RATIONALE: Public health policies are often dependent on political decision-making, but little is known of the impact of different forms of government on countries' health policies. In this exploratory study we studied the association between a wide range of process and outcome indicators of health policy and four groups of political factors (levels of democracy, e.g. voice and accountability; political representation, e.g. voter turnout; distribution of power, e.g. constraints on the executive; and quality of government, e.g. absence of corruption) in contemporary Europe. DATA AND METHODS: Data on 15 aspects of government and 18 indicators of health policy as well as on potential confounders were extracted from harmonized international data sources, covering 30 European countries and the years 1990-2010. In a first step, multivariate regression analysis was used to relate cumulative measures of government to indicators of health policy, and in a second step panel regression with country fixed effects was used to relate changes in selected measures of government to changes in indicators of health policy. RESULTS: In multivariate regression analyses, measures of quality of democracy and quality of government had many positive associations with process and outcome indicators of health policy, while measures of distribution of power and political representation had few and inconsistent associations. Associations for quality of democracy were robust against more extensive contr ...
Gender differences in psychotropic use across Europe: results from a large cross-sectional population-based study
Background:In many epidemiological studies, women have been observed to consume psychotropic medication more often than men. However, the consistency of this relationship across Europe, with differences in mental health care (MHC) resources and reimbursement policies, is unknown. Methods:Questions on 12-month psychotropic use (antidepressants, benzodiazepines, antipsychotics, mood stabilizers) were asked to 34,204 respondents from 10 European countries of the EU-World Mental Health surveys. Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) criteria were used to determine 12-month prevalence of mood/anxiety disorders using the Composite International Diagnostic Interview (v3.0). Results:For all participating countries, women were significantly more likely than men to use psychotropic medication within the previous 12 months (overall-OR?=?2.04, 95% CI: 1.81–2.31). This relationship remained significant after adjusting for common sociodemographic factors (age, income level, employment status, education, marital status) and country-level indicators (MHC provision, private household out-of-pocket expenditure, and Gender Gap Index). In multivariable gender-stratified risk-factor analysis, both women and men were more likely to have taken psychotropic medication with increasing age, decreasing income level, and mental health care use within the past 12 months, with no significant differences between genders. When only including participants with a mental ...
Global evidence on inequities in rural health protection: New data on rural deficits in health coverage for 174 countries
This paper presents global estimates on rural/urban disparities in access to health-care services. The report uses proxy indicators to assess key dimensions of coverage and access involving the core principles of universality and equity. Based on the results of the estimates,policy options are discussed to close the gaps in a multi-sectoral approach addressing issues and their root causes both within and beyond the health sector.
Background: Estimates of socioeconomic inequalities in mortality coming from individual data sources were only available from Madrid, the Basque Country and the city of Barcelona. The aim of this study was to show the geographical pattern of mortality in different socio-economic groups, as well as that of inequalities in mortality in the whole Spanish territory.Methods: All people aged 25 and older in the 2001 census were followed for seven years and two months to determine their vital status (196 470 401 person-years at risk and 2,379,558 deaths). The socioeconomic variable was educational level. Age-adjusted mortality rate was estimated for women and men in every province and in each category of educational level.Inequalities in mortality in each province have been estimated by the ratio of mortality in subjects with primary or lower level of education compared to subjects with university education.Results: In women, the lowest rate ratios –between 1.06 and 1.16- are observed in Palencia, Segovia, Guadalajara, Avila and Castellon and the highest -between 1.53 and 1,75- in Malaga, Las Palmas, Ceuta, Melilla and Toledo. In men, the lowest rate ratios -between 1.00 and 1.12 – are observed in Guadalajara, Teruel, Cuenca, La Rioja and Ávila and the highest -between 1.47 and 1,73- in Las Palmas, Cantabria, Murcia, Melilla and Ceuta.Conclusions: The geographical pattern of mortality rates in Spain varies by educational level. Inequalities in mortality by education have the lowest ...
