Carme Borrell

University Pompeu Fabra, Barcino, Catalonia, Spain

Are you Carme Borrell?

Claim your profile

Publications (473)1054.87 Total impact

  • [Show abstract] [Hide abstract]
    ABSTRACT: Fuel poverty and cold housing constitute a significant public health problem. Energy efficiency interventions, such as façade retrofitting, address the problem from a structural and long-term perspective. Despite evidence of the health benefits of insulation, little is known about the political and social contexts that contribute to social inequalities in receiving and experiencing health benefits from these interventions. We used a realist review methodology to better understand the mechanisms that explain how and why variations across different social groups appear in receiving energy efficiency façade retrofitting interventions and in their impact on health determinants. We considered the four stages of the policy implementation framework: public policy approach; policy; receiving intervention and impact on health determinants. We found strong evidence that certain social groups (low-income, renters, elderly) suffering most from fuel poverty, experience more barriers for undertaking a building retrofitting (due to factors such as upfront costs, “presentism” thinking, split incentives, disruption and lack of control), and that some public policies on housing energy efficiency may exacerbate these inequalities. This can be avoided if such policies specifically aim at tackling fuel poverty or social inequities, are completely free to users, target the most affected groups and are adapted to their needs.
    No preview · Article · Apr 2016
  • [Show abstract] [Hide abstract]
    ABSTRACT: Background: Despite a concerted policy effort in Europe, social inequalities in health are a persistent problem. Developing a standardised measure of socioeconomic level across Europe will improve the understanding of the underlying mechanisms and causes of inequalities. This will facilitate developing, implementing and assessing new and more effective policies, and will improve the comparability and reproducibility of health inequality studies among countries. This paper presents the extension of the European Deprivation Index (EDI), a standardised measure first developed in France, to four other European countries-Italy, Portugal, Spain and England, using available 2001 and 1999 national census data. Methods and results: The method previously tested and validated to construct the French EDI was used: first, an individual indicator for relative deprivation was constructed, defined by the minimal number of unmet fundamental needs associated with both objective (income) poverty and subjective poverty. Second, variables available at both individual (European survey) and aggregate (census) levels were identified. Third, an ecological deprivation index was constructed by selecting the set of weighted variables from the second step that best correlated with the individual deprivation indicator. Conclusions: For each country, the EDI is a weighted combination of aggregated variables from the national census that are most highly correlated with a country-specific individual deprivation indicator. This tool will improve both the historical and international comparability of studies, our understanding of the mechanisms underlying social inequalities in health and implementation of intervention to tackle social inequalities in health.
    No preview · Article · Dec 2015 · Journal of Epidemiology & Community Health

  • No preview · Article · Dec 2015 · Annals of epidemiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: Socioeconomic inequalities in alcohol-related mortality have been documented in several European countries, but it is unknown whether the magnitude of these inequalities differs between countries and whether these inequalities increase or decrease over time. Methods and findings: We collected and harmonized data on mortality from four alcohol-related causes (alcoholic psychosis, dependence, and abuse; alcoholic cardiomyopathy; alcoholic liver cirrhosis; and accidental poisoning by alcohol) by age, sex, education level, and occupational class in 20 European populations from 17 different countries, both for a recent period and for previous points in time, using data from mortality registers. Mortality was age-standardized using the European Standard Population, and measures for both relative and absolute inequality between low and high socioeconomic groups (as measured by educational level and occupational class) were calculated. Rates of alcohol-related mortality are higher in lower educational and occupational groups in all countries. Both relative and absolute inequalities are largest in Eastern Europe, and Finland and Denmark also have very large absolute inequalities in alcohol-related mortality. For example, for educational inequality among Finnish men, the relative index of inequality is 3.6 (95% CI 3.3-4.0) and the slope index of inequality is 112.5 (95% CI 106.2-118.8) deaths per 100,000 person-years. Over time, the relative inequality in alcohol-related mortality has increased in many countries, but the main change is a strong rise of absolute inequality in several countries in Eastern Europe (Hungary, Lithuania, Estonia) and Northern Europe (Finland, Denmark) because of a rapid rise in alcohol-related mortality in lower socioeconomic groups. In some of these countries, alcohol-related causes now account for 10% or more of the socioeconomic inequality in total mortality. Because our study relies on routinely collected underlying causes of death, it is likely that our results underestimate the true extent of the problem. Conclusions: Alcohol-related conditions play an important role in generating inequalities in total mortality in many European countries. Countering increases in alcohol-related mortality in lower socioeconomic groups is essential for reducing inequalities in mortality. Studies of why such increases have not occurred in countries like France, Switzerland, Spain, and Italy can help in developing evidence-based policies in other European countries.
