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Cash-Gibson L, Benach J. Understanding Health Inequalities Research Capacities: Insights and Recommendations From Comparing Two High Income Settings. Int J Soc Determinants Health Health Serv 2024; 54:163-170. [PMID: 38311911 DOI: 10.1177/27551938241230006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/06/2024]
Abstract
Generating evidence on health inequalities (HI) is necessary to raise awareness of these issues, describe and monitor their evolution, analyze their causes, and inform interventions aiming to improve health equity. Yet not all cities and countries have the capacity to produce this type of research. Recent research provides new contextual and causal insights into this research production process, and in-depth understanding on why and how this type of research is produced in certain settings. This article aims to analyze two recent case studies that have uniquely explored this process in two high producers of HI research and high-income country settings to identify learning and distil recommendations, which may be insightful for other settings. Expanding and investing in this line of research is critical, particularly in places with lower HI research output and related capacity, in order to identify key contextual conditions and mechanisms that may enable or hinder this process. This new knowledge could guide the development of new HI research capacity strengthening strategies to foster this research in different settings, worldwide. More understanding is also needed on the relationship between HI research, policy, and action in order to tackle HI.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain
- UPF- Barcelona School of Management (UPF-BSM), University Pompeu Fabra, Barcelona, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain
- UPF- Barcelona School of Management (UPF-BSM), University Pompeu Fabra, Barcelona, Spain
- Department of Health Policy & Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, USA
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Madrid, Spain
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Benach J, Muntaner C. Introduction to Issue 54:2. Int J Soc Determinants Health Health Serv 2024; 54:73-75. [PMID: 38445326 DOI: 10.1177/27551938241237001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/07/2024]
Affiliation(s)
- Joan Benach
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC; UPF-BSM), Barcelona, SpainResearch Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, SpainEcological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Madrid, Spain
| | - Carles Muntaner
- Bloomberg Faculty of Nursing, Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto, Toronto, CanadaJohns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC; UPF-BSM), Barcelona, Spain
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3
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Muntaner C, Benach J. Unveiling Precarious Employment: From the Reserve Army to Techno-Feudalism. Int J Soc Determinants Health Health Serv 2024; 54:5-6. [PMID: 38008988 PMCID: PMC10797832 DOI: 10.1177/27551938231217939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 11/15/2023] [Indexed: 11/28/2023]
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Caroz-Armayones JM, Benach J, Delclós C, Julià M. The double burden of precariousness: linking housing, employment, and perceived stress - a cross-sectional study. Int J Environ Health Res 2023; 33:1102-1111. [PMID: 35549954 DOI: 10.1080/09603123.2022.2075330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2022] [Accepted: 05/05/2022] [Indexed: 06/15/2023]
Abstract
Employment precariousness is widely recognised as a social determinant of health and a chronic stressor. Yet precariousness extends beyond employment, into other aspects of life. Using a multidimensional social pathways approach, this study examines the synergistic effects of employment and housing precariousness on self-perceived stress. This study uses the PRESSED dataset (N = 255) derived from the Barcelona Health Survey, which collects data on stress using the Perceived Stress Scale (PSS). Employment precariousness was operationalized using the Employment Precariousness Scale (EPRES) and a multidimensional indicator of housing precariousness was constructed. Generalized structural equation modelling was used to estimate associations between these indicators and self-perceived stress measured by Perceived Stress Survey (PSS), after accounting for sociodemographic variables. Employment and housing precariousness were positively associated with self-perceived stress (OR = 3.23 ; p = 0.002) (OR = 4.28 ; p = 0.065) respectively. The mediating effect of housing precariousness accounted for 16% of the total effect of employment precariousness on stress after controlling for sociodemographic variables. Furthermore, we find that both precarious conditions were unequally distributed by age, sex educational level, and place of birth in the sample. We conclude that employment and housing precariousness are important chronic stressors and that a social pathway approach is needed.
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Affiliation(s)
- Josep M Caroz-Armayones
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- JHU-UPF Public Policy Center, Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- JHU-UPF Public Policy Center, Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid (UAM), Madrid, Spain
| | - Carlos Delclós
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- JHU-UPF Public Policy Center, Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- Institute of Government and Public Policy (IGOP), Department of Political Science and Public Law, Universitat Autònoma de Barcelona (UAB), Barcelona, Spain
| | - Mireia Julià
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain
- ESIMar (Mar Nursing School), Parc de Salut Mar, University Pompeu Fabra-affiliated, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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Muntaner C, Benach J. Tribute to Barbara Ehrenreich: Fighting for Labor Through Critical Research Journalism. Int J Soc Determinants Health Health Serv 2023; 53:568-569. [PMID: 37872664 PMCID: PMC10631257 DOI: 10.1177/27551938231208339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Accepted: 08/21/2023] [Indexed: 10/25/2023]
Abstract
This is a short commentary to accompany the article "Hospital Workers: Class Conflicts in the Making" by Barbara Ehrenreich and John H. Ehrenreich. The article was originally published in the International Journal of Health Services in 1975. We are revisiting it in the current issue of the International Journal of Social Determinants of Health and Health Services due to its continued relevance and significance in the twenty-first Century.
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Affiliation(s)
- Carles Muntaner
- Public Health, Nursing & Psychiatry, University of Toronto, Toronto, Canada
| | - Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Madrid, Spain
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Benach J, Muntaner C. Social Determinants of Health at the End of 2023: Decolonization, Global South, Mechanisms, Big Pharma, COVID 19 and Health Services. Int J Soc Determinants Health Health Serv 2023; 53:389-391. [PMID: 37933790 DOI: 10.1177/27551938231208953] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2023]
Affiliation(s)
- Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions, Universitat Pompeu Fabra, Barcelona; Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPFBSM), Barcelona; Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Madrid
| | - Carles Muntaner
- University of Toronto, MAP Center for Urban Health Solutions, Toronto, ON, Canada
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Belvis F, Aleta A, Padilla-Pozo Á, Pericàs JM, Fernández-Gracia J, Rodríguez JP, Eguíluz VM, De Santana CN, Julià M, Benach J. Key epidemiological indicators and spatial autocorrelation patterns across five waves of COVID-19 in Catalonia. Sci Rep 2023; 13:9709. [PMID: 37322048 PMCID: PMC10272129 DOI: 10.1038/s41598-023-36169-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Accepted: 05/26/2023] [Indexed: 06/17/2023] Open
Abstract
This research studies the evolution of COVID-19 crude incident rates, effective reproduction number R(t) and their relationship with incidence spatial autocorrelation patterns in the 19 months following the disease outbreak in Catalonia (Spain). A cross-sectional ecological panel design based on n = 371 health-care geographical units is used. Five general outbreaks are described, systematically preceded by generalized values of R(t) > 1 in the two previous weeks. No clear regularities concerning possible initial focus appear when comparing waves. As for autocorrelation, we identify a wave's baseline pattern in which global Moran's I increases rapidly in the first weeks of the outbreak to descend later. However, some waves significantly depart from the baseline. In the simulations, both baseline pattern and departures can be reproduced when measures aimed at reducing mobility and virus transmissibility are introduced. Spatial autocorrelation is inherently contingent on the outbreak phase and is also substantially modified by external interventions affecting human behavior.
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Affiliation(s)
- Francesc Belvis
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005, Barcelona, Spain.
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), 08005, Barcelona, Spain.
| | - Alberto Aleta
- Institute for Biocomputation and Physics of Complex Systems (BIFI), University of Zaragoza, 50018, Zaragoza, Spain
| | - Álvaro Padilla-Pozo
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), 08005, Barcelona, Spain
- Department of Sociology, Cornell University, Ithaca, New York, USA
| | - Juan-M Pericàs
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), 08005, Barcelona, Spain
- Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital, Vall d'Hebron Institute for Research, CIBERehd, 08035, Barcelona, Spain
- Infectious Disease Department, Hospital Clínic, 08036, Barcelona, Spain
| | - Juan Fernández-Gracia
- Instituto de Física Interdisciplinar Y Sistemas Complejos IFISC (CSIC-UIB), 07122, Palma de Mallorca, Spain
| | - Jorge P Rodríguez
- Instituto de Física Interdisciplinar Y Sistemas Complejos IFISC (CSIC-UIB), 07122, Palma de Mallorca, Spain
- Instituto Mediterráneo de Estudios Avanzados IMEDEA (CSIC-UIB), 07190, Esporles, Spain
| | - Víctor M Eguíluz
- Instituto de Física Interdisciplinar Y Sistemas Complejos IFISC (CSIC-UIB), 07122, Palma de Mallorca, Spain
| | - Charles Novaes De Santana
- Instituto de Física Interdisciplinar Y Sistemas Complejos IFISC (CSIC-UIB), 07122, Palma de Mallorca, Spain
| | - Mireia Julià
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), 08005, Barcelona, Spain
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra-Affiliated, 08003, Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08005, Barcelona, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005, Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), 08005, Barcelona, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, 28049, Madrid, Spain
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Salas Quijada C, López-Contreras N, López-Jiménez T, Medina-Perucha L, León-Gómez BB, Peralta A, Arteaga-Contreras KM, Berenguera A, Queiroga Gonçalves A, Horna-Campos OJ, Mazzei M, Anigstein MS, Ribeiro Barbosa J, Bardales-Mendoza O, Benach J, Borges Machado D, Torres Castillo AL, Jacques-Aviñó C. Social Inequalities in Mental Health and Self-Perceived Health in the First Wave of COVID-19 Lockdown in Latin America and Spain: Results of an Online Observational Study. Int J Environ Res Public Health 2023; 20:ijerph20095722. [PMID: 37174240 DOI: 10.3390/ijerph20095722] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 03/29/2023] [Accepted: 04/19/2023] [Indexed: 05/15/2023]
Abstract
COVID-19 lockdowns greatly affected the mental health of populations and collectives. This study compares the mental health and self-perceived health in five countries of Latin America and Spain, during the first wave of COVID 19 lockdown, according to social axes of inequality. This was a cross-sectional study using an online, self-managed survey in Brazil, Chile, Ecuador, Mexico, Peru, and Spain. Self-perceived health (SPH), anxiety (measured through GAD-7) and depression (measured through PHQ-9) were measured along with lockdown, COVID-19, and social variables. The prevalence of poor SPH, anxiety, and depression was calculated. The analyses were stratified by gender (men = M; women = W) and country. The data from 39,006 people were analyzed (W = 71.9%). There was a higher prevalence of poor SPH and bad mental health in women in all countries studied. Peru had the worst SPH results, while Chile and Ecuador had the worst mental health indicators. Spain had the lowest prevalence of poor SPH and mental health. The prevalence of anxiety and depression decreased as age increased. Unemployment, poor working conditions, inadequate housing, and the highest unpaid workload were associated with worse mental health and poor SPH, especially in women. In future policies, worldwide public measures should consider the great social inequalities in health present between and within countries in order to tackle health emergencies while reducing the health breach between populations.