Los indicadores de género son de utilidad para señalar cambios en el estatus y el rol de las mujeres y de los hombres en distintos momentos del tiempo, y por tanto, ofrecer una imagen dinámica de la situación de la equidad de género en un contexto social determinado. La guía aporta cuatro productos: (1) Un esquema con una estructura de dimensiones y subdimensiones para abordar la desigualdades de género en salud y sus dterminantes; (2) Un listado detallado de los indicadores, clasificados dentro de cada una de ls dimensiones y subdimensiones; (3) Un listado priorizado de los indicadores de género; (4) Otros detalles de interés para valora la sensibilidad de los indicadores y su accesibilidad.
Gender differences in hazardous drinking among middle-aged in Europe: the role of social context and women's empowerment
Background: The aim of this study was to estimate the magnitude of gender differences in hazardous drinking among middle-aged people and to analyse whether these differences are associated with contextual factors, such as public policies or socioeconomic factors. Methods: Cross-sectional design. The study population included 50- to 64-year-old residents of 16 European countries who participated in the Survey of Health, Ageing and Retirement in Europe project conducted in 2010–12 (n = 26 017). We estimated gender differences in hazardous drinking in each country. To determine whether different social context or women’s empowerment variables were associated with gender differences in hazardous drinking, we fitted multilevel Poisson regression models adjusted for various individual and country-level variables, which yielded prevalence ratios and their 95% confidence intervals (95% CI). Results: Prevalence of hazardous drinking was significantly higher in men than women [30.2% (95% CI: 29.1–31.4%) and 18.6% (95% CI: 17.7–19.4%), respectively] in most countries, although the extent of these differences varied between countries. Among individuals aged 50–64 years in Europe, risk of becoming a hazardous drinker was 1.69 times higher (95% CI: 1.45–1.97) in men, after controlling for individual and country-level variables. We also found that lower values of the gender empowerment measure and higher unemployment rates were associated with higher gender differences in hazardous drinking ...
Growing up in the unhappy shadow of the economic crisis. Mental health and well-being of the European child and adolescent population
This report from the European Public Health Alliance (EPHA) highlights existing evidence on the detrimental effect of the ongoing economic crisis and austerity-driven measures on the mental health and well-being outcomes of the European child and adolescent population.The report shows how political choices, made within a framework of fiscal consolidation on many socio-economic determinants of people’s health, have had negative impacts on citizens’ mental health and well-being. The determinants include, for instance, employment status, household income and ability to provide adequate living conditions fundamental to optimal and sustainable human development.Children, as a particularly vulnerable group, are disproportionately affected by declining living standards. The restrictive atmosphere of the crisis, where political and financial choices of many national governments is to cut, rather than invest in early years, means that living standards and social and labour environments for families have been adversely affected.
This thesis is part of the studies of gender bias in health which together with the paradigm of evidence-based medicine shares the empirical assumption that there are inaccuracies in medical practice, in addition to a lack of rigour and transparency. It worked with the distinction between the concepts of sex and gender and between the concepts of sex-related differences and gender inequalities, in terms of applying a gender perspective in the study design and the subsequent analysis. This PhD review presents the research process conducted in Spain, which can provide an example for future research. Study I described a review of 58 clinical trials (CTs) of etoricoxib to assess its compliance with the Recommendations of Evaluation of Gender Differences in the Clinical Evaluation of Drugs. In Study II, key informants from professions related to different areas in drug development and pharmacovigilance held a working meeting to reach a consensus document on recommendations for the study and evaluation of gender differences in CTs in Spain. In Study III, the websites of the eight best-selling hormone replacement therapy drugs in Spain on Google first page of results were analysed. In Study IV, a logistic regression analysis was performed to compare analgesic prescription by sex in regions with a higher or lower Gender Development Index (GDI) than the Spanish average. Gender biases identified in this thesis limited the legitimacy of medicine, which is not based on the best possible ...
La disminución y estabilización de la epidemia de SIDA en Brasil deben ser consideradas con prudencia, ya que, en un país grande y diverso, los datos agregados pueden ocultar desigualdades regionales pronunciadas. El estudio reevaluó la difusión espacial de la epidemia y las muertes secundarias por SIDA. Se consideraron todos los casos diagnosticados con 18+ años, residentes en Brasil, así como las muertes registradas en 1998-2008. Se estimaran las tasas medias móviles desde hace tres años y se llevó a cabo el análisis espacial a través del método bayesiano empírico local. La epidemia estaba en expansión en el Norte y Noreste, mientras que se redujo en el resto del país, en especial en el Sureste. Los análisis subrayan que la aparente estabilización de la mortalidad por SIDA oculta disparidades regionales. Los determinantes sociales de la salud y las disparidades regionales son claves en la formulación de programas y políticas públicas en Brasil.