    Full-text · Article · Dec 2015 · PLoS Medicine
  • [Show abstract] [Hide abstract]
    ABSTRACT: In the aftermath of the Great Recession, public health scholars have grown increasingly interested in studying the health consequences of macroeconomic changes. Reflecting existing debates on the nature of this relationship, research on effects of the recent economic crisis has sparked considerable controversy. On one hand, there is evidence to support the notion that macroeconomic downturns are good for health. On the other hand, a growing number of studies warn that the current economic crisis can be expected to pose serious problems for the public's health. This article contributes to this debate through a review of recent evidence in three case studies: Iceland, Spain, and Greece. It shows that the economic crisis has negatively impacted some population health indicators (e.g., mental health) in all three countries, but especially in Greece. Available evidence defies deterministic conclusions, including increasingly "common sense" claims about economic downturns improving life expectancy and reducing mortality. While our results echo previous research in finding that the relationship between economic crises and population health is complex, they also indicate that this complexity is not arbitrary. On the contrary, changing social and political contexts provide meaningful, if partial, explanations for the perplexing nature of recent empirical findings.
    No preview · Article · Nov 2015 · International Journal of Health Services
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction Given the increasing number of people in Spain struggling to pay housing-related costs during the economic recession, it is important to assess the health status of these communities as compared to the general population and to better understand the different housing dimensions that are related with poor mental health. This study aims to describe the housing conditions and health status of a sample of people assisted by Caritas Barcelona (Spain) and living in inadequate housing and/or struggling to pay their rent or mortgage, to compare the health outcomes of this population with those of the overall population of Barcelona, and to analyze the association between housing dimensions and mental health. Methods We used a cross-sectional design. The participating adults (n = 320) and children (n = 177) were those living in the dioceses of Barcelona, Sant Feliu and Terrassa (Spain) in 2012 and assisted by Cáritas. They were asked to answer to three questionnaires on housing and health conditions. Eight health related variables were used to compare participants with Barcelona’s residents and associations between housing conditions and poor mental health were examined with multivariate logistic regression models. Results In Barcelona, people seeking Caritas’s help and facing serious housing problems had a much poorer health status than the general population, even when compared to those belonging to the most deprived social classes. For example, 69.4 % of adult participants had poor mental health compared to 11.5 % male and 15.2 % female Barcelona residents. Moreover, housing conditions were associated with poor mental health. Conclusions This study has shown how, in a country hit by the financial recession, those people facing housing problems have much worse health compared to the general population.
    Full-text · Article · Nov 2015 · International Journal for Equity in Health
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose: The purpose of the study was to analyze the determinants of citations such as publication year, article type, article topic, article selected for a press release, number of articles previously published by the corresponding author, and publication language in a Spanish journal of public health. Methods: Observational study including all articles published in Gaceta Sanitaria during 2007-2011. We retrieved the number of citations from the ISI Web of Knowledge database in June 2013 and also information on other variables such as number of articles published by the corresponding author in the previous 5 years (searched through PubMed), selection for a press release, publication language, article type and topic, and others. Results: We included 542 articles. Of these, 62.5% were cited in the period considered. We observed an increased odds ratio of citations for articles selected for a press release and also with the number of articles published previously by the corresponding author. Articles published in English do not seem to increase their citations. Conclusions: Certain externalities such as number of articles published by the corresponding author and being selected for a press release seem to influence the number of citations in national journals.
