Hacia la equidad: Monitorización de los determinantes sociales de la salud y reducción de las desigualdades en salud Destacadowww.msps.es/profesionales/saludPublica/prevPromocion/promoci
Este informe técnico, desarrollado por un grupo de personas expertas comisionadas por la Dirección General de Salud Pública y Sanidad Exterior del Ministerio de Sanidad y Política Social, hace una revisión del trabajo realizado hasta ahora sobre monitorización de los determinantes sociales de la salud y las desigualdades en salud a nivel nacional e internacional. El fin último de este informe es contribuir a alcanzar la equidad en salud, actuando sobre los determinantes sociales de la salud.
Hombres sanitarios implicados en las estrategias contra la violencia de género: procesos facilitadores de su compromiso Destacadowww.msc.es/organizacion/sns/planCalidadSNS/pdf/equidad/Sanit
Este recurso, elaborado para el Observatorio de Salud de las Mujeres del Ministerio de Sanidad y Política Social, tiene como objetivo aportar elementos de análisis que puedan orientar las acciones destinadas a implicar a mayor número de hombres sanitarios en el abordaje de la violencia de género desde el Sistema Nacional de Salud
Este recurso, publicado por el "European Observatory on Health Systems and Policies", se centra en como los sistemas de salud pueden abordar la equidad de género con el fin de reducir las disparidades de salud entre hombres y mujeres, y a su vez mejorar la eficiencia. Este documento analiza los principales enfoques utilizados para abordar la equidad de género en los sistemas de salud e ilustra con tres ejemplos cómo estos se podrían desarrollar en el contexto de las políticas de salud en toda Europa.
Health Behaviour in School-aged Children (HBSC), a WHO collaborative cross-national study, has provided information about the health, well-being, social environment and health behaviour of 11-, 13- and 15-year-old boys and girls for over 30 years. This latest international report from the study presents findings from the 2013/2014 survey, which collected data from almost 220 000 young people in 42 countries in Europe and North America. The data focus on social context (relations with family, peers and school), health outcomes (subjective health, injuries, obesity and mental health), health behaviours (patterns of eating, toothbrushing and physical activity) and risk behaviours (use of tobacco, alcohol and cannabis, sexual behaviour, fighting and bullying) relevant to young people’s health and well-being. New items on family and peer support, migration, cyberbullying and serious injuries are also reflected in the report.
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.
Healthcare coverage for undocumented migrants in Spain: Regional differences after Royal Decree Law 16/2012
The economic crisis has prompted the debate on how to regulate health coverage of undocumented migrants in publicly funded healthcare systems. Spain, as one of the most heavily affected countries in Europe, can be considered a case of particular interest. In 2012 the Spanish Government issued a Royal Decree Law (RDL 16/2012) which revoked their previous full right to public healthcare coverage, now limited for some exceptions. However, the Spanish National Health System is highly decentralized, and this Central Government decree had to be implemented by the Regional Health Authorities. Our aim is to compare regional policies regarding entitlement to healthcare for undocumented migrants after RDL 16/2012 in the 17 Autonomous Regions by performing an exhaustive review of the regional health policy regulations published after the enactment of RDL 16/2012. Our analysis shows that many Regions adopted legal, legislative and administrative actions to void or limit its effects, while others applied it as intended, resulting in huge differences in healthcare coverage for irregular migrants among Spanish Regions. The unequal implementation of this Law constitutes a paradigmatic example of the complexity of nation-wide regulation of controversial key issues in decentralized health systems. In addition, our results highlight that within-country differences in access and/or entitlement can be as relevant as those reported among-country when there is healthcare decentralization.