Global market integration over the past three decades has led to labour market restructuring in most countries around the world. Employment flexibility has been emphasized as a way for employers to restructure their organizations to remain globally competitive. This flexibility has resulted in the growth of precarious employment, which has been exacerbated by the global financial crisis and resulting recession in 2007/2008, and the ongoing economic uncertainty throughout much of the world. Precarious employment may result in short and long-term health consequences for many workers. This presents a deeper and more structural determinant of health than what health promoters have traditionally considered. It calls for a different understanding of workplace health promotion research and intervention that goes beyond enabling healthier lifestyle choices or advocating safer workplace conditions to ensuring adequate social protection floors that provide people with sufficient resources to lead healthy lives, and for advocacy for taxation justice to finance such protection.
Background: Few studies have considered using environmental amenities to explain social health inequalities.Nevertheless, Green spaces that promote good health may have an effect on socioeconomic health inequalities. In developed countries, there is considerable evidence that green spaces have a beneficial effect on the health of urban populations and recent studies suggest they can have a positive effect on pregnancy outcomes. To investigate the relationship between green spaces and the spatial distribution of infant mortality taking account neighborhood deprivation levels. Methods: The study took place in Lyon metropolitan area, France. All infant deaths that occurred between 2000 and 2009 were geocoded at census block level. Each census block was assigned greenness and socioeconomic deprivation levels. The spatial–scan statistic was used to identify high risk cluster of infant mortality according to these neighborhood characteristics. Results: The spatial distribution of infant mortality was not random with a high risk cluster in the south east of the Lyon metropolitan area (p<0.003). This cluster disappeared (p=0.12) after adjustment for greenness level and socioeconomic deprivation, suggesting that these factors explain part of the spatial distribution of infant mortality. These results are discussed using a conceptual framework with 3 hypothetical pathways by which green spaces may have a beneficial effect on adverse pregnancy outcomes: (i) a psychological pa ...
Este informe analiza por qué las políticas e intervenciones para abordar los determinantes sociales de las desigualdades sanitarias y de salud tienen éxito o fracasan. También se analizan las características importantes de la gobernanza y los sistemas de prestación de servicios que aumentan la probabilidad de éxito en la reducción de las inequidades. El informe presenta una lista de verificación de sistemas para gobernar para la equidad en salud desde una perspectiva integral-de-gobierno. Esto está pensado para su posterior discusión y como un marco para ayudar a los países en el fortalecimiento de su gobernanza para la equidad en salud en la práctica, a través de la acción sobre los determinantes sociales de la salud.
Este informe analiza por qué las políticas e intervenciones para abordar los determinantes sociales de las desigualdades en salud tienen éxito o fracasan. También se analizan las características importantes de la gobernanza y los sistemas de prestación de servicios que aumentan la probabilidad de éxito en la reducción de las inequidades. El informe presenta una lista de verificación de sistemas para gobernar para la equidad en salud desde una perspectiva integral de gobierno. Con esto se quiere fomentar la discusión y proporcionar un marco para ayudar a los países en el fortalecimiento de su gobernanza para la equidad en salud en la práctica, a través de la acción sobre los determinantes sociales de la salud.
La desigualdad económica crece rápidamente en la mayoría de los países. La riqueza mundial está dividida en dos: casi la mitad está en manos del 1% más rico de la población, y la otra mitad se reparte entre el 99% restante. El Foro Económico Mundial considera que esta desigualdad supone un grave riesgo para el progreso de la humanidad. La desigualdad económica extrema y el secuestro de los procesos democráticos por parte de las élites son demasiado a menudo interdependientes. La falta de control en las instituciones políticas produce su debilitamiento, y los gobiernos sirven abrumadoramente a las élites económicas en detrimento de la ciudadanía de a pie. La desigualdad extrema no es inevitable, y puede y debe revertirse lo antes posible.