    No preview · Article · Oct 2015 · Annals of epidemiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Social and economic policies can help reduce health inequalities Over the past few years, SOPHIE has accumulated evidence regarding the influence of social and economic policies on the level of health across the population and on the degree to which health inequalities are influenced by socioeconomic, gender and immigration factors. At the same time, SOPHIE has shown — through the analysis of several examples across Europe — how equity-oriented policies can ameliorate these health inequalities. These studies can help public health and social justice advocates build a strong case for fairer social and economic policies that will lead to the reductions in health inequalities that most governments have included among their goals. Our findings and their policy implications Economic recessions, fiscal policies and health. The impact of the Great Recession on health in Europe varies depending on the health indicator in question, the levels of social protection offered by particular countries as well as one’s gender and socioeconomic status. Social protection policies appear to be effective in limiting the influence of macroeconomic fluctuations on mortality rates. In addition, interventions aimed at protecting and promoting mental health, preventing suicides, treating mental disorders and preventing alcohol abuse become especially significant in times of economic hardship. Even though recessions may have the effect of reducing short-term mortality, those positive effects may be more than offset by the increases in mortality brought on by austerity policies, at least in the case of some causes of mortality. Generous social protection policies reduce poverty and improve health. Generous unemployment insurance policies reduce material hardship and psychological distress for unemployed and employed people alike. Health benefits can result from enhancements to unemployment insurance generosity, such as measures that ensure that the majority of unemployed individuals receive unemployment benefits; flexible eligibility criteria that include situations such as seasonal work, reduced hours and self-employment; an adequate income replacement rate that meets the cost of living a healthy life; short or no waiting periods between a job loss and the receipt of benefits; and the continuance of benefits throughout the entire period of unemployment. A large proportion of new onset of chronic illness can be attributed to unemployment. Policy interventions that maintain employment and rapidly return the unemployed back to the workforce can reduce the burden of chronic conditions on European health care systems. Generous family support policies are predictive of reductions in child poverty. Higher levels of spending on active labour market policies are linked to better population health. Efforts to oppose cuts in social protection programmes are successful when the target group is politically powerful. High quality employment in a regulated labour market is beneficial for workers’ health and reduces inequality. To measure and monitor precarious and informal employment situations and their impact on health, standardised definitions and indicators, as well as improved surveys and information systems, must be developed. Employment conditions and job quality, as they relate to health inequalities, differ between and within EU countries. The growth of precarious employment must be halted, and jobs should become more secure and of better quality in order to protect the health and well-being of workers and to reduce health inequalities. Employment security and the quality of psychosocial working conditions and work-family balance should be improved. This improvement should also apply to self-employment and micro-enterprise situations. Labour market policies governing employment protection, part-time arrangements and workplace safety impact on workers’ health. Urban planning impacts health equity. Social and functional mixing, density, safety and accessibility all matter when it comes to health. The way cities manage urban planning makes a difference in the health of residents, particularly that of women and the elderly. Policies aimed at achieving ‘equal’ access to recreational facilities, markets and other core public services may not suffice. Deprived neighbourhoods may need more tailor-made investments to benefit from the health-promoting capacities of urban density, access to public spaces and facilities, and a vital mix of functions. As an example, the health of populations in the most deprived areas could benefit from investments in urban regeneration. Urban renewal projects have been shown to have a positive impact on self-reported health. They are also associated with decreased socioeconomic health inequalities and increases in healthy behaviours, but not with reductions in road traffic injuries. Housing policies can reduce health inequalities. A large body of literature shows the link between inadequate housing conditions and poor physical and mental health. In Europe, housing conditions related to fuel poverty are unevenly distributed and affect health. Housing insulation for fuel-poor households can improve health and reduce cold-related mortality. Policies on housing energy efficiency can reduce the health consequences of fuel poverty, but need to be free to users, target the most affected groups and be adapted to their needs. Public policies that tackle housing instability and its consequences are urgently needed. This is