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Affiliation(s)
| | - Natalia López-Contreras
- Vicerrectoría de Investigación y Postgrado, Universidad de La Frontera, Temuco 4811230, Chile
| | - Tomás López-Jiménez
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Laura Medina-Perucha
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
| | - Brenda Biaani León-Gómez
- Unitat de Suport a la Recerca Metropolitana Nord, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08303 Mataró, Spain
| | - Andrés Peralta
- Public Health Institute, Pontificia Universidad Católica del Ecuador (PUCE), Quito 170525, Ecuador
| | - Karen M Arteaga-Contreras
- Servicios de Atención Psiquiátrica, Anillo Periférico #2767, Ed.5 P.B., Alcaldía La Magdalena Contreras, Cuidad de México 10200, Mexico
| | - Anna Berenguera
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- Departament d'Infermeria, Universitat de Girona, Emili Grahit, 77, 17003 Girona, Spain
| | - Alessandra Queiroga Gonçalves
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
- Unitat de Suport a la Recerca Terres de l'Ebre, Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 43500 Tortosa, Spain
- Unitat Docent de Medicina de Família i Comunitària Tortosa-Terres de L'Ebre, Institut Català de la Salut, 43500 Tortosa, Spain
| | - Olivia Janett Horna-Campos
- Escuela de Salud Pública "Salvador Allende", Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile
| | - Marinella Mazzei
- Escuela de Salud Pública "Salvador Allende", Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile
| | - Maria Sol Anigstein
- Escuela de Salud Pública "Salvador Allende", Facultad de Medicina, Universidad de Chile, Santiago 8380000, Chile
- Departamento de Antropología, Universidad de Chile, Santiago 6850331, Chile
| | - Jakeline Ribeiro Barbosa
- Center for Epidemiology and Health Surveillance, Oswaldo Cruz Foundation, Brasília 70904-130, Brazil
| | | | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Universitat Pompeu Fabra, 08002 Barcelona, Spain
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), 08002 Barcelona, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Daiane Borges Machado
- Center of Data and Knowledge Integration for Health, Gonçalo Moniz Institute, Oswaldo Cruz Foundation, Salvador 41745-715, Brazil
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA 02115, USA
| | | | - Constanza Jacques-Aviñó
- Fundació Institut Universitari per a la Recerca a l'Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), 08007 Barcelona, Spain
- Universitat Autònoma de Barcelona, 08193 Cerdanyola del Vallès, Spain
- Network for Research on Chronicity, Primary Care, and Health Promotion (RICAPPS), Spain
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Cash-Gibson L, Martinez-Herrera E, Benach J. Why and how has the United Kingdom become a high producer of health inequalities research over the past 50 years? A realist explanatory case study. Health Res Policy Syst 2023; 21:23. [PMID: 36959666 PMCID: PMC10037802 DOI: 10.1186/s12961-023-00968-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2023] [Accepted: 02/17/2023] [Indexed: 03/25/2023] Open
Abstract
BACKGROUND Evidence on health inequalities has been growing over the past few decades, yet the capacity to produce research on health inequalities varies between countries worldwide and needs to be strengthened. More in-depth understanding of the sociohistorical, political and institutional processes that enable this type of research and related research capacity to be generated in different contexts is needed. A recent bibliometric analysis of the health inequalities research field found inequalities in the global production of this type of research. It also found the United Kingdom to be the second-highest global contributor to this research field after the United States. This study aims to understand why and how the United Kingdom, as an example of a "high producer" of health inequalities research, has been able to generate so much health inequalities research over the past five decades, and which main mechanisms might have been involved in generating this specific research capacity over time. METHODS We conducted a realist explanatory case study, which included 12 semi-structured interviews, to test six theoretical mechanisms that we proposed might have been involved in this process. Data from the interviews and grey and scientific literature were triangulated to inform our findings. RESULTS We found evidence to suggest that at least four of our proposed mechanisms have been activated by certain conditions and have contributed to the health inequalities research production process in the United Kingdom over the past 50 years. Limited evidence suggests that two new mechanisms might have potentially also been at play. CONCLUSIONS Valuable learning can be established from this case study, which explores the United Kingdom's experience in developing a strong national health inequalities research tradition, and the potential mechanisms involved in this process. More research is needed to explore additional facilitating and inhibiting mechanisms and other factors involved in this process in this context, as well as in other settings where less health inequalities research has been produced. This type of in-depth knowledge could be used to guide the development of new health inequalities research capacity-strengthening strategies and support the development of novel approaches and solutions aiming to tackle health inequalities.
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Affiliation(s)
- Lucinda Cash-Gibson
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain.
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Catalonia, Spain.
- UPF Barcelona School of Management (UPF-BSM), Barcelona, Spain.
| | - Eliana Martinez-Herrera
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Catalonia, Spain
- Research Group of Epidemiology, National School of Public Health "Héctor Abad Gómez", University of Antioquia, Calle 62 No. 52-59 Bloque 33 Segundo Piso, Medellín, Colombia
| | - Joan Benach
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Catalonia, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma, Madrid, Spain
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Muntaner C, Benach J. Why Social (Political, Economic, Cultural, Ecological) Determinants of Health? Part 1: Background of a Contested Construct. Int J Soc Determinants Health Health Serv 2023; 53:27551938231152996. [PMID: 36721356 DOI: 10.1177/27551938231152996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
This article is the first half of a 2-part essay on the Social Determinants of Health (SDOH) as a field of scientific inquiry and theoretical framework, exploring its historical roots, current applications, and the controversies that surround it. Part 1 (this article) discusses the background and rationale of the SDOH framework, whilst part 2 (forthcoming) will analyze the current alternatives to this framework. The authors analyze the debate surrounding the contested term "social" in the field of health equity, through a clarification of the terms "social" and "social systems" and providing an alternative model through realist semantics and ethics. Despite the misunderstandings of the term "social," the authors argue that SDOH remains a useful umbrella term to capture the political, economic, cultural, and ecological determinants of health. Through this essay, the authors outline the reasons behind our decision to change this journal's title from International Journal of Health Services to International Journal of Social Determinants of Health and Health Services.
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Affiliation(s)
- Carles Muntaner
- Bloomberg Faculty of Nursing, Dalla Lana School of Public Health and Department of Psychiatry, University of Toronto, Toronto, Canada
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC; UPF-BSM), Barcelona, Spain
| | - Joan Benach
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC; UPF-BSM), Barcelona, Spain
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, 16770Universitat Pompeu Fabra, Barcelona, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Madrid, Spain
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Lemkow–Tovías G, Lemkow L, Cash‐Gibson L, Teixidó‐Compañó E, Benach J. Impact of COVID-19 inequalities on children: An intersectional analysis. Sociol Health Illn 2023; 45:145-162. [PMID: 36181484 PMCID: PMC9538856 DOI: 10.1111/1467-9566.13557] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 08/31/2022] [Indexed: 05/07/2023]
Abstract
Societal concerns about the effects of the COVID-19 pandemic have largely focussed on the social groups most directly affected, such as the elderly and health workers. However, less focus has been placed on understanding the effects on other collectives, such as children. While children's physical health appears to be less affected than the adult population, their mental health, learning and wellbeing is likely to have been significantly negatively affected during the pandemic due to the varying policy restrictions, such as withdrawal from face to face schooling, limited peer-to-peer interactions and mobility and increased exposure to the digital world amongst other things. Children from vulnerable social backgrounds, and especially girls, will be most negatively affected by the impact of COVID-19, given their different intersecting realities and the power structures already negatively affecting them. To strengthen the understanding of the social determinants of the COVID-19 crisis that unequally influence children's health and wellbeing, this article presents a conceptual framework that considers the multiple axes of inequalities and power relations. This understanding can then be used to inform analyses and impact assessments, and in turn inform the development of effective and equitable mitigation strategies as well as assist to be better prepared for future pandemics.
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Affiliation(s)
- Gabriel Lemkow–Tovías
- Facultat de Ciències Socials de ManresaUniversitat Vic‐Universitat Central de Catalunya (UVic‐UCC)ManresaSpain
| | - Louis Lemkow
- Institut de Ciència i Tecnologia AmbientalsUniversitat Autònoma de BarcelonaBarcelonaSpain
| | - Lucinda Cash‐Gibson
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS‐EMCONET), Department of Political and Social SciencesUniversitat Pompeu FabraBarcelonaCataloniaSpain
- Johns Hopkins University ‐ Pompeu Fabra University Public Policy Center (UPF‐BSM)BarcelonaCataloniaSpain
- Pompeu Fabra University‐UPF Barcelona School of Management (UPF‐BSM)BarcelonaSpain
| | - Ester Teixidó‐Compañó
- Facultat de Ciències de la Salut de ManresaUniversitat Vic‐Universitat Central de Catalunya (UVic‐UCC)ManresaSpain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS‐EMCONET), Department of Political and Social SciencesUniversitat Pompeu FabraBarcelonaCataloniaSpain
- Johns Hopkins University ‐ Pompeu Fabra University Public Policy Center (UPF‐BSM)BarcelonaCataloniaSpain
- Pompeu Fabra University‐UPF Barcelona School of Management (UPF‐BSM)BarcelonaSpain
- Ecological Humanities Research Group (GHECO)Universidad AutónomaMadridSpain
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12
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Ventura-Cots M, Bataller R, Lazarus JV, Benach J, Pericàs JM. Applying an equity lens to liver health and research in Europe. J Hepatol 2022; 77:1699-1710. [PMID: 35985542 DOI: 10.1016/j.jhep.2022.07.021] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Revised: 07/18/2022] [Accepted: 07/25/2022] [Indexed: 12/04/2022]
Abstract
Liver disease is a major cause of premature death and disability in Europe. However, morbidity and mortality are not equally distributed in the population. In spite of this, there are few studies addressing the issue of health inequalities in Europe. In this Public Health Corner article, we compare the research conducted on health inequalities in Europe to other settings and highlight the main differences based upon an extensive review of the literature. We report that only 10.2% of studies were led by European institutions or conducted in European populations and that certain topics such as alcohol-related liver disease are largely overlooked. In addition, we discuss the relevance of including a health equity lens when conducting clinical, epidemiological and health systems' research in liver disease and set out the basic requirements to tackle health inequalities in liver disease in Europe.
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Affiliation(s)
- Meritxell Ventura-Cots
- Liver Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades digestivas y hepáticas (CIBERehd), Madrid, Spain
| | - Ramon Bataller
- Center for Liver Diseases, Division of Gastroenterology, Hepatology and Nutrition, University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, Barcelona, Spain; Faculty of Medicine and Health Sciences, University of Barcelona, Barcelona, Spain; CUNY Graduate School of Public Health and Health Policy, NY, New York, USA
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain; Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain; Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Madrid, Spain
| | - Juan M Pericàs
- Liver Unit, Vall d'Hebron University Hospital, Barcelona, Spain; Vall d'Hebron Institut de Recerca (VHIR), Vall d'Hebron Barcelona Campus Hospitalari, Barcelona, Spain; Centro de Investigación Biomédica en Red de enfermedades digestivas y hepáticas (CIBERehd), Madrid, Spain; Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain.
