Social and health policies or interventions to tackle health inequalities in European cities: a scoping reviewwww.biomedcentral.com
Background: Health inequalities can be tackled with appropriate health and social policies, involving all community groups and governments, from local to global. The objective of this study was to carry out a scoping review on social and health policies or interventions to tackle health inequalities in European cities published in scientific journals. Methods Scoping review. The search was done in "PubMed" and the "Sociological Abstracts" database and was limited to articles published between 1995 and 2011. The inclusion criteria were: interventions had to take place in European cities and they had to state the reduction of health inequalities among their objectives. Results A total of 54 papers were included, of which 35.2% used an experimental design, and 74.1% were carried out in the United Kingdom. The whole city was the setting in 27.8% of them and 44.4% were based on promoting healthy behaviours. Adults and children were the most frequent target population and half of the interventions had a universal approach and the other half a selective one. Half of the interventions were evaluated and showed positive results. Conclusions Although health behaviours are not the main determinants of health inequalities, the majority of the selected documents were based on e
La Región Europea de la OMS ha vivido notables avances en salud, aunque persisten las desigualdades tanto entre países como dentro de ellos. Gracias a la publicación del informe de 2008 de la Comisión sobre Determinantes Sociales de la Salud ahora se conoce más sobre el alcance y las causas sociales de estas desigualdades. Este informe es una revisión de las inequidades en salud a través de los 53 estados miembros de la Región europea y se encargó de apoyar el desarrollo del nuevo marco de la política europea para la salud y el bienestar, Salud 2020. Está basado en la evidencia global y recomienda políticas para reducir las desigualdades en salud y la brecha de salud en todos los países, incluidos aquellos que tienen ingresos más bajos. El informe se divide en cuatros parte. En la Parte I constan los antecedentes y el contexto de la revisión y se establecen los principios de las recomendaciones y razones para abordar cuatro grandes temas: las etapas del curso de vida, la sociedad en general, el contexto macrosocial y la gobernanza. La Parte II resume la evidencia actual sobre la brecha de salud entre los países de la Región, describiendo las desigualdades en salud y sus determinantes sociales. La parte III hace propuestas basadas en la evidencia. Y por último, en la Parte IV se describen los problemas de implementación y se ofrece orientación y un resumen de las principales conclusiones y recomendaciones de la revisión.
Background: European city councils are increasingly developing interventions against health inequalities. There is little knowledge about how they are perceived. This study describes and analyses good practices and challenges for local interventions on inequalities in health through the narratives of European city managers. Methods: A qualitative study was conducted. Each participating city (Amsterdam, Barcelona, Cluj-Napoca, Helsinki, Lisbon, London, Madrid, Rotterdam) selected interventions following these criteria: at least 6 months of implementation; an evaluation performed or foreseen; the reduction of health inequalities among their objectives, and only one of the interventions selected could be based on health care. Managers of these local interventions were interviewed following an outline. Eleven individual in-depth interviews describing nine local interventions were obtained. A thematic content analysis was performed. Results: One or more local interventions against health inequalities were identified in each city. Most relied on quantitative data and were linked to national strategies. Few interventions addressed socio-economic determinants. Health care, employment and education were the main determinants addressed. With variable depth, evidence-base, participation and intersectorality were regular components of the interventions. Half of them targeted the city and half some deprived neighbourhoods. Few interventions had been evaluated. Scarcity of fundin ...
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
Measuring employment precariousness in the European working conditions survey: The social distribution in Europeiospress.metapress.com/content/x276pvp181608518/
BACKGROUND: Precarious employment is becoming an increasingly important social determinant of health inequalities among workers. The way in which contemporary employment arrangements and their health consequences are addressed in empirical research is mostly based on the contract-related or employment instability dimension. A broader conceptual approach including various important characteristics of the degrading of employment conditions and relations is needed. OBJECTIVE: The general objective of this paper is to empirically test a new multidimensional construct for measuring precarious employment in an existing database. Special focus is on the social distribution of precarious employment. METHODS: A subsample of 21,415 participants in the EU-27 from the Fourth European Working Conditions Survey-2005 was analysed. A cross-sectional study of the social distribution of precarious employment was conducted through the analysis of proportional differences according to gender, social class and credentials for the European Union as a whole and within each country. The 8 dimensions of the Employment Precariousness Construct were represented by 11 indicators. RESULTS: In general, women, workers without supervisory authority, those with fewer credentials, and those living in Eastern and Southern European countries suffer the highest levels of precarious employment. Exceptionally, men, workers with supervisory authority and those with the highest credentials suffer the highest le ...
Background: Informal employment is assumed to be an important but seldom studied social determinant of health, affecting a large number of workers around the world. Although informal employment arrangements constitute a permanent, structural pillar of many labor markets in low- and middle-income countries, studies about its relationship with health status are still scarce. In Central America more than 60 % of non-agricultural workers have informal employment. Therefore, we aimed to assess differences in self-perceived and mental health status of Central Americans with different patterns of informal and formal employment. Methods: Employment profiles were created by combining employment relations (employees, self-employed, employers), social security coverage (yes/no) and type of contract -only for employees- (written, oral, none), in a cross-sectional study of 8,823 non-agricultural workers based on the I Central American Survey of Working Conditions and Health of 2011. Using logistic regression models, adjusted odds ratios (aOR) by country, age and occupation, of poor self-perceived and mental health were calculated by sex. Different models were first fitted separately for the three dimensions of employment conditions, then for employment profiles as independent variables. Results:Poor self-perceived health was reported by 34 % of women and 27 % of men, and 30 % of women and 26 % of men reported poor mental health. Lack of social security coverage was associated with poor ...
There are many reasons for the health inequities that we see around the world today. Public policy and the way society organises its affairs affects the economic, social and physical factors that influence the conditions in which people are born, grow, live, work and age - the social determinants of health. Tackling health inequities is a political issue that requires leadership, political courage, progressive public policy, social struggle and action, and a sound evidence base.
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 ...
The British Academy presents a collection of opinion pieces on health inequalities from leading social scientists. Each of the authors has written an article, drawing on the evidence base for their particular area of expertise, identifying one policy interventionthat they think local authorities could introduce to improve the health of the local population and reduce health inequalities. The report seeks to help local policymakers improve the health of their communities by presenting evidence from the social sciences that can help reduce inequalities in health. With a foreword from Sir Michael Marmot, the report further explores whatThe Marmot Reviewconfirmed: that socio-economic inequalities affect health outcomes and that there is a social gradient in health. In some senses this is a social sciences dialogue companion toThe Marmot Review.
The British Academy presents a collection of opinion pieces on health inequalities from leading social scientists. Each of the authors has written an article, drawing on the evidence base for their particular area of expertise, identifying one policy intervention that they think local authorities could introduce to improve the health of the local population and reduce health inequalities. The report seeks to help local policymakers improve the health of their communities by presenting evidence from the social sciences that can help reduce inequalities in health. With a foreword from Sir Michael Marmot, the report further explores what The Marmot Reviewconfirmed: that socio-economic inequalities affect health outcomes and that there is a social gradient in health. In some senses this is a social sciences dialogue companion to The Marmot Review.