especially true in Southern European countries, where people facing housing exclusion experience intense levels of mental distress. Access to secure and adequate housing can improve the health of these populations. Gender policies influence gender inequalities in health. Gender inequalities in health are larger in countries with policies less oriented towards gender equity. Policies that support women’s participation in the labour force and decrease their burden of care, such as increasing public services and support for families and entitlements for fathers, are related to lower levels of gender inequalities in terms of health. Parental leave for both parents with universal coverage and earning replacement combined with working time flexibility to balance family demands seem to contribute to equalising time use between genders. Public services and benefits for disabled and dependent people can reduce the burden placed on their family caregivers and hence improve caregivers’ health. Integration policies make a difference on immigrants’ health. Different integration policy models across Europe appear to make a difference on immigrants’ health. Immigrants in ‘exclusionist’ countries — with severe restrictions on access to citizenship and few integration policies — suffer from poorer health, higher levels of depression and mortality. Therefore, adopting restrictive policies in areas related to immigrants’ integration may bring health consequences. Within the healthcare sector, legal barriers to public system entitlement hinder immigrants’ access to necessary care. Lessons learned on the research process that can inform future studies Evaluating structural policies is a new methodological challenge. Mixed methods are essential to such evaluation, and we found that a combination of quantitative and qualitative methods, as well as realist approaches, yielded evidence that was strong, rich and relevant. Quantitative cross-national comparisons provided new data on association between broad policy ‘regimes’ and health inequalities, especially in new researched fields. Most comparative studies would not have been possible without the many European-wide surveys initiated in the last 10 to 15 years, and we strongly recommend further development of these surveys. When available, quasi-experimental data (e.g. time-trend or pre-post intervention-control) could yield stronger evidence, even though such data usually refer to specific interventions with limited impact — in sharp contrast to the current magnitude of health inequalities. Despite several challenges in their application, realist approaches do help to address new and vital questions about how policies achieve impacts and under which conditions. Moreover, as the impacts of changing contexts and policies differ at the intersection of different axes of inequality, the intersectionality perspective should be taken into account in the design and evaluation of policies and reinforced in the research carried out on health inequalities. Community and civil society participation in health equity research is a costly, long-term yet worthwhile process. The participation of affected populations and frontline professionals adds validity to policy evaluations and research, and the voice of frontline organisations is highly valued by society and can maximise the impact of research. Face-to-face contact, respect and gaining trust are key for the effective involvement of stakeholders in research and in the use of findings. Complementary to scientific dissemination, social media are effective channels for broadening the reach of politically relevant research. Researchers should make efforts to actively disseminate their work on and knowledge of the social and political determinants of health through emerging social channels, and agencies and research institutions should back these efforts.
    Full-text · Book · Sep 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Objective: To analyse gender inequalities in research on public health and epidemiology in Spain for the period 2007-2014. Method: A descriptive study was conducted by sex of leadership positions in the Centre for Biomedical Research Network (CIBER), especially in the subject area of epidemiology and public health (CIBERESP) in 2014; scientific societies of public health (SESPAS) and epidemiology (SEE) 2009-2014; research projects requested (13,320) and financed (4,699), and monetary amounts of calls for Strategic Action in Health (AES), 2007-2013. Results: Women were clearly under-represented in positions of leadership and in research excellence in public health (CIBER), with a predominance of men in decision-making positions. Although research projects led by women in AES increased slightly between 2007 and 2013, among proposed projects this figure was less than 50%, with the exception of the public health commission. The gender gap was even greater in funded projects. Projects led by men were more likely to be funded, representing 29% in public health. There was also a persistence of horizontal gender segregation in positions of scientific recognition in the SESPAS and SEE Congresses. Conclusions: The overrepresentation of male leaders in public health research in Spain can be understood as an indicator and a consequence of androcentrism in scientific societies and professional groups. This sexist situation threatens the existence of innovative products and services from a gender perspective that respond to the needs and demands of society as a whole. More women are needed in research incorporating this perspective.
