Scoping review: national monitoring frameworks for social determinants of health and health equity

Scoping review: national monitoring frameworks for social determinants of health and health equity Background: The strategic importance of monitoring social determinants of health (SDH) and health equity and inequity has been a central focus in global discussions around the 2011 Rio Political Declaration on SDH and the Millennium Development Goals. This study is part of the World Health Organization (WHO) equity-oriented analysis of linkages between health and other sectors (EQuAL) project, which aims to define a framework for monitoring SDH and health equity.Objectives: This review provides a global summary and analysis of the domains and indicators that have been used in recent studies covering the SDH. These studies are considered here within the context of indicators proposed by the WHO EQuAL project. The objectives are as follows: to describe the range of international and national studies and the types of indicators most frequently used; report how they are used in causal explanation of the SDH; and identify key priorities and challenges reported in current research for national monitoring of the SDH.Design: We conducted a scoping review of published SDH studies in the PubMed® database to obtain evidence of socio-economic indicators. We evaluated, selected, and extracted data from national scale studies published from 2004 to 2014. The research included papers published in English, Italian, French, Portuguese, and Spanish.Results: The final sample consisted of 96 articles. SDH monitoring is well reported in the scientific literature independent of the economic le ...

Publicado en ODS2016-03-11

Swimming "upstream" to tackle the social determinants of health

Swimming "upstream" to tackle the social determinants of health Quality improvement interventions typically focus on how to improve the care delivered within healthcare organisations or by health systems. Rarely do efforts venture beyond the walls of clinics and hospitals to target the social determinants of health. Berkowitz et al remind us that swimming "upstream" is essential if we want to improve health outcomes for vulnerable or disadvantaged patients.The authors conducted a cross-sectional study of a Health Leads intervention in two urban adult primary care practices. Social needs were identified and then addressed by advocates based in the practices. They found that 15% of patients seen had an unmet resource need, most commonly food insecurity or a health resource need such as difficulty obtaining health insurance or affording medications. Patients with unmet resource needs were less healthy, had more "no-show" appointments, more emergency department visits and were less likely to meet care targets.

Publicado en ODS2016-03-09

Socioeconomic inequalities in injuries treated in primary care in Madrid, Spain.

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.

Categoría:Clase Social
Publicado en ODS2016-02-19

Situación actual de la investigación sobre las condiciones de vida y el estado de salud de las personas mayores en España

Situación actual de la investigación sobre las condiciones de vida y el estado de salud de las personas mayores en España Objetivo:Analizar las dimensiones estudiadas en la investigación sobre las condiciones de vida y salud de las personas mayores no institucionalizadas en la literatura científica en el medio español. Método: Análisis de contenidos basado en fuentes secundarias, realizado mediante búsquedas bibliográficas de documentos en Pubmed y Embase en castellano y en inglés. La estrategia de búsqueda combinó términos o categorías relacionados con personas mayores, condiciones de vida y/o salud y España. Se incluyeron los estudios que evaluasen condiciones de vida y/o salud de las personas mayores en España. Se excluyeron los que analizaban un aspecto concreto de las condiciones de vida o salud y los que incluían o se centraban en la población institucionalizada. Resultados:Para el análisis de contenidos se consideró un total de 14 estudios y/o informes como relevantes. Los trabajos localizados son habitualmente de ámbito local, de tipo transversal y la recogida de datos se realiza mediante entrevista al individuo. Se observó variabilidad en los aspectos analizados sobre las condiciones de vida y salud de las personas mayores. La valoración de las características sociodemográficas, el estado de salud y los hábitos de vida se estudiaron de forma habitual. Los aspectos relacionados con el estado del entorno de la vivienda fueron escasamente analizados. Conclusiones:Este estudio permite conocer las dimensiones priorizadas en los estudios sobre condiciones de vida y salud realizados hasta e ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2016-02-15

Social determinants of health, inequality and social inclusion among people with disabilities

Objective: to analyze the socio-familial and community inclusion and social participation of people with disabilities, as well as their inclusion in occupations in daily life. Methods: qualitative study with data collected through open interviews concerning the participants' life histories and systematic observation. The sample was composed of ten individuals with acquired or congenital disabilities living in the region covered by a Family Health Center. The social conception of disability was the theoretical framework used. Data were analyzed according to an interpretative reconstructive approach based on Habermas' Theory of Communicative Action. Results: the results show that the socio-familial and community inclusion of the study participants is conditioned to the social determinants of health and present high levels of social inequality expressed by difficult access to PHC and rehabilitation services, work and income, education, culture, transportation and social participation. Conclusion: there is a need to develop community-centered care programs in cooperation with PHC services aiming to cope with poverty and improve social inclusion.