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13
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Tumas N, Rodríguez López S, Mazariegos M, Ortigoza A, Anza Ramírez C, Pérez Ferrer C, Moore K, Yamada G, Menezes MC, Sarmiento OL, Pericàs JM, Belvis Costes F, Lazo M, Benach J. Are Women's Empowerment and Income Inequality Associated with Excess Weight in Latin American Cities? J Urban Health 2022; 99:1091-1103. [PMID: 36357625 PMCID: PMC7613896 DOI: 10.1007/s11524-022-00689-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/13/2022] [Indexed: 11/12/2022]
Abstract
While income gradients and gender inequalities in excess weight have been noted elsewhere, data from Latin American cities is lacking. We analyzed gender-specific associations between city-level women's empowerment and income inequality with individual-level overweight/obesity, assessing how these associations vary by individual education or living conditions within cities in Latin America. Data came from national surveys and censuses, and was compiled by the SALURBAL project (Urban Health in Latin America). The sample included 79,422 individuals (58.0% women), living in 538 sub-cities, 187 cities, and 8 countries. We used gender-stratified Poisson multilevel models to estimate the Prevalence Rate Ratios (PRR) for overweight/obesity (body mass index ≥ 25 kg/m2) per a unit change in city-level women's empowerment (proxied by a score that measures gender inequalities in employment and education) and income inequality (proxied by income-based Gini coefficient). We also tested whether individual education or sub-city living conditions modified such associations. Higher city labor women's empowerment (in women) and higher city Gini coefficient (in men) were associated with a lower prevalence of overweight/obesity (PRR = 0.97 (95%CI 0.94, 0.99) and PRR = 0.94 (95%CI 0.90, 0.97), respectively). The associations varied by individual education and sub-city living conditions. For labor women's empowerment, we observed weakened associations towards the null effect in women with lower education and in residents of sub-cities with worse living conditions (men and women). For the Gini coefficient, the association was stronger among men with primary education, and a negative association was observed in women with primary education. Our findings highlight the need for promoting equity-based policies and interventions to tackle the high prevalence of excess weight in Latin American cities.
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Affiliation(s)
- Natalia Tumas
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain. .,Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain. .,Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba, Córdoba, Argentina.
| | - Santiago Rodríguez López
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas (CONICET) y Universidad Nacional de Córdoba, Córdoba, Argentina.,Facultad de Ciencias Exactas, Físicas y Naturales, Universidad Nacional de Córdoba, Córdoba, Argentina
| | - Mónica Mazariegos
- INCAP Research Center for the Prevention of Chronic Diseases (CIIPEC), Institute of Nutrition of Central America and Panama (INCAP), Guatemala City, Guatemala
| | - Ana Ortigoza
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Cecilia Anza Ramírez
- CRONICAS Centre of Excellence in Chronic Diseases, Universidad Peruana Cayetano Heredia, Lima, Perú
| | | | - Kari Moore
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Goro Yamada
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | | | | | - Juan M Pericàs
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain.,Liver Unit, Internal Medicine Department, Vall d'Hebron Institute for Research, Vall d'Hebron University Hospital, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), Madrid, Spain
| | - Francesc Belvis Costes
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain
| | - Mariana Lazo
- Urban Health Collaborative, Dornsife School of Public Health, Drexel University, Philadelphia, USA
| | - Joan Benach
- Department of Political and Social Sciences, Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center (UPF-BSM), Universitat Pompeu Fabra, Barcelona, Spain.,Ecological Humanities Research Group (GHECO), Universidad Autónoma, Madrid, Spain
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14
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Beseran E, Pericàs JM, Cash-Gibson L, Ventura-Cots M, Porter KMP, Benach J. Deaths of Despair: A Scoping Review on the Social Determinants of Drug Overdose, Alcohol-Related Liver Disease and Suicide. Int J Environ Res Public Health 2022; 19:ijerph191912395. [PMID: 36231697 PMCID: PMC9566538 DOI: 10.3390/ijerph191912395] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2022] [Revised: 09/22/2022] [Accepted: 09/26/2022] [Indexed: 05/31/2023]
Abstract
BACKGROUND There is a lack of consensus on the social determinants of Deaths of Despair (DoD), i.e., an increase in mortality attributed to drug overdose, alcohol-related liver disease, and suicide in the United States (USA) during recent years. The objective of this study was to review the scientific literature on DoD with the purpose of identifying relevant social determinants and inequalities related to these mortality trends. METHODS Scoping review focusing on the period 2015-2022 based on PubMed search. Articles were selected according to the following inclusion criteria: published between 1 January 2000 and 31 October 2021; including empirical data; analyzed DoD including the three causes defined by Case and Deaton; analyzed at least one social determinant; written in English; and studied DoD in the USA context only. Studies were excluded if they only analyzed adolescent populations. We synthesized our findings in a narrative report specifically addressing DoD by economic conditions, occupational hazards, educational level, geographical setting, and race/ethnicity. RESULTS Seventeen studies were included. Overall, findings identify a progressive increase in deaths attributable to suicide, drug overdose, and alcohol-related liver disease in the USA in the last two decades. The literature concerning DoD and social determinants is relatively scarce and some determinants have been barely studied. However different, however, large inequalities have been identified in the manner in which the causes of death embedded in the concept of DoD affect different subpopulations, particularly African American, and Hispanic populations, but blue collar-whites are also significantly impacted. Low socioeconomic position and education levels and working in jobs with high insecurity, unemployment, and living in rural areas were identified as the most relevant social determinants of DoD. CONCLUSIONS There is a need for further research on the structural and intermediate social determinants of DoD and social mechanisms. Intersectional and systemic approaches are needed to better understand and tackle DoD and related inequalities.
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Affiliation(s)
- Elisabet Beseran
- Research Group on Health Inequalities, Environment, and Employment Conditions, Pompeu Fabra University, 08002 Barcelona, Spain
| | - Juan M. Pericàs
- Research Group on Health Inequalities, Environment, and Employment Conditions, Pompeu Fabra University, 08002 Barcelona, Spain
- Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, CIBERehd, 08036 Barcelona, Spain
- Johns Hopkins University—Pompeu Fabra University Public Policy Center (UPF-BSM), 08002 Barcelona, Spain
| | - Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment, and Employment Conditions, Pompeu Fabra University, 08002 Barcelona, Spain
- Johns Hopkins University—Pompeu Fabra University Public Policy Center (UPF-BSM), 08002 Barcelona, Spain
- UPF Barcelona School of Management, Pompeu Fabra University, 08008 Barcelona, Spain
| | - Meritxell Ventura-Cots
- Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, CIBERehd, 08036 Barcelona, Spain
| | - Keshia M. Pollack Porter
- Johns Hopkins University—Pompeu Fabra University Public Policy Center (UPF-BSM), 08002 Barcelona, Spain
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, ON M5T 1P8, Canada
- Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD 21205, USA
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions, Pompeu Fabra University, 08002 Barcelona, Spain
- Johns Hopkins University—Pompeu Fabra University Public Policy Center (UPF-BSM), 08002 Barcelona, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, 28049 Madrid, Spain
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15
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Benach J, Muntaner C. Arms, Conventional Wisdom, and Public Health Prevention. Int J Health Serv 2022; 53:207314221125057. [PMID: 36121906 DOI: 10.1177/00207314221125057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Every year, 8 million small arms and 15 billion rounds of ammunition are manufactured in the world. Every day, 700 people worldwide (more than 2.5 million in a decade) die from firearms such as pistols, shotguns, assault rifles, or machine guns. Between 1968 and 2011, there were 1.4 million gun-related deaths in the United States (including suicides, homicides, and accidents) compared with 1.2 million North American deaths in all wars. This article looks at the historic and cultural context that has generated and shaped the U.S.'s "gun culture" and prevailing mentality regarding the right to bear arms, critiquing the vision that such a pro-arms mentality is an intrinsic and unchangeable element of U.S. culture. It exposes the neoliberal roots of the current U.S. gun violence epidemic, asking the question of "why?" in order to move toward an alternative conventional wisdom and overcome this urgent public health crisis in the U.S. and elsewhere.
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Affiliation(s)
- Joan Benach
- Department of Political and Social Sciences, 16770Universitat Pompeu Fabra, Barcelona, Spain
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16
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Benach J, Muntaner C. A New Journal for a New Era. Int J Health Serv 2022; 52:421-422. [PMID: 35706402 DOI: 10.1177/00207314221102882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Joan Benach
- Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (UPF-BSM), Barcelona, Spain.,Bloomberg Faculty of Nursing.,Dalla Lana School of Public Health
| | - Carles Muntaner
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
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17
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Carrere J, Belvis F, Peralta A, Marí-Dell'Olmo M, López MJ, Benach J, Novoa AM. Effectiveness of an Energy-Counseling Intervention in Reducing Energy Poverty: Evidence from a Quasi-Experimental Study in a Southern European City. J Urban Health 2022; 99:549-561. [PMID: 35622196 PMCID: PMC9187783 DOI: 10.1007/s11524-022-00642-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/29/2022] [Indexed: 11/30/2022]
Abstract
Energy poverty is a serious social problem with well-known adverse health consequences. This problem has been addressed mainly through improvements in the energy efficiency of housing. Still, little is known about the effects of information-based measures on energy poverty and their impacts on health. A quasi-experimental study was implemented to assess the effectiveness of an energy-counseling home visit intervention targeting the vulnerable population in a southern European city, Barcelona, in alleviating energy poverty and improving health. The intervention had beneficial impacts on keeping homes at an adequate indoor temperature and reducing primary care visits. No effects were found on self-perceived health or self-reported anxiety and depression. After the intervention, participants reported a decrease in arrears on utility bills, but less pronounced than in the comparison group. In conclusion, the study showed that information-based measures lead to psychosocial gains and reduced healthcare use. Nevertheless, the impact of these measures could be enhanced by combining them with policies and programmes that address the structural determinants of energy poverty.