    Full-text · Article · Sep 2015 · Gaceta Sanitaria

  • No preview · Article · Sep 2015 · International journal of cardiology
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background: The objective of this study was to estimate changes over time in health status and selected health behaviours during the Great Recession, in the period 2011/12, in Spain, both overall, and according to socioeconomic position and gender. Methods: We applied a before-after estimation on data from four editions of the Spanish National Health Survey: 2001, 2003/04, 2006/07 and 2011/12. This involved applying linear probability regression models accounting for time-trends and with robust standard errors, using as outcomes self-reported health and health behaviours, and as the main explanatory variable a dummy "Great Recession" for the 2011/12 survey edition. All the computations were run separately by gender. The final sample consisted of 47,156 individuals aged between 25 and 64 years, economically active at the time of the interview. We also assessed the inequality of the effects across socio-economic groups. Results: The probability of good self-reported health increased for women (men) by 9.6 % (7.6 %) in 2011/12, compared to the long term trend. The changes are significant for all educational levels, except for the least educated. Some healthy behaviours also improved but results were rather variable. Adverse dietary changes did, however, occur among men (though not women) who were unemployed (e.g., the probability of declaring eating fruit daily changed by -12.1 %), and among both men (-21.8 %) and women with the lowest educational level (-15.1 %). Conclusions: Socioeconomic inequalities in health and health behaviour have intensified, in the period 2011/12, in at least some respects, especially regarding diet. While average self-reported health status and some health behaviours improved during the economic recession, in 2011/12, this improvement was unequal across different socioeconomic groups.
    Full-text · Article · Sep 2015 · BMC Public Health
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: To describe the magnitude and characteristics of crashes and drivers involved in head-on crashes on two-way interurban roads in Spain between 2007 and 2012, and to identify the factors associated with the likelihood of head-on crashes on these roads compared with other types of crash. A cross-sectional study was conducted using the National Crash Register. The dependent variables were head-on crashes with injury (yes/no) and drivers involved in head-on crashes (yes/no). Factors associated with head-on crashes and with being a driver involved in a head-on crash versus other types of crash were studied using a multivariate robust Poisson regression model to estimate proportion ratios (PR) and confidence intervals (95% CI). There were 9,192 head-on crashes on two-way Spanish interurban roads. A total of 15,412 men and 3,862 women drivers were involved. Compared with other types of crash, head-on collisions were more likely on roads 7 m or more wide, on road sections with curves, narrowings or drop changes, on wet or snowy surfaces, and in twilight conditions. Transgressions committed by drivers involved in head-on crashes were driving in the opposite direction and incorrectly overtaking another vehicle. Factors associated with a lower probability of head-on crashes were the existence of medians (PR=0.57; 95%CI: 0.48-0.68) and a paved shoulder of less than 1.5 meters (PR=0.81; 95%CI: 0.77-0.86) or from 1.5 to 2.45 meters (PR=0.90; 95%CI: 0.84-0.96). This study allowed the characterization of crashes and drivers involved in head-on crashes on two-way interurban roads. The lower probability observed on roads with median strips point to these measures as an effective way to reduce these collisions. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.
    Full-text · Article · Sep 2015 · Gaceta Sanitaria
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Discrimination harms immigrants' health. The objective of this study was to analyze the association between perceived discrimination and health outcomes among first and second generation immigrants from low-income countries living in Europe, while accounting for sex and the national policy on immigration. Cross-sectional study including immigrants from low-income countries aged ≥15 years in 18 European countries (European Social Survey, 2012) (sample of 1271 men and 1335 women). The dependent variables were self-reported health, symptoms of depression, and limitation of activity. The independent variables were perceived group discrimination, immigrant background and national immigrant integration policy. We tested for association between perceived group discrimination and health outcomes by fitting robust Poisson regression models. We only observed significant associations between perceived group discrimination and health outcomes in first generation immigrants. For example, depression was associated with discrimination among both men and women (Prevalence Ratio-, 1.55 (95% CI: 1.16-2.07) and 1.47 (95% CI: 1.15-1.89) in the multivariate model, respectively), and mainly in countries with assimilationist immigrant integration policies. Perceived group discrimination is associated with poor health outcomes in first generation immigrants from low-income countries who live in European countries, but not among their descendants. These associations are more important in assimilationist countries.