Publicado en ODS2015-06-15

Severe labour exploitation: workers moving within or into European Union

Severe labour exploitation: workers moving within or into European Union The term ‘severe labour exploitation’ refers to all forms of labour exploitation that are criminal under the legislation of the EU Member State where the exploitation occurs. A keyfocus of this report is exploitation at work and the risks surrounding it. The report does not analyse the preceding process of workers moving or being moved from theirhome countries into a situation of exploitation. It focuses on less well?known areas of EU law, which –along with the Anti?Trafficking Directive – can be used to deal with thephenomenon of severe labour exploitation. While the EU has legislation prohibiting certain forms of severe labour exploitation, working moving within or migrating to the EU are at risk of becoming victims.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-09

State of inequality: reproductive, maternal, newborn and child health

State of inequality: reproductive, maternal, newborn and child health The State of inequality: reproductive, maternal, newborn and child health report delivers both promising and disappointing messages about the situation in low- and middle-income countries. On the one hand,within-country inequalities have narrowed, with a tendency for national improvements driven by faster improvements in disadvantaged subgroups. In certain indicators and countries, these improvements have been substantial. On the other hand, however, inequalities still persist in most reproductive, maternal,newborn and child health (RMNCH) indicators. The extent of within-country inequality differed by dimension of inequality and by country, country income group and geographical region. There is still much progress to be made in reducing inequalities in RMNCH.The objective of this report is to showcase best practices in reporting the state of inequality in low- and middle-income countries using high-quality data, sound and transparent analysis methods, and user-oriented, comprehensive reporting.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-06-02

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 ...

Categoría:Clase Social
TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-05-20

Strengthening the implementation of Health in All Policies: a methodology for realist explanatory case studies

Strengthening the implementation of Health in All Policies: a methodology for realist explanatory case studies To address macro-social and economic determinants of health and equity, there has been growing use of intersectoral action by governments around the world. Health in All Policies (HiAP) initiatives are a special case where governments use cross-sectoral structures and relationships to systematically address health in policymaking by targeting broad health determinants rather than health services alone. Although many examples of HiAP have emerged in recent decades, the reasons for their successful implementation—and for implementation failures—have not been systematically studied. Consequently, rigorous evidence based on systematic research of the social mechanisms that have regularly enabled or hindered implementation in different jurisdictions is sparse. We describe a novel methodology for explanatory case studies that use a scientific realist perspective to study the implementation of HiAP. Our methodology begins with the formulation of a conceptual framework to describe contexts, social mechanisms and outcomes of relevance to the sustainable implementation of HiAP. We then describe the process of systematically explaining phenomena of interest using evidence from literature and key informant interviews, and looking for patterns and themes. Finally, we present a comparative example of how Health Impact Assessment tools have been utilized in Sweden and Quebec to illustrate how this methodology uses evidence to first describe successful practices for implementation of HiAP an ...

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-04-17

Spanish children: the population group most affected by the economic crisis. Statement of the Spanish Society of Public Health (SESPAS) on child poverty and health

Spanish children: the population group most affected by the economic crisis. Statement of the Spanish Society of Public Health (SESPAS) on child poverty and health The current economic crisis has affected the whole European economy. Children are the most vulnerable population group in these situations. As the Taylor-Robinson et al. report has pointed out child health and wellbeing has taken “a great leap backwards” in many countries. The Spanish Society of Public Health (SESPAS) calls on governments and public administrations to implement urgent measures to combat the effects of child poverty on health of the current economic crisis. There are several messages about the importance of children, but there are no measures included in the agenda that prioritizes economic and social policies to ensure equal opportunities to growth and development...

Publicado en ODS2015-04-15

Social welfare matters: A realist review of when, how, and why unemployment insurance impacts poverty and health

Social welfare matters: A realist review of when, how, and why unemployment insurance impacts poverty and health The recent global recession and concurrent rise in job loss makes unemployment insurance (UI) increasingly important to smooth patterns of consumption and keep households from experiencing extreme material poverty. In this paper, we undertake a realist review to produce a critical understanding of how and why UI policies impact on poverty and health in different welfare state contexts between 2000 and 2013. We relied on literature and expert interviews to generate an initial theory and set of propositions about how UI might alleviate poverty and mental distress. We then systematically located and synthesized peer-review studies to glean supportive or contradictory evidence for our initial propositions. Poverty and psychological distress, among unemployed and even the employed, are impacted by generosity of UI in terms of eligibility, duration and wage replacement levels. Though unemployment benefits are not intended to compensate fully for a loss of earnings, generous UI programs can moderate harmful consequences of unemployment.