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Affiliation(s)
- Juli Carrere
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain. .,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain. .,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.
| | - Francesc Belvis
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET) Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), Barcelona, Spain
| | - Andrés Peralta
- Instituto de Salud Pública, Facultad de Medicina, Pontificia Universidad Católica del Ecuador, Quito, Ecuador
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - María José López
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET) Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center (JHU-UPF PPC), Barcelona, Spain.,UPF Barcelona School of Management (UPF-BSM), Barcelona, Spain
| | - Ana M Novoa
- Agència de Salut Pública de Barcelona, 08023, Pl. Lesseps 1, Barcelona, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain
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18
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Benach J, Cash-Gibson L, Rojas-Gualdrón DF, Padilla-Pozo Á, Fernández-Gracia J, Eguíluz VM. Inequalities in COVID-19 inequalities research: Who had the capacity to respond? PLoS One 2022; 17:e0266132. [PMID: 35551268 PMCID: PMC9098009 DOI: 10.1371/journal.pone.0266132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2021] [Accepted: 03/07/2022] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic has been testing countries’ capacities and scientific preparedness to actively respond and collaborate on a common global threat. It has also heightened awareness of the urgent need to empirically describe and analyze health inequalities to be able to act effectively. In turn, this raises several important questions that need answering: What is known about the rapidly emerging COVID-19 inequalities research field? Which countries and world regions have been able to rapidly produce research on this topic? What research patterns and trends have emerged, and how to these compared to the (pre-COVID-19) global health inequalities research field? Which countries have been scientifically collaborating on this important topic? Where are the scientific knowledge gaps, and indirectly where might research capacities need to be strengthened? In order to answer these queries, we analyzed the global scientific production (2020–2021) on COVID-19 associated inequalities by conducting bibliometric and network analyses using the Scopus database. Specifically, we analyzed the volume of scientific production per country (via author affiliations), its distribution by country income groups and world regions, as well as the inter-country collaborations within this production. Our results indicate that the COVID-19 inequalities research field has been highly collaborative; however, a number of significant inequitable research practices exist. When compared to the (pre-COVID-19) global health inequalities research field, similar inequalities were identified, however, several new dynamics and partnerships have also emerged that warrant further in-depth exploration. To ensure preparedness for future crises, and effective strategies to tackle growing social inequalities in health, investment in global health inequalities research capacities must be a priority for all.
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Affiliation(s)
- Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions (GREDS-EMCONET), Pompeu Fabra University, Barcelona, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (JHU-UPF PPC UPF-BSM), Barcelona, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, Spain
- * E-mail:
| | - Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment and Employment Conditions (GREDS-EMCONET), Pompeu Fabra University, Barcelona, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (JHU-UPF PPC UPF-BSM), Barcelona, Spain
- Pompeu Fabra University–UPF Barcelona School of Management (UPF-BSM), Barcelona, Spain
| | | | - Álvaro Padilla-Pozo
- Research Group on Health Inequalities, Environment and Employment Conditions (GREDS-EMCONET), Pompeu Fabra University, Barcelona, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center (JHU-UPF PPC UPF-BSM), Barcelona, Spain
| | - Juan Fernández-Gracia
- Institute for Cross-Disciplinary Physics and Complex Systems, Campus Universitat de les Illes Balears, Palma de Mallorca, Islas Baleares, Spain
| | - Víctor M. Eguíluz
- Institute for Cross-Disciplinary Physics and Complex Systems, Campus Universitat de les Illes Balears, Palma de Mallorca, Islas Baleares, Spain
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19
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Padrosa E, Vanroelen C, Muntaner C, Benach J, Julià M. Precarious employment and mental health across European welfare states: a gender perspective. Int Arch Occup Environ Health 2022; 95:1463-1480. [PMID: 35142869 DOI: 10.1007/s00420-022-01839-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Accepted: 01/22/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE The aim of this article was to examine the relationship between precarious employment (PE), welfare states (WS) and mental health in Europe from a gender perspective. METHODS Data were derived from the European Working Conditions Survey 2015. PE was measured through the Employment Precariousness Scale for Europe (EPRES-E), validated for comparative research in 22 European countries, and categorized into quartiles. Countries were classified into Continental, Anglo-Saxon, Scandinavian, Southern and Central-Eastern WS. Mental health was assessed through the WHO-5 Well-Being Index and dichotomized into poor and good mental health. In a sample of 22,555 formal employees, we performed gender-stratified multi-level logistic regression models. RESULTS Results showed greater prevalences of PE and poor mental health among women. However, the association between them was stronger among men. Cross-country differences were observed in multi-level regressions, but the interaction effect of WS was only significant among women. More precisely, Central-Eastern WS enhanced the likelihood of poor mental health among women in high precarious employment situations (quartiles 3 and 4). CONCLUSIONS These findings suggest the interaction between contextual and individual factors in the production of mental health inequalities, both within and across countries. They also call for the incorporation of gender-sensitive welfare policies if equitable and healthy labor markets are to be achieved in Europe.
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Affiliation(s)
- Eva Padrosa
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra-Affiliated, Mar Campus, 08003, Barcelona, Spain. .,SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain. .,Research Group On Health Inequalities, Environment, and Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.
| | - Christophe Vanroelen
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Interface Demography (ID), Department of Sociology, Vrije Universiteit Brussel, Barcelona, Spain
| | - Carles Muntaner
- Faculty of Nursing, University of Toronto, Toronto, Canada.,Dalla Lana School of Public Health, University of Toronto, Toronto, Canada
| | - Joan Benach
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Group On Health Inequalities, Environment, and Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Transdisciplinary Research Group On Socioecological Transitions (GinTrans2), Autonomous University of Madrid, Madrid, Spain
| | - Mireia Julià
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra-Affiliated, Mar Campus, 08003, Barcelona, Spain.,SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Group On Health Inequalities, Environment, and Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
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20
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Belvis F, Bolíbar M, Benach J, Julià M. Precarious Employment and Chronic Stress: Do Social Support Networks Matter? Int J Environ Res Public Health 2022; 19:ijerph19031909. [PMID: 35162929 PMCID: PMC8835513 DOI: 10.3390/ijerph19031909] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/31/2022]
Abstract
Precarious employment has been identified as a potentially damaging stressor. Conversely, social support networks have a well-known protective effect on health and well-being. The ways in which precariousness and social support may interact have scarcely been studied with respect to either perceived stress or objective stress biomarkers. This research aims to fill this gap by means of a cross-sectional study based on a non-probability quota sample of 250 workers aged 25–60 in Barcelona, Spain. Fieldwork was carried out between May 2019 and January 2020. Employment precariousness, perceived social support and stress levels were measured by means of scales, while individual steroid profiles capturing the chronic stress suffered over a period of a month were obtained from hair samples using a liquid chromatography-tandem mass spectrometry methodology. As for perceived stress, analysis indicates that a reverse buffering effect exists (interaction B = 0.22, p = 0.014). Steroid biomarkers are unrelated to social support, while association with precariousness is weak and only reaches significance at p < 0.05 in the case of women and 20ß dihydrocortisone metabolites. These results suggest that social support can have negative effects on the relationship between perceived health and an emerging stressful condition like precariousness, while its association with physiological measures of stress remains uncertain.
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Affiliation(s)
- Francesc Belvis
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005 Barcelona, Spain; (M.B.); (J.B.); (M.J.)
- Johns Hopkins University—Universitat Pompeu Fabra Public Policy Center (UPF-PPC), 08005 Barcelona, Spain
- Correspondence:
| | - Mireia Bolíbar
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005 Barcelona, Spain; (M.B.); (J.B.); (M.J.)
- Department of Sociology, Universitat de Barcelona, 08034 Barcelona, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005 Barcelona, Spain; (M.B.); (J.B.); (M.J.)
- Johns Hopkins University—Universitat Pompeu Fabra Public Policy Center (UPF-PPC), 08005 Barcelona, Spain
- Ecological Humanities Research Group (GHECO), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Mireia Julià
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, 08005 Barcelona, Spain; (M.B.); (J.B.); (M.J.)
- ESIMar (Mar Nursing School), Parc de Salut Mar, Universitat Pompeu Fabra-Affiliated, 08005 Barcelona, Spain
- SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), 08005 Barcelona, Spain
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21
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Benach J, Padilla-Pozo Á, Martínez-Herrera E, Molina-Betancur JC, Gutiérrez M, Pericàs JM, Gutiérrez-Zamora Navarro M, Zografos C. What do we know about the impact of economic recessions on mortality inequalities? A critical review. Soc Sci Med 2022; 296:114733. [DOI: 10.1016/j.socscimed.2022.114733] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 12/07/2021] [Accepted: 01/17/2022] [Indexed: 11/26/2022]
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22
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Cash-Gibson L, Martinez-Herrera E, Benach J. What key conditions and mechanisms generate health inequalities research in different contexts? Study protocol for two realist explanatory case studies. Eval Program Plann 2021; 89:101986. [PMID: 34390924 DOI: 10.1016/j.evalprogplan.2021.101986] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Revised: 06/15/2021] [Accepted: 07/01/2021] [Indexed: 06/13/2023]
Abstract
Evidence on health inequalities has grown in recent decades, however, the capacity to generate health inequalities research is uneven, worldwide. A recent bibliometric analysis found notable inequalities of the global production of health inequalities scientific research across countries. What determines the capacity to produce high volumes of health inequalities scientific research, in different settings? What mechanisms are involved? To answer these questions requires in-depth knowledge on the health inequalities research production process, in different settings. We plan to conduct two realist explanatory case studies, to understand why and how particular settings (e.g. the United Kingdom and the city of Barcelona) have generated high volumes of health inequalities research over past decades, and identify the potential key contextual conditions and causal mechanisms involved. This study protocol outlines the rationale and methodology involved, highlights the strengths and limitations of the approach, and provides guidance on how to overcome certain operational challenges and ensure validity of research findings. Valuable learning may be derived from these case experiences, with implications for research, policy and practice. This work can serve as a tool for researcher and planners to guide the development of further case studies to evaluate health inequalities research capacities in other settings.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network, Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain; Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain.
| | - Eliana Martinez-Herrera
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network, Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain; Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain; Research Group of Epidemiology, National School of Public Health 'Héctor Abad Gómez', University of Antioquia, Medellín, Colombia.
| | - Joan Benach
- Research Group on Health Inequalities, Environment, Employment Conditions Knowledge Network, Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain; Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain; Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma, Madrid, Spain.
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23
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Matilla-Santander N, Jonsson J, Kreshpaj B, Orellana C, Benach J, Badarin K, Burström B, Vives A, Kjellberg K, Strömdahl S, Johansson G, Östergren PO, Bodin T. The Relation Between Precarious Employment Arrangements and Social Precarity: Findings from the PREMIS Study in Stockholm, Sweden. Int J Health Serv 2021; 52:201-211. [PMID: 34817272 PMCID: PMC8894623 DOI: 10.1177/00207314211051880] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Precarious employment (PE) is a well-known social determinant of health and health inequalities. However, as most previous studies have focused on physical and mental well-being, less is known about the social-related outcomes (ie, social precarity) associated with precarious arrangements. This cross-sectional study aims to investigate whether PE is associated with social precarity in a working population of 401 nonstandard employed workers in Stockholm, Sweden (2016-2017). PE was assessed with the Swedish version of the Employment Precarious Scale (EPRES-Se) and analyzed in relation to social precarity related to working life (eg, task quality and job security) and living conditions (eg, restraint in social activities and financial constraints). We found positive adjusted associations between quartiles of EPRES-Se and social precarity related to working life (eg, being locked in an occupation [aPRq4:1.33 [1.10-1.61]]) and living conditions (eg, inability to participate in social activities because of work [aPRq4:1.27 [1.10-1.46]]). Our findings suggest that individuals in PE experience social precarity, stressing that PE may have negative effects on well-being. Further studies using multidimensional constructs of PE and larger samples should analyze these findings according to social and policy contexts in order to be able to inform policymakers.