    Full-text · Article · Aug 2015 · International Journal of Environmental Research and Public Health
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: In this paper, we discuss the discourses about the health privatization from the analysis of interviews and manifests of three Catalan movements: Centre d'Anàlisis i Programes Sanitaris (Caps), Grup de Defensa de Sanitat Pública (15MBCNSalut) and Plataforma Pel Dret a la Salut (PDS). The content analysis has been adopted as methodology. The analysis has evidenced a dichotomy between public and private systems as a duality that structures discourses favoring the public model and the great efforts made by the movements to guarantee that model. This has shaped the movements as a revolutionary force that defends the public system from private threats by assuming that it essentially represents the people's ideals. The debate between the traditional and the new in social action has been central to the analysis, as well as the problem of coexistence of different models of action.
    Full-text · Article · Jul 2015 · Athenea Digital: Revista de Pensamiento e Investigacion Social
  • [Show abstract] [Hide abstract]
    ABSTRACT: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15-64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24-1.56, PR2012 = 1.56; 95% CI: 1.33-1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86-1.40, PR2012 = 1.34; 95% CI: 1.06-1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11-0.43, PR2012 = 1.20; 95% CI: 0.73-2.01). Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants' health status. © The Author 2015. Published by Oxford University Press on behalf of the European Public Health Association. All rights reserved.
    No preview · Article · Jun 2015 · The European Journal of Public Health

  • No preview · Article · Jun 2015 · Gaceta Sanitaria
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Introduction: Socioeconomic inequalities affecting health are of major importance in Europe. The literature enhances the role of social determinants of health, such as socioeconomic characteristics and urbanization, to achieve health equity. Yet, there is still much to know, mainly concerning the association between cause-specific mortality and several social determinants, especially in metropolitan areas. Methods: A cross-sectional ecological study was carried out. Using a hierarchical Bayesian spatial model, we estimated sex-specific smoothed Standardized Mortality Ratios (sSMR) and measured the relative risks (RR), and 95 % credible intervals, for cause-specific mortality relative to 1. urbanization level, 2. material deprivation and 3. material deprivation adjusted by urbanization. Results: The statistical association between mortality and material deprivation and between mortality and urbanization changes by cause of death and sex. Dementia and MN larynx, trachea, bronchus and lung are the causes of death showing higher relative risk associated with urbanization. Infectious and parasitic diseases, Chronic liver disease and Diabetes are the causes of death presenting higher relative risk associated with material deprivation. Ischemic heart disease was the only cause with a statistical association with both determinants, and MN female breast was the only without any statistical association. Urbanization level reduces the impact of material deprivation for most of the causes of death. Men face a higher impact of material deprivation and urbanization level, than women, in most cause-specific mortality, even when considering the adjusted model. Conclusions: Our findings explore the specific pattern of fourteen causes of death in LMA and reveals small areas with an excess risk of mortality associated with material deprivation, thereby identifying problematic areas that could potentially benefit from public policies effecting social inequalities.
    Full-text · Article · Jun 2015 · International Journal for Equity in Health
  • [Show abstract] [Hide abstract]
    ABSTRACT: The aim of this study was to analyze inequalities in the prevalence of poor mental health and their association with socioeconomic variables and with the care network in the Autonomous Communities in Spain. A cross-sectional multilevel study was performed, which analyzed individual data from the National Health Survey in Spain (ENS), in 2006 ( n = 29,476 people over the age of 16). The prevalence of poor mental health was the dependent variable, measured by the General Health Questionnaire (GHQ-12 > = 3). Individual and contextual socioeconomic variables, along with mental health services in the Autonomous Communities, were included as independent variables. Models of multilevel logistic regression were used, and odds ratios (OR) were obtained, with confidence intervals (CI) of 95%. The results showed that there are inequalities in the prevalence of poor mental health in Spain, associated to contextual variables, such as unemployment rate (men OR 1.04 CI 1.01–1.07; women OR 1.02 CI 1.00–1.05). On the other hand, it was observed that inequalities in the mental health care resources in the Autonomous Communities also have an impact on poor mental health.