Categoría:Protección Social
Publicado en ODS2015-03-23

Salud autorreferida: influencia de la pobreza y la desigualdad en el área de residencia

Objetivo:Evaluar la influencia de la desigualdad de ingresos y de la pobreza de las localidades de Bogotá-Colombia sobre la percepción de mala salud de sus residentes. Métodos:El estudio se basó en la encuesta multipropósito aplicada en Bogotá-Colombia. Se utilizó la estructura jerárquica de los datos (individuos=nivel 1, localidades=nivel 2) para definir un modelo logístico multinivel de tipo logit. La variable dependiente fue la percepción de mala salud, y las variables de localidad fueron la desigualdad de ingresos y la pobreza. Todos los análisis se controlaron por variables sociodemográficas y se estratificaron por sexo. Resultados:La prevalencia de reportar regular o mala salud en la población estudiada fue del 23,2%. Las mujeres mostraron mayor riesgo de mala salud, así como también los hombres y mujeres de bajo nivel educativo, con edad avanzada, sin trabajo en la última semana y afiliados al régimen subsidiado de salud. Los mayores niveles de pobreza en la localidad incrementan el riesgo de mala salud. Las interacciones transnivel mostraron que mujeres jóvenes y hombres con bajo nivel educativo son los más afectados por la desigualdad de ingresos de la localidad. Conclusiones:En Bogotá existen diferencias geográficas en la percepción de la salud, y mayores porcentajes de pobreza y desigualdad de ingreso se mostraron asociados a un mayor riesgo de mala salud. Destacan grandes inequidades de salud entre individuos y entre localidades.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-03-09

Salud y conductas relacionadas con la salud según la atracción y la conducta sexual

Salud y conductas relacionadas con la salud según la atracción y la conducta sexual Objetivo:Describir la salud percibida, la salud mental y algunas conductas relacionadas con la salud según la atracción y la conducta sexual en los residentes en Barcelona en 2011. Métodos:Se analizó la salud percibida y mental, los trastornos crónicos y las conductas relacionadas con la salud, en 2675 personas de 15 a 64 años de edad teniendo en cuenta la atracción y la conducta sexual en el marco de la Encuesta de Salud de Barcelona 2011. Se ajustaron modelos multivariados de regresión de Poisson robusta para obtener razones de prevalencia. Resultados:Las personas atraídas por el mismo sexo presentaron mayor prevalencia de mala salud percibida y mental. Estas personas y las que habían tenido relaciones con personas del mismo sexo declararon más frecuentemente conductas perjudiciales para la salud. Conclusiones:La población lesbiana, gay, transexual y bisexual puede presentar problemas de salud que deben ser explorados en profundidad, prevenidos y atendidos.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-02-27

Social Determinants of Child Health: Concepts and Measures for Future Research

Objectives: This review examines the effects of family economic security policies on child and family health outcomes, formulates a framework for possible mechanisms of effect, and introduces our policy surveillance system to measure changes in state laws affecting social determinants of health. Methods: We carried out a comprehensive review of the published literature on family economic security policies and health outcomes. Results: There is a paucity of studies examining effects of economic policies on child and family health behaviors and outcomes; moreover, even fewer investigate causal pathways from policy to mediating changes in social and physical conditions or health behaviors. Conclusion: State policy variations offer a valuable opportunity for scientists to conduct natural experiments and contribute to evidence linking social policy effects to family and child wellbeing.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-01-30

Socioeconomic differences in the use of ill-defined causes of death in 16 European countries

Background:Cause-of-death data linked to information on socioeconomic position form one of the most important sources of information about health inequalities in many countries. The proportion of deaths from ill-defined conditions is one of the indicators of the quality of cause-of-death data. We investigated educational differences in the use of ill-defined causes of death in official mortality statistics. Methods:Using age-standardized mortality rates from 16 European countries, we calculated the proportion of all deaths in each educational group that were classified as due to “Symptoms, signs and ill-defined conditions”. We tested if this proportion differed across educational groups using Chi-square tests. Results:The proportion of ill-defined causes of death was lower than 6.5% among men and 4.5% among women in all European countries, without any clear geographical pattern. This proportion statistically significantly differed by educational groups in several countries with in most cases a higher proportion among less than secondary educated people compared with tertiary educated people. Conclusions:We found evidence for educational differences in the distribution of ill-defined causes of death. However, the differences between educational groups were small suggesting that socioeconomic inequalities in cause-specific mortality in Europe are not likely to be biased.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2015-01-14