The Global Gender Gap Report 2013 benchmarks national gender gaps of 136 countries on economic, political, education- and health-based criteria. The Global Gender Gap Index was developed in 2006, partially to address the need for a consistent and comprehensive measure of gender equality that can track a country’s progress over time. The index points to potential role models by revealing those countries that – within their region or income group – are leaders in dividing resources more equitably between women and men than other countries, regardless of the overall level of resources available. The Global Gender Gap Report 2013 emphasizes persisting gender gap divides across and within regions. Based on the eight years of data available for the 110 countries that have been part of the report since its inception, it finds that the majority of countries covered have made slow progress on closing gender gaps. This year’s findings show that Iceland continues to be at the top of the overall rankings in The Global Gender Gap Index for the fifth consecutive year. Finland ranks in second position, and Norway holds the third place in the overall ranking. Sweden remains in fourth position. Northern European countries dominate the top 10 with Ireland in the sixth position, Denmark (8) and Switzerland (9). New Zealand (7), Philippines (5) and Nicaragua (10) complete the top 10.
Health in All Policies (HiAP) is becoming increasingly popular as a governmental strategy to improve population health by coordinating action across health and non-health sectors. A variety of intersectoral initiatives may be used in HiAP that frame health determinants as the bridge between policies and health outcomes. The purpose of this glossary is to present concepts and terms useful in understanding the implementation of HiAP as a cross-sectoral policy. The concepts presented here were applied and elaborated over the course of case studies of HiAP in multiple jurisdictions, which used key informant interviews and the systematic review of literature to study the implementation of specific HiAP initiatives.
Gender inequalities in occupational health related to the unequal distribution of working and employment conditions: a systematic reviewwww.equityhealthj.com
INTRODUCTION: Gender inequalities exist in work life, but little is known about their presence in relation to factors examined in occupation health settings. The aim of this study was to identify and summarize the working and employment conditions described as determinants of gender inequalities in occupational health in studies related to occupational health published between 1999 and 2010. METHODS: A systematic literature review was undertaken of studies available in MEDLINE, EMBASE, Sociological Abstracts, LILACS, EconLit and CINAHL between 1999 and 2010. Epidemiologic studies were selected by applying a set of inclusion criteria to the title, abstract, and complete text. The quality of the studies was also assessed. Selected studies were qualitatively analysed, resulting in a compilation of all differences between women and men in the prevalence of exposure to working and employment conditions and work-related health problems as outcomes. RESULTS: Most of the 30 studies included were conducted in Europe (n=19) and had a cross-sectional design (n=24). The most common topic analysed was related to the exposure to work-related psychosocial hazards (n=8). Employed women had more job insecurity, lower control, worse contractual working conditions and poorer self-perceived physical and mental health than men did. Conversely, employed men had a higher degree of physically demanding work, lower support, higher levels of effort-reward imbalance, higher job status, were more e ...
Este artículo, publicado en el Boletín de la Organización Mundial de la Salud, tiene como objetivo determinar si la relación de la prevalencia del tabaquismo entre mujeres y hombres también es más elevada en los países con un empoderamiento de género alto.
Esta guía, publicada por el Instituto Vasco de la Mujer, analiza la presencia de las mujeres y de los hombre en el lenguaje sanitario. A partir del análisis de los documentos, se proponen soluciones a los problemas y ausencias que se han detectado respecto a la visibilización y a la inclusión de las mujeres en la lengua del ámbito sanitario.
Gender Differences in Educational Outcomes: Study on the Measures Taken and the Current Situation in Europeeacea.ec.europa.eu/education/eurydice/documents/thematic_rep
Este estudio comparativo, publicado por la red Eurydice, mapea las políticas y estrategias educativas aplicadas para reducir las desigualdades de género en el ámbito educativo europeo. Unos 29 países han participado facilitando datos sobre su sistema educativo, desde el nivel primario al terciario. El informe ofrece un perfil detallado de la situación específica de cada país en materia de políticas, currículum escolar, logros y profesorado desde la perspectiva de género.