HIV infection in migrant populations in the European Union and European Economic Area in 2007-2012; an epidemic on the move
Background: Migrants are considered a key group at risk for HIV infection. This study describes the epidemiology of HIV and the distribution of late HIV presentation among migrants within the European Union/European Economic Area (EU/EEA) during 2007-2012. Methods: HIV cases reported to European Surveillance System (TESSy) were analysed. Migrants were defined as people whose geographical origin was different to the reporting country. Multiple logistic regression was used to model late HIV presentation. Results: Overall 156,817 HIV cases were reported of which 60,446 (38%) were migrants. Of these, 53% were from Sub-Saharan Africa, 12% from Latin-America, 9% from Western Europe, 7% from Central Europe; 5% from South & South-East-Asia, 4% from East Europe, 4% from Caribbean, 3% from North-Africa & Middle-East. Male and female migrants from Sub-Saharan Africa and Latin-America had higher odds of late HIV presentation than native men and women. Migrants accounted for 40% of all HIV notifications in 2007 versus 35% in 2012. HIV cases in women from Sub-Saharan Africa decreased from 3,725 in 2007 to 2,354 in 2012. The number of HIV cases from Latin America peaked in 2010 to decrease thereafter. HIV diagnoses in migrant MSM increased from 1,927 in 2007 to 2,459 in 2012. Conclusions: Migrants represent two-fifths of the HIV cases reported and had higher late HIV presentation. HIV epidemic in migrant populations in EU/EEA member states is changing, probably reflecting t ...
Hispano- Americans in Europe: what do we know about their health status and determinants? A scoping review
Background:Policy makers and health practitioners are in need of guidance to respond to the growing geographic mobility of Hispano-American migrants in Europe. Drawing from contributions from epidemiology, social sciences, demography, psychology, psychiatry and economy, this scoping review provides an up-to-date and comprehensive synthesis of studies addressing the health status and determinants of this population. We describe major research gaps and suggest specific avenues of further inquiry. Methods:We identified systematically papers that addressed the concepts “health” and “Hispano Americans” indexed in five data bases from Jan 1990 to May 2014 with no language restrictions. We screened the 4,464 citations retrieved against exclusion criteria and classified 193 selected references in 12 thematic folders with the aid of the reference management software ENDNOTE X6. After reviewing the full text of all papers we extracted relevant data systematically into a table template to facilitate the synthesising process. Results:Most studies focused on a particular disease, leaving unexplored the interlinkages between different health conditions and how these relate to legislative, health services, environmental, occupational, and other health determinants. We elucidated some consistent results but there were many heterogeneous findings and several popular beliefs were not fully supported by empirical evidence. Few studies adopted a trans-national perspective and many consisted of ...
This manual is a training resource to increase understanding of the importance of Health in All Policies among health and other professionals. The material will form the basis of 2- and 3-day workshops, which will:build capacity to promote, implement and evaluate HiAP encourage engagement and collaboration across sectors facilitate the exchange of experiences and lessons learned promote regional and global collaboration on HiAP; and promote dissemination of skills to develop training courses for trainers.
How can inequalities in mortality be reduced? A quantitative analysis of 6 risk factors in 21 european populations
Background:Socioeconomic inequalities in mortality are one of the greatest challenges for health policy in all European countries, but the potential for reducing these inequalities is unclear. We therefore quantified the impact of equalizing the distribution of six risk factors for mortality: smoking, overweight, lack of physical exercise, lack of social participation, low income, and economic inactivity. Methods:We collected and harmonized data on mortality and risk factors by educational level for 21 European populations in the early 2000s. The impact of the risk factors on mortality in each educational group was determined using Population Attributable Fractions. We estimated the impact on inequalities in mortality of two scenarios: a theoretical upward levelling scenario in which inequalities in the risk factor were completely eliminated, and a more realistic best practice scenario, in which inequalities in the risk factor were reduced to those seen in the country with the smallest inequalities for that risk factor. Findings:In general, upward levelling of inequalities in smoking, low income and economic inactivity hold the greatest potential for reducing inequalities in mortality. While the importance of low income is similar across Europe, smoking is more important in the North and East, and overweight in the South. On the basis of best practice scenarios the potential for reducing inequalities in mortality is often smaller, but still substantial in many countries for ...