Supporting a Movement for Health and Health Equity – Workshop Summary

Supporting a Movement for Health and Health Equity – Workshop Summary The idea of movements and movement building is inextricably linked with the history of public health. Historically, most movements—including, for example, those for safer working conditions, for clean water, and for safe food—have emerged from the sustained efforts of many different groups of individuals, which were often organized in order to protest and advocate for changes in the name of such values as fairness and human rights.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-12-17

Systematic review of parenting interventions in European countries aiming to reduce social inequalities in children’s health and development

Background: Early child development influences many aspects of wellbeing, health, competence in literacy andnumeracy, criminality, and social and economic participation throughout the life course. Children fromdisadvantaged groups have less possibilities of achieving full development. By providing a positive start for allchildren across the social gradient, improved developmental outcomes will be seen during later childhood andthroughout their lives. The objective of this systematic review was to identify interventions during early childhoodin countries from the World Health Organisation European Region in 1999–2013 which reduced inequalities inchildren’s health and development.Methods: A systematic review was carried out adhering to the PRISMA guidelines. The review examined universal,targeted and proportionate universalism interventions, programs and services using an electronic search strategy inPubMed and the International Bibliography of the Social Sciences [IBSS] databases. A further search was performedin the grey literature. Interventions were included only if they were aimed at children or their parents and hadbeen evaluated.Results: We identified 23 interventions in total: 6 in the PubMed data base, 5 in IBSS and 12 in grey literature. Allbut 1 intervention-delivered in Sweden-were carried out in the United Kingdom and the Republic of Ireland. Theseaimed to improve parenting abilities, however, some had additional components such as: day-care provision,improving hou ...

TipoRevisiones Bibliográficas
Publicado en ODS2014-11-12

Social Determinants of Mental Health

Social Determinants of Mental Health This report was written by the UCL Institute of Health Equity and published by the World Health Organization and the Gulbenkian Foundation.Its key messages are as follows:- Mental health and many common mental disorders are shaped to a great extent by the social, economic, and physical environments in which people live.- Social inequalities are associated with increased risk of many common mental disorders.- Taking action to improve the conditions of daily life from before birth, during early childhood, at school age, during family building and working ages, and at older ages provides opportunities both to improve population mental health and to reduce the risk of those mental disorders that are associated with social inequalities.- While comprehensive action across the life course is needed, scientific consensus is considerable that giving every child the best possible start will generate the greatest societal and mental health benefits.- Action needs to be universal: across the whole of society, and proportionate to need in order to level the social gradient in health outcomes.- This paper highlights effective actions to reduce risk of mental disorders throughout the life course, at the community level and at the country level. It includes environmental, structural, and local interventions. Such actions to prevent mental disorders are likely to promote mental health in the population.

TipoComunicaciones/Informes/Artículos (individual)
Publicado en ODS2014-09-30

Social Determinants of Health Equity

Language is important. The call for papers in this supplement was entitled health equity. Yet the call asked for papers that address disparities in health. In the United States, disparities, most often, has been used to refer to racial/ethnic differences in health, or more commonly health care. We note that the call in this supplement expands the focus and highlights differences by socioeconomic status and geographic location, among others. By tradition, in the United Kingdom we have used the term inequalities to describe the differences in health between groups defined on the basis of socioeconomic conditions.To reduce health inequalities requires action to reduce socioeconomic and other inequalities. There are other factors that influence health, but these are outweighed by the overwhelming impact of social and economic factors—the material, social, political, and cultural conditions that shape our lives and our behaviors. Much of the evidence describing this was set out in the World Health Organization Global Commission on the Social Determinants of Health....

Publicado en ODS2014-09-16

Secuelas a largo plazo de la crisis económica y desigualdades sociales en salud

Al margen de las definiciones oficiales de crisis económica, desde la perspectiva de la salud puede considerarse un fenómeno difuso que se resiste a cronologías precisas. Conceptualmente, ya al inicio de la crisis propusimos los mecanismos y procesos por los que puede acabar afectando a la salud, directa e indirectamente, a corto y a largo plazo. Cuantificar cada uno de ellos requiere métodos rigurosos, indicadores adecuados y tiempo (es decir, distancia temporalsuficiente para que los efectos a largo plazo se puedan apreciar). Porque las consecuencias de la crisis económica sobre la salud tardan más en empezar a percibirse que las que tienen lugar sobre la renta y el bienestar económico de las familias y que los efectos sobre la sanidad. Comparando los cuatro años de crisis (2008-2011) con los previos, los indicadores de mortalidad prematura no muestran empeoramiento y tampoco la salud percibida ni la incidencia de HIV/SIDA.

Categoría:Crisis Económica
Publicado en ODS2014-09-01