related mortality (11.5%), parasitic infection-related mortality (4.1%), but an increase in the suicide rate (34.1%). In general, the effects were more marked in countries with lower levels of social protection, compared to those with higher levels. Conclusions:An increase in the unemployment rate during the Great Recession has had a beneficial health effect on average across EU countries, except for suicide mortality. Social protection expenditures appear to help countries “smooth” the health response to a recession, limiting health damage but also forgoing potential health gains that could otherwise result.
Educational differences in mortality and the relative importance of different causes of death: a 7-year follow-up study of Spanish adults.
BACKGROUND:The evidence on mortality patterns by education in Spain comes from regional areas. This study aimed to estimate these patterns in the whole Spanish population.METHODS:All citizens aged 25?years and over and residing in Spain in 2001 were followed during 7?years to determine their vital status, resulting in a total of 196?470?401 person-years and 2?379?558 deaths. We estimated the age-adjusted total and cause-specific mortality by educational level-primary, lower secondary, upper secondary and university education-and then calculated the relative and absolute measures of inequality in mortality and contribution of the leading causes of death to absolute inequalities.RESULTS:Except for some cancer sites, the mortality rate for the leading causes of death shows an inverse gradient with educational level. The leading causes of death with the highest relative index of inequality ratios were HIV disease (9.81 in women and 11.61 in men), diabetes in women (4.02) and suicide in men (3.52). The leading causes of death that contribute most to the absolute inequality in mortality are cardiovascular diseases (48.8%), respiratory diseases (9.3%) and diabetes mellitus (8.8%) in women, and cardiovascular diseases (20.8%), respiratory diseases (19.8%) and cancer (19.6%) in men.CONCLUSIONS:Although the causes of death with the strongest gradient in mortality rate are HIV disease in both sexes, diabetes mellitus in women and suicide in men, most of the absolute education-related in ...
Background: There is increasing interest on whether the current global economic uncertainties have an influence on the population's mental health. In this paper, we examined the association of negative socioeconomic changes, job loss and household income reductions with incident mental disorders. The moderating effect of gender was assessed. Methods: Data come from the Netherlands Mental Health Survey and Incidence Study-2 (NEMESIS-2), a representative population-based, longitudinal study. Individuals with a paid job and without a 12-month mental disorder at baseline were selected and reassessed 3?years later (2007–2009/2010–2012). Substantial household income reductions and not being at a paid job anymore were self-reported at follow-up. Multivariate logistic models were utilised to investigate the association between these negative socioeconomic changes and the incidence of mood, anxiety and substance use Diagnostic and Statistical Manual-IV disorders assessed by the Composite International Diagnostic Interview 3.0. Results: After 3?years, 6% had lost their job, 11% had a substantial household income reduction and 12.2% had developed a mental disorder. Household income reductions increased the risk of any mental disorder (aOR=1.77), particularly the risk of mood (aOR=2.24). Job loss increased the risk of mood disorders (aOR=2.02). Gender modified the relationship: job loss increased the risk of any mental disorder among men (aOR=3.04) and household income reductions did s ...
Mortality inequality among older adults in Mexico: the combined role of infectious and chronic diseaseswww.paho.org/journal/index.php?option=com_content&view=artic
OBJECTIVE: To assess the effects of education and chronic and/or infectious disease, and the interaction between both variables, on the risk of dying among Mexicans 60 years and older. METHODS: Using data from the Mexican Health and Aging Study (MHAS), logistic regressions were performed to estimate the risk of mortality for older Mexicans between 2001 and 2003. Estimated mortality risks associated with chronic disease, infectious disease, and a combination of both were used to estimate additional life expectancy at age 60. RESULTS: Compared to the group with some schooling, the probability of dying over the twoyear inter-wave period was 26% higher among those with no schooling. Not having at least one year of formal education translated into a shorter additional life expectancy at age 60 by 1.4-2.0 years. Having chronic and/or infectious disease also increased the risk of mortality during the same period CONCLUSIONS: These results indicate that 1) a mixed epidemiological regime (the presence of both chronic and infectious disease) adds to the mortality health burden experienced by older people, and 2) there are persistent inequalities in mortality risks based on socioeconomic status.&l