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Affiliation(s)
- Nuria Matilla-Santander
- Unit of Occupational Medicine, Institute of Environmental Medicine, 27106Karolinska Institutet, Sweden
| | - Johanna Jonsson
- Unit of Occupational Medicine, Institute of Environmental Medicine, 27106Karolinska Institutet, Sweden
| | - Bertina Kreshpaj
- Unit of Occupational Medicine, Institute of Environmental Medicine, 27106Karolinska Institutet, Sweden
| | - Cecilia Orellana
- Unit of Occupational Medicine, Institute of Environmental Medicine, 27106Karolinska Institutet, Sweden
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), 16770Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma Madrid, Madrid, Spain
| | - Kathryn Badarin
- Unit of Occupational Medicine, Institute of Environmental Medicine, 27106Karolinska Institutet, Sweden
| | - Bo Burström
- Equity and Health Policy Research Group, 27106Karolinska Institutet, Sweden
| | - Alejandra Vives
- School of Medicine, CEDEUS, 28033Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Katarina Kjellberg
- Unit of Occupational Medicine, Institute of Environmental Medicine, 27106Karolinska Institutet, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
| | - Susanne Strömdahl
- Section of Infectious Diseases, Uppsala University, Sweden.,27106Karolinska Institutet, Sweden
| | - Gun Johansson
- Unit of Occupational Medicine, Institute of Environmental Medicine, 27106Karolinska Institutet, Sweden
| | | | - Theo Bodin
- Unit of Occupational Medicine, Institute of Environmental Medicine, 27106Karolinska Institutet, Sweden.,Centre for Occupational and Environmental Medicine, Region Stockholm, Stockholm, Sweden
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24
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Benach J, Zografos C, Cash-Gibson L, Martínez-Herrera E, Pericàs JM. The case for planetary health prevention. J Epidemiol Community Health 2021; 76:105-106. [PMID: 34764217 DOI: 10.1136/jech-2021-217988] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The lack of preparedness and the adoption of a reactive approach underlie many mistakes in handling the COVID-19 pandemic. We need a vision with a proactive approach to planetary health prevention, that is suited for addressing the neglected systemic determinants of health which generate disease, inequality and environmental degradation, and capable of anticipating known and unknown risks, and foreseeing possible threatening scenarios. To achieve a healthy, equitable and sustainable future, it is time to make health prevention planetary.
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Affiliation(s)
- Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions (Dept. Political and Social Sciences), Pompeu Fabra University, Barcelona, Spain .,Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, Madrid, Spain
| | - Christos Zografos
- Research Group on Health Inequalities, Environment and Employment Conditions (Dept. Political and Social Sciences), Pompeu Fabra University, Barcelona, Spain.,Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Spain
| | - Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment and Employment Conditions (Dept. Political and Social Sciences), Pompeu Fabra University, Barcelona, Spain.,Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Spain.,Pompeu Fabra University- UPF Barcelona School of Management, Barcelona, Spain
| | - Eliana Martínez-Herrera
- Research Group on Health Inequalities, Environment and Employment Conditions (Dept. Political and Social Sciences), Pompeu Fabra University, Barcelona, Spain.,Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Spain.,Research Group of Epidemiology, National School of Public Health "Héctor Abad Gómez", University of Antioquia, Medellín, Colombia
| | - Juan M Pericàs
- Research Group on Health Inequalities, Environment and Employment Conditions (Dept. Political and Social Sciences), Pompeu Fabra University, Barcelona, Spain.,Johns Hopkins University-Pompeu Fabra University Public Policy Center (UPF-BSM), Barcelona, Spain.,Liver Unit, Internal Medicine Department, Vall d'Hebron University Hospital- Vall d'Hebron Institute for Research, CIBERehd, Barcelona, Spain
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25
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Talens M, Tumas N, Lazarus JV, Benach J, Pericàs JM. What Do We Know about Inequalities in NAFLD Distribution and Outcomes? A Scoping Review. J Clin Med 2021; 10:jcm10215019. [PMID: 34768539 PMCID: PMC8584385 DOI: 10.3390/jcm10215019] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Revised: 10/17/2021] [Accepted: 10/25/2021] [Indexed: 02/06/2023] Open
Abstract
With prevalence high and rising given the close relationship with obesity and diabetes mellitus, non-alcoholic fatty liver disease (NAFLD) is progressively becoming the most common chronic liver condition worldwide. However, little is known about the health inequalities in NAFLD distribution and outcomes. This review aims to analyze health inequalities in NAFLD distribution globally and to assess the health disparities in NAFLD-related outcomes. We conducted a scoping review of global health inequalities in NAFLD distribution and outcomes according to gender/sex, ethnicity/race, and socioeconomic position from PubMed's inception to May 2021. Ultimately, 20 articles were included in the review, most (75%) of them carried out in the United States. Males were found to have a higher NAFLD prevalence (three articles), while available evidence suggests that women have an overall higher burden of advanced liver disease and complications (four articles), whereas they are less likely to be liver-transplanted once cirrhosis develops (one article). In the US, the Hispanic population had the highest NAFLD prevalence and poorer outcomes (seven articles), whereas Whites had fewer complications than other ethnicities (two articles). Patients with low socioeconomic status had higher NAFLD prevalence (four articles) and a higher likelihood of progression and complications (five articles). In conclusion, globally there is a lack of studies analyzing NAFLD prevalence and outcomes according to various axes of inequality through joint intersectional appraisals, and most studies included in our review were based on the US population. Available evidence suggests that NAFLD distribution and outcomes show large inequalities by social group. Further research on this issue is warranted.
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Affiliation(s)
- Mar Talens
- Research Group on Health Inequalities, Environment, and Employment Conditions, Department of Social and Political Science, Pompeu Fabra University, 08005 Barcelona, Spain; (M.T.); (N.T.); (J.B.)
| | - Natalia Tumas
- Research Group on Health Inequalities, Environment, and Employment Conditions, Department of Social and Political Science, Pompeu Fabra University, 08005 Barcelona, Spain; (M.T.); (N.T.); (J.B.)
- Public Policy Center (UPF-BSM), Johns Hopkins University-Pompeu Fabra University, 08005 Barcelona, Spain
- Centro de Investigaciones y Estudios sobre Cultura y Sociedad, Consejo Nacional de Investigaciones Científicas y Técnicas y Universidad Nacional de Córdoba, Córdoba 5016, Argentina
| | - Jeffrey V. Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clínic, University of Barcelona, 08036 Barcelona, Spain;
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions, Department of Social and Political Science, Pompeu Fabra University, 08005 Barcelona, Spain; (M.T.); (N.T.); (J.B.)
- Public Policy Center (UPF-BSM), Johns Hopkins University-Pompeu Fabra University, 08005 Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, 28049 Madrid, Spain
| | - Juan M. Pericàs
- Research Group on Health Inequalities, Environment, and Employment Conditions, Department of Social and Political Science, Pompeu Fabra University, 08005 Barcelona, Spain; (M.T.); (N.T.); (J.B.)
- Public Policy Center (UPF-BSM), Johns Hopkins University-Pompeu Fabra University, 08005 Barcelona, Spain
- Liver Unit, Internal Medicine Department, Vall d’Hebron University Hospital, Vall d’Hebron Institute for Research, 08035 Barcelona, Spain
- Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBERehd), 28029 Madrid, Spain
- Correspondence:
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26
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Llop-Gironés A, Santillan-Garcia A, Cash-Gibson L, Benach J, Zabalegui A. COVID-19 and the global need for knowledge on nurses' health. Int Nurs Rev 2021; 69:196-200. [PMID: 34614229 PMCID: PMC8652808 DOI: 10.1111/inr.12722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2021] [Accepted: 09/07/2021] [Indexed: 11/29/2022]
Abstract
Aim To emphasize that nurses need to be fully protected to carry out their vital role, particularly during pandemics, yet the lack of a standardized and systematic collection of high‐quality disaggregated data on nurses health inhibits our ability to assess this within and across countries. Background Nurses are the largest workforce group in the health sector, yet only 59 countries worldwide report on nurse COVID‐19 infections and related deaths, and the standardized, systematic collection of disaggregated health data is not yet in place. Sources of evidence Medline, International Council of Nurses, World Health Organization, Centers of Disease Control and Prevention and the experiences of the authors. Discussion Inconsistent recording and definitions of nurses, precarious and informal employment conditions, limited transparent and reliable data, lack of mass testing and long‐standing structural issues and biases have affected nursing for too long. Conclusions These issues are reflected in the limited capacity of many national public health information systems to collect, monitor and report on the health of the largest group of health workers. Political will, accountability and public data transparency at different levels are essential to adequately protect nurses at work. Implications for nursing practice, and nursing and health policy Building on current momentum in the nursing field, immediate political action is required to strengthen existing nursing and midwifery policies, standards and regulatory capacity, as well as existing public health services and information and surveillance systems. The generation of up‐to‐date, context‐specific knowledge is needed to inform and monitor political decisions related to the protection of nurses, and the improvement of their employment conditions, as well as to strengthen accountability for these areas at various levels.
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Affiliation(s)
- Alba Llop-Gironés
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,The Johns Hopkins-UPF Public Policy Center (JHU-UPF PPC, Barcelona, Spain
| | | | - Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,The Johns Hopkins-UPF Public Policy Center (JHU-UPF PPC), Vall d'Hebron Research Institute (VHIR), Barcelona, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions, Political Science Department, Pompeu Fabra University, Barcelona, Spain.,Johns Hopkins University-Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, Spain
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27
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Llop-Gironés A, Vračar A, Llop-Gironés G, Benach J, Angeli-Silva L, Jaimez L, Thapa P, Bhatta R, Mahindrakar S, Bontempo Scavo S, Nar Devi S, Barria S, Marcos Alonso S, Julià M. Employment and working conditions of nurses: where and how health inequalities have increased during the COVID-19 pandemic? Hum Resour Health 2021; 19:112. [PMID: 34530844 PMCID: PMC8444178 DOI: 10.1186/s12960-021-00651-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 08/30/2021] [Indexed: 05/07/2023]
Abstract
BACKGROUND Nurses and midwives play a critical role in the provision of care and the optimization of health services resources worldwide, which is particularly relevant during the current COVID-19 pandemic. However, they can only provide quality services if their work environment provides adequate conditions to support them. Today the employment and working conditions of many nurses worldwide are precarious, and the current pandemic has prompted more visibility to the vulnerability to health-damaging factors of nurses' globally. This desk review explores how employment relations, and employment and working conditions may be negatively affecting the health of nurses in countries such as Brazil, Croatia, India, Ireland, Italy, México, Nepal, Spain, and the United Kingdom. MAIN BODY Nurses' health is influenced by the broader social, economic, and political system and the redistribution of power relations that creates new policies regarding the labour market and the welfare state. The vulnerability faced by nurses is heightened by gender inequalities, in addition to social class, ethnicity/race (and caste), age and migrant status, that are inequality axes that explain why nurses' workers, and often their families, are exposed to multiple risks and/or poorer health. Before the COVID-19 pandemic, informalization of nurses' employment and working conditions were unfair and harmed their health. During COVID-19 pandemic, there is evidence that the employment and working conditions of nurses are associated to poor physical and mental health. CONCLUSION The protection of nurses' health is paramount. International and national enforceable standards are needed, along with economic and health policies designed to substantially improve employment and working conditions for nurses and work-life balance. More knowledge is needed to understand the pathways and mechanisms on how precariousness might affect nurses' health and monitor the progress towards nurses' health equity.