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 ...
Health is a core element in people’s well-being and happiness. Health is an important enabler and a prerequisite for a person’s ability to reach his/her goals and aspirations, and for society to reach many of the societal goals. Health in All Policies (HiAP) is an approach to public policies across sectors that systematically takes into account the health and health systems implications of decisions, seeks synergies and avoids harmful health impacts, in order to improve population health and health equity. A HiAP approach is founded on health-related rights and obligations. It emphasizes the consequences of public policies on health determinants, and aims to improve the accountability of policy-makers for health impacts at all levels of policy-making.Core features of HiAP include a strong foundation on human rights and social justice, and a focus on policy-making. It is often necessary to prioritize efforts; seek synergies to enhance health and other important societal goals; and seek to avoid harmful impacts on health.Application of HiAP involves identifying policy developments across sectors with potential implications for health and health equity; assessing impacts;and advocating and negotiating for changes. Long term vision and sustained efforts are often needed.Policy-making is a dynamic process in which windows of opportunity for policy decisions arise from changing economic, social, economic and political realities. This book uses Kingdon’s framework on problems, polic ...
This third edition of Health at a Glance: Europe presents the latest information on health and health systems in 35 European countries, including all European Union Member States, candidate countries (with the exception of Albania due to limited data availability) and European Free Trade Association (EFTA) countries. The selection of indicators is largely based on the European Core Health Indicators (ECHI) shortlist, a list of indicators that has been developed by the European Commission to guide the development and reporting of health statistics. It is complemented by additional indicators on health expenditure, quality of care and access to care, building on the OECD expertise in these areas. Each health information area is based on health indicators including charts illustrating variations across countries and over time, brief descriptive analyses highlighting the major findings, and an information box on the definition of the indicators and possible limitations in data comparability. An annex provides additional information on the demographic and economic context in which health systems operate. This publication is the result of collaboration between the OECD and the European Commission in the field of health information, with the help of national data correspondents from the 35 countries.
Background: Literature on health and access to care of undocumented migrants in the European Union (EU) is limited and heterogeneous in focus and quality. Authors conducted a scoping review to identify the extent, nature and distribution of existing primary research (1990–2012), thus clarifying what is known, key gaps, and potential next steps. Methods: Authors used Arksey and O’Malley’s six-stage scoping framework, with Levac, Colquhoun and O’Brien’s revisions, to review identified sources. Findings were summarized thematically: (i) physical, mental and social health issues, (ii) access and barriers to care, (iii) vulnerable groups and (iv) policy and rights. Results: Fifty-four sources were included of 598 identified, with 93% (50/54) published during 2005–2012. EU member states from Eastern Europe were under-represented, particularly in single-country studies. Most study designs (52%) were qualitative. Sampling descriptions were generally poor, and sampling purposeful, with only four studies using any randomization. Demographic descriptions were far from uniform and only two studies focused on undocumented children and youth. Most (80%) included findings on health-care access, with obstacles reported at primary, secondary and tertiary levels. Major access barriers included fear, lack of awareness of rights, socioeconomics. Mental disorders appeared widespread, while obstetric needs and injuries were key reasons for seeking care. Pregnant women, children and detainees app ...
After more than a year of global consultations, the United Nations convenes to agree on a broad outline of the post-2015 Sustainable Development Goals and begin a year-long state negotiation process. Concerned that the voices of marginalized communities are not being sufficiently sought out and listened to, the international research consortium 'Goals and Governance for Global Health' (Go4Health) has undergone a series of health-focused consultations in marginalized communities in nine countries to seek their views on their essential health needs, accountability, and more. Many of the results and associated lessons are being published in this new thematic series from the International Journal for Equity in Health entitled ""Health, equity and the post-2015 agenda: raising the voices of marginalized communities," guest edited by Ana Lorena Ruano, Peter Hill, and Eric Friedman.