    No preview · Article · May 2015
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: Background Preventable mortality is a good indicator of possible problems to be investigated in the primary prevention chain, making it also a useful tool with which to evaluate health policies particularly public health policies. This study describes inequalities in preventable avoidable mortality in relation to socioeconomic status in small urban areas of thirty three Spanish cities, and analyses their evolution over the course of the periods 1996–2001 and 2002–2007. Methods We analysed census tracts and all deaths occurring in the population residing in these cities from 1996 to 2007 were taken into account. The causes included in the study were lung cancer, cirrhosis, AIDS/HIV, motor vehicle traffic accidents injuries, suicide and homicide. The census tracts were classified into three groups, according their socioeconomic level. To analyse inequalities in mortality risks between the highest and lowest socioeconomic levels and over different periods, for each city and separating by sex, Poisson regression were used. Results Preventable avoidable mortality made a significant contribution to general mortality (around 7.5%, higher among men), having decreased over time in men (12.7 in 1996–2001 and 10.9 in 2002–2007), though not so clearly among women (3.3% in 1996–2001 and 2.9% in 2002–2007). It has been observed in men that the risks of death are higher in areas of greater deprivation, and that these excesses have not modified over time. The result in women is different and differences in mortality risks by socioeconomic level could not be established in many cities. Conclusions Preventable mortality decreased between the 1996–2001 and 2002–2007 periods, more markedly in men than in women. There were socioeconomic inequalities in mortality in most cities analysed, associating a higher risk of death with higher levels of deprivation. Inequalities have remained over the two periods analysed. This study makes it possible to identify those areas where excess preventable mortality was associated with more deprived zones. It is in these deprived zones where actions to reduce and monitor health inequalities should be put into place. Primary healthcare may play an important role in this process.
    Full-text · Article · Apr 2015 · International Journal for Equity in Health
  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: 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 (iii) 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.
    Full-text · Article · Mar 2015 · Social Science & Medicine

Publication Stats

8k Citations
1,054.87 Total Impact Points


  • 1997-2016
    • University Pompeu Fabra
      • Department of Experimental and Health Sciences
      Barcino, Catalonia, Spain
    • Catalan Institute of Oncology
      Badalona, Catalonia, Spain
  • 2013-2015
    • IR-Sant Pau - Sant Pau Institute of Biomedical Research
      Barcino, Catalonia, Spain
  • 1997-2015
    • Agència de Salut Pública de Barcelona
      Barcino, Catalonia, Spain
  • 2014
    • Erasmus MC
      • Department of Public Health
      Rotterdam, South Holland, Netherlands
  • 2012-2013
    • University of Alicante
      • Community Nursing, Preventive Medicine and Public Health and History of Science
      Alicante, Valencia, Spain
    • IMIM Hospital del Mar Medical Research Institute
      Barcino, Catalonia, Spain
  • 2004-2012
    • Instituto de Salud Carlos III
      Madrid, Madrid, Spain
  • 2003-2012
    • Institut Marqués, Spain, Barcelona
      Barcino, Catalonia, Spain
    • Johns Hopkins University
      Baltimore, Maryland, United States
  • 2008
    • Universitat de Girona
      • Department of Nursing
      Girona, Catalonia, Spain
  • 2004-2005
    • University of Helsinki
      • Department of Dental Public Health
      Helsinki, Uusimaa, Finland
    • Instituto Nacional de Salud Pública
      Cuernavaca, Morelos, Mexico
  • 1999-2003
    • Instituto de Salud Global de Barcelona
      Barcino, Catalonia, Spain
  • 2001
    • Fred Hutchinson Cancer Research Center
      • Cancer Prevention Program
      Seattle, Washington, United States
  • 1998
    • The Andalusian School of Public Health
      Granata, Andalusia, Spain
  • 1993-1997
    • Institut Català de la Salut
      Cerdanyola del Vallès, Catalonia, Spain
  • 1996
    • Harvard University
      Cambridge, Massachusetts, United States