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Affiliation(s)
- Alba Llop-Gironés
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Escola Superior d’Infermeria del Mar (ESIMar), Barcelona, Spain
- Social Determinants and Health Education Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Ana Vračar
- Organization for Workers’ Initiative and Democratization, Zagreb, Croatia
| | | | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- The Johns Hopkins - UPF Public Policy Center (JHU-UPF PPC), Barcelona, Spain
- Transdisciplinary Research Group On Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, Madrid, Spain
| | | | | | | | | | | | | | | | | | | | - Mireia Julià
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Escola Superior d’Infermeria del Mar (ESIMar), Barcelona, Spain
- Social Determinants and Health Education Research Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
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28
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Cash-Gibson L, Pericàs JM, Martinez-Herrera E, Benach J. Health Inequalities in the Time of COVID-19: The Globally Reinforcing Need to Strengthen Health Inequalities Research Capacities. Int J Health Serv 2021; 51:300-304. [PMID: 33684016 PMCID: PMC8191151 DOI: 10.1177/0020731421993939] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The full impact of coronavirus disease 2019 (COVID-19) is yet to be well established; however, as the pandemic spreads, and early results emerge, unmet needs are being revealed, and pressing questions are being asked about who is most affected, how, where, and in what ways government responses might be exacerbating inequalities. A number of scholars have called for more in-depth critical research on COVID-19 and health inequalities to produce a strong empirical evidence based on these issues. There are also justifiable concerns about the scarcity of health-equity actions oriented analyses of the situation and calls for more empirical evidence on COVID-19 and health inequalities. A preliminary condition to establish this type of information is strong capacity to conduct health inequalities research. Worldwide, however, this type of capacity is limited, which, alongside other challenges, will likely hinder capacities of many countries to develop comprehensive equity-oriented COVID-19 analyses, and adequate responses to present and future crises. The current pandemic reinforces the pending need to invest in and strengthen these research capacities. These capacities must be supported by widespread recognition and concern, cognitive social capital, and greater commitment to coordinated, transparent action, and responsibility. Otherwise, we will remain inadequately prepared to respond and meet our society's unmet needs.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
| | - Juan M. Pericàs
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
- Hospital Clínic de Barcelona, Barcelona, Spain
- Institute for Research, Vall d’Hebron Hospital Universitari, Barcelona, Spain
| | - Eliana Martinez-Herrera
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Research Group of Epidemiology, National School of Public Health “Héctor Abad Gómez”, University of Antioquia, Medellín, Colombia
| | - Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions, Pompeu Fabra University, Barcelona, Spain
- Pompeu Fabra University Public Policy Center, Johns Hopkins University, Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, Madrid, Spain
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29
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Bolibar M, Belvis FX, Jódar P, Vives A, Méndez F, Bartoll-Roca X, Pozo OJ, Gomez-Gomez A, Padrosa E, Benach J, Julià M. Precarious Employment and Stress: The Biomedical Embodiment of Social Factors. PRESSED Project Study Protocol. Front Public Health 2021; 9:649447. [PMID: 33859972 PMCID: PMC8042135 DOI: 10.3389/fpubh.2021.649447] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2021] [Accepted: 03/03/2021] [Indexed: 11/13/2022] Open
Abstract
The PRESSED project aims to explain the links between a multidimensional measure of precarious employment and stress and health. Studies on social epidemiology have found a clear positive association between precarious employment and health, but the pathways and mechanisms to explain such a relationship are not well-understood. This project aims to fill this gap from an interdisciplinary perspective, integrating the social and biomedical standpoints to comprehensively address the complex web of consequences of precarious employment and its effects on workers' stress, health and well-being, including health inequalities. The project objectives are: (1) to analyze the association between multidimensional precarious employment and chronic stress among salaried workers in Barcelona, measured both subjectively and using biological indicators; (2) to improve our understanding of the pathways and mechanisms linking precarious employment with stress, health and well-being; and (3) to analyze health inequalities by gender, social class and place of origin for the first two objectives. The study follows a sequential mixed design. First, secondary data from the 2017 Survey on Workers and the Unemployed of Barcelona is analyzed (N = 1,264), yielding a social map of precarious employment in Barcelona that allows the contextualization of the scope and characteristics of this phenomenon. Drawing on these results, a second survey on a smaller sample (N = 255) on precarious employment, social precariousness and stress is envisaged. This study population is also asked to provide a hair sample to have their levels of cortisol and its related components, biomarkers of chronic stress, analyzed. Third, a sub-sample of the latter survey (n = 25) is selected to perform qualitative semi-structured interviews. This allows going into greater depth into how and why the experience of uncertainty, the precarization of living conditions, and the degradation of working conditions go hand-in-hand with precarious employment and have an impact on stress, as well as to explore the potential role of social support networks in mitigating these effects.
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Affiliation(s)
- Mireia Bolibar
- Department of Sociology, University of Barcelona, Barcelona, Spain.,Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Francesc Xavier Belvis
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Pere Jódar
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Alejandra Vives
- Department of Public Health, CEDEUS, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Fabrizio Méndez
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
| | | | - Oscar J Pozo
- Integrative Pharmacology and Systems Neuroscience Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Alex Gomez-Gomez
- Integrative Pharmacology and Systems Neuroscience Group, IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Eva Padrosa
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Joan Benach
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
| | - Mireia Julià
- Research Group on Health Inequalities, Environment, and Employment Conditions (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
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30
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Vives A, Gonzalez Lopez F, Benach J. Measuring Precarious Employment: Type of Contract Can Lead to Serious Misclassification Error. Ann Work Expo Health 2021; 64:1035-1038. [PMID: 32918450 DOI: 10.1093/annweh/wxaa089] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2020] [Revised: 06/10/2020] [Accepted: 08/10/2020] [Indexed: 11/14/2022] Open
Abstract
This study aims to assess the accuracy of temporary employment as indicator or proxy measure of precarious employment. Using sensitivity and specificity analysis, we compared type of contract (temporary versus permanent) with the Chilean version of the multidimensional Employment Precariousness Scale. Temporary employment exhibited very low sensitivity (<30%) (specificity >90%), resulting in roughly 38% of false negative results. Different EPRES-Ch cut-off scores produced similar results. The main implication of these findings is that the public health relevance of precarious employment is being underestimated both in terms of prevalence and of its association with health, making it critical that valid multidimensional measures of precarious employment be implemented.
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Affiliation(s)
- Alejandra Vives
- Department of Public Health, Pontificia Universidad Católica de Chile, CEDEUS, Diagonal Paraguay, Santiago, Chile
| | - Francisca Gonzalez Lopez
- Department of Mathematics, Universidad Técnica Federico Santa María, Avenida España, Valparaíso, Chile
| | - Joan Benach
- Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, Barcelona, Spain
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Molina-Betancur JC, Martínez-Herrera E, Pericàs JM, Benach J. Coronavirus disease 2019 and slums in the Global South: lessons from Medellín (Colombia). Glob Health Promot 2020; 28:65-69. [PMID: 33054562 DOI: 10.1177/1757975920962797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic is hitting the world's most vulnerable people hardest, primarily the communities living in slums in the Global South. Lockdown, handwashing and social distancing are impossible privileges for many urban dwellers - measures which make structural inequities more visible, exacerbating racial, gender and class differences. There are many social determinants of health to explain these inequalities that trigger a high prevalence of infectious and chronic diseases. In Medellín (Colombia), it is a challenge to cope with this crisis, especially when the resources and aid provided by the government and institutions are limited. Yet, an organized social response is happening in some communes and slums, with high community participation, as a potentially effective key to control the pandemic. Once the emergency is over, communities in slums will have to face the social and economic reactivation, and effectively react to the multiple social and psychological consequences, new waves of COVID-19 or other pandemics.
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Affiliation(s)
- Juan Camilo Molina-Betancur
- Epidemiology Research Group (Research Line on Epidemiology and Urban Health), National School of Public Health, Universidad de Antioquia, Medellín, Colombia
| | - Eliana Martínez-Herrera
- Epidemiology Research Group (Research Line on Epidemiology and Urban Health), National School of Public Health, Universidad de Antioquia, Medellín, Colombia.,Health Inequalities Research Group (GREDS-Emconet), Political Science Department, Pompeu Fabra University, Barcelona, Spain.,Johns Hopkins University-Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Juan M Pericàs
- Health Inequalities Research Group (GREDS-Emconet), Political Science Department, Pompeu Fabra University, Barcelona, Spain.,Johns Hopkins University-Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Infectious Disease Department, Hospital Clínic de Barcelona, Spain.,Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain
| | - Joan Benach
- Health Inequalities Research Group (GREDS-Emconet), Political Science Department, Pompeu Fabra University, Barcelona, Spain.,Johns Hopkins University-Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTrans2), Universidad Autónoma de Madrid, Spain
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Agustí C, Font-Casaseca N, Belvis F, Julià M, Vives N, Montoliu A, Pericàs JM, Casabona J, Benach J. The role of socio-demographic determinants in the geo-spatial distribution of newly diagnosed HIV infections in small areas of Catalonia (Spain). BMC Public Health 2020; 20:1533. [PMID: 33036599 PMCID: PMC7547437 DOI: 10.1186/s12889-020-09603-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/23/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Spatial visualization of HIV surveillance data could improve the planning of programs to address the HIV epidemic. The objectives of the study were to describe the characteristics and the spatial distribution of newly diagnosed HIV infection in Catalonia and to identify factors associated with HIV infection rates. METHODS Surveillance data from the national registry were presented in the form of descriptive and ring maps and used to study the spatial distribution of new HIV diagnoses in Catalonia (2012-2016) and associated risk factors at the small area level (ABS, acronym for "basic health area" in Catalan). Incident cases were modeled using the following as predictors: type of municipality, prevalence of young men and migrant groups, GBMSM activity indicators, and other variables at the aggregated level. RESULTS New HIV diagnoses are heterogeneously distributed across Catalonia. The predictors that proved to be significantly associated with a higher rate of new HIV diagnoses were ABS located in the city of Barcelona (IRR, 2.520; P < 0.001), a higher proportion of men aged 15-44 years (IRR, 1.193; P = 0.003), a higher proportion of GBMSM (IRR, 1.230; P = 0.030), a higher proportion of men from Western Europe (IRR, 1.281; P = 0.003), a higher proportion of men from Latin America (IRR, 1.260; P = 0.003), and a higher number of gay locations (IRR, 2.665; P < 0.001). No association was observed between the HIV diagnosis rate and economic deprivation. CONCLUSIONS Ring maps revealed substantial spatial associations for the rate of new HIV diagnoses. New HIV diagnoses are concentrated in ABS located in urban areas. Our results show that, in the case of HIV infection, the socioeconomic deprivation index on which the Catalan government bases its budget allocation policies among the ABS should not be the only criterion used.