Cada persona aspira conseguir un buen nivel de bienestar. Pero ¿qué significa un buen nivel de bienestarEn eta publicación la OCDE define un marco de bienestar ensus paísesintegrantes y otras economías importantes, al observar las condiciones materiales y la calidad de vida de las personas. Además, el informe contiene estudios en profundidad sobre cuatro temas transversales en el bienestar de la población, particularmente relevantes, como son: la evolución del bienestar durante la crisis económica y financiera mundial, las diferencias de género en el bienestar, el bienestar en el lugar de trabajo su evaluación y la medición de la sostenibilidad del bienestar a lo largo del tiempo.
Este informe ofrece un resumen de nueva evidencia sobre las desigualdades en salud en la Unión Europea (UE) y las políticas nacionales y comunitarios desarrollados desde 2009. El informe advierte que la actual crisis financiera, económica y social amenaza con socavar las políticas existentes, y puede afectar negativamente a las desigualdades en salud. Se insta a que el abordaje de las desigualdades en salud siga siendo una prioridad y se integre en las políticas básicas del sector de la salud y de otros sectores administrativos. El informe formula cinco recomendaciones clave para la Comisión, los Estados miembros de la UE y las regiones, de la siguiente manera: 1. Diseñar estrategias claras y completas para corregir los patrones y la magnitud de las desigualdades de salud actuales.2. Asegurar la coherencia y la eficacia de las medidas para reducir las desigualdades en salud en todos los niveles de gobierno y en todos los sectores y partes interesadas.3. Asegurar que existen capacidades para la aplicación coherente y eficaz de la acción sobre las desigualdades en salud 4. Mejorar la disponibilidad y uso de los datos para la identificación de prioridades,la planificación de la acción, seguimiento de las tendencias y evaluar qué acciones son las más efectivas .5. Liderazgo a nivel de la Comisión Europea, para estimular la acción y desarrollar la capacidad para hacer frente a las desigualdades en salud.
Have health trends worsened in Greece as a result of the financial crisis? A quasi-experimental approacheurpub.oxfordjournals.org
Background: Health in Greece deteriorated after the recent financial crisis, but whether this decline was caused by the recent financial crisis has not been established. This article uses a quasi-experimental approach to examine the impact of the recent financial crisis on health in Greece. Methods: Data came from the European Union Statistics on Income and Living Conditions survey for the years 2006–09. We applied a difference-in-differences approach that compares health trends before and after the financial crisis in Greece with trends in a control population (Poland) that did not experience a recession and had health trends comparable with Greece before the crisis. We used logistic regression to model the impact of the financial crisis on poor self-rated health, controlling for demographic confounders. Results: Results provide strong evidence of a statistically significant negative effect of the financial crisis on health trends. Relative to the control population, Greece experienced a significantly larger increase in the odds of reporting poor health after the crisis (odds ratio, 1.16; 95% confidence interval, 1.04–1.29). There was no difference in health trends between Poland and Greece before the financial crisis, supporting a causal interpretation of health declines in Greece as a result of the financial crisis. Conclusion: Results provide evidence that trends in self-rated health in Greece worsened as a result of the recent financial crisis. Findings stress the need f ...
Séptima edición de Health at Glance, documento que ofrece los últimos datos estadístico comparables sobre diferentes aspectos de los sistemas de salud en países de la OCDE. Proporciona evidencia de grandes variaciones entre los distintos países, a nivel de costos, actividades y resultados de los sistemas de salud. Los principales indicadores que proporcionan están relacionados con información sobre el estado de salud, los determinantes de la salud, las actividades de atención de la salud, el gasto sanitario y la financiación en los países de la OCDE. Cada indicador del documento se presenta en un formato fácil de usar, consistente en tablas que ilustran los diferentes patrones entre países a lo largo del tiempo, breves análisis descriptivos con las principales conclusiones de los datos, y un cuadro metodológico sobre la definición del indicador y las limitaciones en la comparabilidad de los datos.