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Affiliation(s)
- Cristina Agustí
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Edifici Muntanya, Ctra Can Ruti, Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain. .,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain. .,Fundació Institut d'Investigació Germans Trias i Pujol IGTP, Badalona, Barcelona, Spain.
| | | | - Francesc Belvis
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Unit of Infections and Cancer - Information and Interventions (UNIC - I&I), Cancer Epidemiology Research Program (CERP), Hospitalet de Llobregat, Barcelona, Spain
| | - Mireia Julià
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Núria Vives
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Cancer Screening Unit, Catalan Institute of Oncology, Hospitalet de Llobregat, Barcelona, Spain
| | - Alexandra Montoliu
- Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Unit of Infections and Cancer - Information and Interventions (UNIC - I&I), Cancer Epidemiology Research Program (CERP), Hospitalet de Llobregat, Barcelona, Spain
| | - Juan M Pericàs
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Vall d'Hebron Institute for Research (VHIR), Barcelona, Spain.,Infectious Disease Department, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Casabona
- Centre d'Estudis Epidemiològics sobre les Infeccions de Transmissió Sexual i Sida de Catalunya (CEEISCAT), Agència de Salut Pública de Catalunya (ASPC), Generalitat de Catalunya, Edifici Muntanya, Ctra Can Ruti, Cami de les Escoles s/n, 08916 Badalona, Barcelona, Spain.,Centro de Investigación Biomédica en Red de Epidemiologia y Salud Pública CIBERESP, Madrid, Spain.,Fundació Institut d'Investigació Germans Trias i Pujol IGTP, Badalona, Barcelona, Spain.,Departament de Pediatria, d'Obstetrícia i Ginecologia i de Medicina Preventiva i de Salut Pública, Universidad Autónoma de Barcelona, Bellaterra, Cerdanyola del Vallès, Barcelona, Spain
| | - Joan Benach
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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Vives A, Benmarhnia T, González F, Benach J. The importance of using a multi-dimensional scale to capture the various impacts of precarious employment on health: Results from a national survey of Chilean workers. PLoS One 2020; 15:e0238401. [PMID: 32970671 PMCID: PMC7514101 DOI: 10.1371/journal.pone.0238401] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 08/15/2020] [Indexed: 11/23/2022] Open
Abstract
Background Social epidemiologic research in relation to the health impacts of precarious employment has grown markedly during the past decade. While the multidimensional nature of precarious employment has long been acknowledged theoretically, empirical studies have mostly focused on one-dimensional approach only (based either on employment temporariness or perceived job insecurity). This study compares the use of a multidimensional employment precariousness scale (EPRES) with traditional one-dimensional approaches in relation to distinct health outcomes and across various socio-demographic characteristics. Methods We used a subsample of formal salaried workers (n = 3521) from the first Chilean employment and working conditions survey (2009–2010). Multilevel modified Poisson regressions with fixed effects (individuals nested within regions) and survey weights were conducted to estimate the association between general health, mental health and occupational injuries and distinct precarious employment exposures (temporary employment, perceived job insecurity, and the multidimensional EPRES scale). We assessed the presence of effect measure modification according to sex, age, educational level, and occupational class (manual/non-manual). Results Compared to one-dimensional approaches to precarious employment, the multidimensional EPRES scale captured a larger picture of potential health effects and differences across subgroups of workers. Patterns of effect measure that modification were consistent with the expectations that groups in greater disadvantage (women, older individuals, less educated and manual workers) were more vulnerable to poor employment conditions. Conclusions Multidimensional measures of precarious employment better capture its association with a breath of health outcomes, being necessary tools for research in order to strengthen the evidence base for policy making in the protection of workers’ health.
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Affiliation(s)
- Alejandra Vives
- Department of Public Health, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
- Center for Sustainable Urban Development (CEDEUS), Conicyt/Fondap, Santiago, Chile
- * E-mail:
| | - Tarik Benmarhnia
- Department of Family Medicine and Public Health & Scripps Institution of Oceanography University of California, San Diego, CA, United States of America
| | - Francisca González
- Department of Mathematics, Universidad Técnica Federico Santa María, Valparaíso, Chile
| | - Joan Benach
- Department of Political and Social Sciences, Health Inequalities Research Group, (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University-Pompeu Fabra University Public Policy Center, Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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Benach J. We Must Take Advantage of This Pandemic to Make a Radical Social Change: The Coronavirus as a Global Health, Inequality, and Eco-Social Problem. Int J Health Serv 2020; 51:50-54. [PMID: 32746700 PMCID: PMC7404087 DOI: 10.1177/0020731420946594] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
COVID-19 not only constitutes a serious public health problem and a global major threat to the poorest and most vulnerable social groups and neighborhoods of the world, creating a potential pandemic of inequality, but also poses an enormous challenge from the perspective of public health, ethics, economy, environment, and politics. However, many of the deep and complex systemic interrelationships created and developed by this pandemic are largely hidden, unknown, or neglected, both by the hegemonic media and by a highly specialized and fragmented academic world. However, when all the available knowledge is critically integrated, the origins and effects underlying this pandemic are likely to be found in the development of neoliberal capitalism and its inherent logic of ceaseless accumulation, economic growth, large inequalities, and ecological devastation. This commentary reflects on these issues, drawing out some of the most important lessons to be learned and challenges to be faced in the COVID-19 pandemic and its aftermath, advocating for a radical social change to deal with these challenges.
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Affiliation(s)
- Joan Benach
- Health Inequalities Research Group (GREDS-EMCONET), Department of Political and Social Sciences, 16770Universitat Pompeu Fabra, Barcelona, Spain.,Johns-Hopkins-UPF Public Policy Center, Barcelona, Spain.,GinTrans2, Madrid Autonomous University (UAM), Madrid, Spain
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Julià M, Belvis F, Vives A, Tarafa G, Benach J. Informal employees in the European Union: working conditions, employment precariousness and health. J Public Health (Oxf) 2020; 41:e141-e151. [PMID: 29982746 DOI: 10.1093/pubmed/fdy111] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 06/07/2018] [Accepted: 06/13/2018] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The aim of this study is to estimate the prevalence of informal workers and their working conditions and employment precariousness in the EU-27; and to explore the association of different contract arrangements with health outcomes and how they are influenced by working and employment conditions. METHODS A sample of 27 245 working-age employees from the fifth European Working Condition Survey of 2010 was analysed. Logistic regression models were fitted to estimate the contribution of different contract arrangement (permanent, temporary and informal) and working and employment precariousness variables on health outcomes (psychosocial well-being and self-rated health). RESULTS Prevalence of informal employees in the EU-27 is 4.1% among men and 5.1% among women. Although informal employees have the poorest working conditions and employment precariousness, they did not seem to reflect poorer health. Precariousness employment variables have a greater impact than working conditions variables in reducing the association between health outcomes and type of contract arrangement, especially in the case of informal employees. CONCLUSIONS Informal employment in the EU-27 is characterized by worse working conditions and employment precariousness than the conditions for formal employees. There is no evidence at all that being in informal employment implies better health outcomes compared to permanent employees.
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Affiliation(s)
- Mireia Julià
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Science, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Francesc Belvis
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Science, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Alejandra Vives
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Science, Universitat Pompeu Fabra, Barcelona, Spain.,Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago de Chile, Chile.,ACCDiS, FONDAP, Santiago de Chile, Chile.,CEDEUS, FONDAP, Santiago de Chile, Chile
| | - Gemma Tarafa
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Science, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma Madrid, Madrid, Spain
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Science, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma Madrid, Madrid, Spain
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Llop-Gironés A, Julià M, Chicumbe S, Dulá J, Odallah AAP, Alvarez F, Zahinos I, Mazive E, Benach J. Inequalities in the access to and quality of healthcare in Mozambique: evidence from the household budget survey. Int J Qual Health Care 2020; 31:577-582. [PMID: 30388229 DOI: 10.1093/intqhc/mzy218] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2018] [Revised: 08/16/2018] [Accepted: 10/15/2018] [Indexed: 01/10/2023] Open
Abstract
OBJECTIVES To assess the inequalities in the access to and quality of care and its related direct payments. DESIGN Secondary analysis of the cross-sectional Mozambican Household Budget Survey (HBS). SETTING Nationally-representative sample of households in Mozambique. PARTICIPANTS 11 480 households (58 118 individuals) interviewed during HBS 2014/15. INTERVENTION None. MAIN OUTCOME MEASURES Equity, utilization of healthcare, access to quality care and direct payments. RESULTS About 12.2% of women and 10.1% of men of the survey report a perceive health need. About 72.1% of women and 72.9% men use healthcare. Population in a disadvantaged position living in rural areas have less probabilities of using healthcare for equal health compared to the individuals of a wealthier position and living in urban settings. With regard to quality care, 47.7% women and 46.8% men do not report quality problems. No differences for women's wealth. Men in a disadvantaged position report less chances of accessing quality care compared to men of advantaged position. Also, women and men living in rural areas have less probabilities of accessing quality care. Finally, the majority of people who access healthcare paid 1 Mt during their visit. CONCLUSIONS This study tackles a fundamental policy concern for health systems of Sub-Saharan Africa and points to areas that urge action to address the existent of socioeconomic and geographical inequalities in the access to and quality of care for women and men, including the strengthening of health facilities in rural and deprived areas to ensure that access to adequate care of acceptable quality is distributed according to need.
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Affiliation(s)
- Alba Llop-Gironés
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Mireia Julià
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Sergio Chicumbe
- Programa de Sistemas de Saúde, Instituto Nacional de Saúde, Ministry of Health, Estrada national 1, Marracuene
| | - Janeth Dulá
- Programa de Sistemas de Saúde, Instituto Nacional de Saúde, Ministry of Health, Estrada national 1, Marracuene
| | - Anita Aunda Pedro Odallah
- Department of Community Health, Faculty of Medicine, Universidade Eduardo Mondlane, Maputo, Mozambique, Salvador Allende Avenue 702, 257
| | - Francesc Alvarez
- Medicus Mundi Mediterrània, Secretari Coloma st 112, Barcelona, Spain
| | - Ivan Zahinos
- Medicus Mundi Mediterrània, Secretari Coloma st 112, Barcelona, Spain
| | - Elisio Mazive
- National Institute of Statistics of Mozambique, Maputo, Mozambique, Avenue 24 de Julho 1989, 493
| | - Joan Benach
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra Public Policy Center, Barcelona, Spain.,Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid
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Cash-Gibson L, Harris M, Guerra G, Benach J. A novel conceptual model and heuristic tool to strengthen understanding and capacities for health inequalities research. Health Res Policy Syst 2020; 18:42. [PMID: 32366322 PMCID: PMC7197115 DOI: 10.1186/s12961-020-00559-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2019] [Accepted: 04/06/2020] [Indexed: 12/27/2022] Open
Abstract
Background Despite increasing evidence on health inequalities over the past decades, further efforts to strengthen capacities to produce research on this topic are still urgently needed to inform effective interventions aiming to address these inequalities. To strengthen these research capacities, an initial comprehensive understanding of the health inequalities research production process is vital. However, most existing research and models are focused on understanding the relationship between health inequalities research and policy, with less focus on the health inequalities research production process itself. Existing conceptual frameworks provide valuable, yet limited, advancements on this topic; for example, they lack the capacity to comprehensively explain the health (and more specifically the health inequalities) research production process at the local level, including the potential pathways, components and determinants as well as the dynamics that might be involved. This therefore reduces their ability to be empirically tested and to provide practical guidance on how to strengthen the health inequalities research process and research capacities in different settings. Several scholars have also highlighted the need for further understanding and guidance in this area to inform effective action. Methods Through a critical review, we developed a novel conceptual model that integrates the social determinants of health and political economy perspectives to provide a comprehensive understanding of how health inequalities research and the related research capacities are likely to be produced (or inhibited) at local level. Results Our model represents a global hypothesis on the fundamental processes involved, and can serve as a heuristic tool to guide local level assessments of the determinants, dynamics and relations that might be relevant to better understand the health inequalities research production process and the related research capacities. Conclusions This type of knowledge can assist researchers and decision-makers to identify any information gaps or barriers to be addressed, and establish new entry points to effectively strengthen these research capacities. This can lead to the production of a stronger evidence base, both locally and globally, which can be used to inform strategic efforts aimed at achieving health equity.
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Affiliation(s)
- Lucinda Cash-Gibson
- Research Group on Health Inequalities, Environment and Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain. .,Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain.
| | - Matthew Harris
- The School of Public Health, Imperial College London, London, United Kingdom
| | - Germán Guerra
- National Institute of Public Health, Mexico, Av. Universidad No. 655 Colonia Santa Maria Ahuacatitlán, C.P, 62100, Cuernavaca, Morelos, Mexico
| | - Joan Benach
- Research Group on Health Inequalities, Environment and Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Mercè Rodoreda 24 Building, Campus Ciutadella UPF, Ramon Trias Fargas, 25-27, 08003, Barcelona, Catalonia, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Catalonia, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma, Madrid, Spain
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Alzate-Ángel J, Arroyave A, Gómez A, Pericàs J, Benach J. What have we researched about HIV infection in Colombia? A bibliometric review 1983 - 2018. Infect 2020. [DOI: 10.22354/in.v24i1.825] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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Llop-Gironés A, Cash-Gibson L, Chicumbe S, Alvarez F, Zahinos I, Mazive E, Benach J. Health equity monitoring is essential in public health: lessons from Mozambique. Global Health 2019; 15:67. [PMID: 31847863 PMCID: PMC6918557 DOI: 10.1186/s12992-019-0508-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 10/11/2019] [Indexed: 01/01/2023] Open
Abstract
Background Countries must be able to describe and monitor their populations health and well-being needs in an attempt to understand and address them. The Sustainable Development Goals (SDGs) have re-emphasized the need to invest in comprehensive health information systems to monitor progress towards health equity; however, knowledge on the capacity of health information systems to be able do this, particularly in low-income countries, remains very limited. As a case study, we aimed to evaluate the current capacity of the national health information systems in Mozambique, and the available indicators to monitor health inequalities, in line with SDG 3 (Good Health and Well Being for All at All Ages). Methods A data source mapping of the health information system in Mozambique was conducted. We followed the World Health Organization’s methodology of assessing data sources to evaluate the information available for every equity stratifier using a three-point scale: 1 - information is available, 2 - need for more information, and 3 - an information gap. Also, for each indicator we estimated the national average inequality score. Results Eight data sources contain health information to measure and monitor progress towards health equity in line with the 27 SDG3 indicators. Seven indicators bear information with nationally funded data sources, ten with data sources externally funded, and ten indicators either lack information or it does not applicable for the matter of the study. None of the 27 indicators associated with SDG3 can be fully disaggregated by equity stratifiers; they either lack some information (15 indicators) or do not have information at all (nine indicators). The indicators that contain more information are related to maternal and child health. Conclusions There are important information gaps in Mozambique’s current national health information system which prevents it from being able to comprehensively measure and monitor health equity. Comprehensive national health information systems are an essential public health need. Significant policy and political challenges must also be addressed to ensure effective interventions and action towards health equity in the country.
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Affiliation(s)
- Alba Llop-Gironés
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain. .,Johns Hopkins University University Pompeu Fabra Public Policy Center, Barcelona, Spain. .,GREDS-EMCONET, Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08003, Barcelona, Spain.
| | - Lucinda Cash-Gibson
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University University Pompeu Fabra Public Policy Center, Barcelona, Spain.,GREDS-EMCONET, Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08003, Barcelona, Spain
| | - Sergio Chicumbe
- National Institute of Health, Ministry of Health of Mozambique, Maputo, Mozambique.,Instituto Nacional de Saude, Eduardo Mondlane Ave, 1008, Maputo, Mozambique
| | - Francesc Alvarez
- Medicus Mundi Mediterrània, Secretari Coloma st 112, 08024, Barcelona, Spain
| | - Ivan Zahinos
- Medicus Mundi Mediterrània, Secretari Coloma st 112, 08024, Barcelona, Spain
| | - Elisio Mazive
- National Institute of Statistics of Mozambique, Maputo, Mozambique.,Instituto Nacional de Estatística, 24 de Julho Ave, 1989, Maputo, Mozambique
| | - Joan Benach
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain.,Johns Hopkins University University Pompeu Fabra Public Policy Center, Barcelona, Spain.,GREDS-EMCONET, Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas 25-27, 08003, Barcelona, Spain.,Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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Peralta A, Espinel-Flores V, Gotsens M, Pérez G, Benach J, Marí-Dell'Olmo M. Developing a deprivation index to study geographical health inequalities in Ecuador. Rev Saude Publica 2019; 53:97. [PMID: 31800910 PMCID: PMC9586448 DOI: 10.11606/s1518-8787.2019053001410] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2018] [Accepted: 03/11/2019] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVES: To develop a deprivation index to study health inequalities in 221 areas of Ecuador, to describe the pattern of deprivation in Ecuador, and to explore the applications of the index to study health inequalities by analysing the association between deprivation and mortality in the study areas. METHODS: We performed principal component analyses of available indicators of the 221 cantons of Ecuador. A set of 41 sociodemographic, social capital, and subjective well-being variables were obtained from the 2010 National Population Census and the National Living Conditions Survey 2013–2014. To explore the application of the index in public health, the association between the index and standardised mortality ratios was estimated through a Poisson regression model. RESULTS: The final index was constructed with 17 indicators. The first component explained 51.8% of the total variance of the data. A geographic pattern and a positive association of the index with the standardised mortality ratios of the cantons were observed in both men and women. CONCLUSIONS: We constructed a deprivation index that can identify disadvantaged areas in Ecuador. This index could be a valuable tool for the detection of vulnerabilised populations and the development of interventions and policies adapted to local needs.
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Affiliation(s)
- Andrés Peralta
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra. Department of Political and Social Sciences. Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET). Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Verónica Espinel-Flores
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra. Department of Experimental and Health Sciences. Barcelona, Catalonia, Spain
| | - Mercè Gotsens
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau). Barcelona, Spain
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Universitat Pompeu Fabra. Department of Experimental and Health Sciences. Barcelona, Catalonia, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau). Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
| | - Joan Benach
- Universitat Pompeu Fabra. Department of Political and Social Sciences. Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET). Barcelona, Spain.,Johns Hopkins University - Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Universidad Autónoma Madrid. Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2). Madrid, Spain
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona. Barcelona, Catalonia, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau). Barcelona, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Spain
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Jonsson J, Vives A, Benach J, Kjellberg K, Selander J, Johansson G, Bodin T. Measuring precarious employment in Sweden: translation, adaptation and psychometric properties of the Employment Precariousness Scale (EPRES). BMJ Open 2019; 9:e029577. [PMID: 31551377 PMCID: PMC6773301 DOI: 10.1136/bmjopen-2019-029577] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES Precarious employment (PE) is a determinant of poor health and health inequality. However, the evidence of health consequences and mechanisms underlying the associations, are still limited due to a lack of a comprehensive multidimensional definition and measurement instrument. The Employment Precariousness Scale (EPRES) is a Spanish, multidimensional scale, developed to measure degree of PE. The aim of this study was to translate the EPRES-2010 into Swedish, adapt it to the Swedish context and to assess the psychometric properties of the Swedish EPRES. METHOD EPRES was translated, adapted and implemented for data collection within the research project PRecarious EMployment in Stockholm (PREMIS). During 2016-2017, questionnaire data were collected from 483 non-standard employees in Stockholm, Sweden, sampled with web-based respondent-driven sampling. Analyses included item descriptive statistics, scale descriptive statistics and exploratory factor analysis. RESULTS The final EPRES-Se (Swedish version of the EPRES),consisted of six dimensions and 23 items. There was a high response rate to all items and response options. Global Cronbach's alpha was 0.83. Subscales 'vulnerability', 'rights' and 'exercise rights' had reliability coefficients between α=0.78-0.89 and item-subscale correlations between r=0.48-0.78. 'Temporariness' had poor reliability (α=-0.08) and inter-item correlation (r=-0.04), while 'disempowerment' showed acceptable psychometric properties (α=0.5; r=0.34). Exploratory factor analysis confirmed the original EPRES factor structure. CONCLUSIONS 'Vulnerability', 'wages', 'rights', 'exercise rights' and 'disempowerment' worked in the Swedish context; however, 'temporariness' would need revising before implementing the EPRES-Se in further research. Continued work and validation of EPRES-Se is encouraged. In order to enable international comparisons and multinational studies, similar studies in other European countries are also called for.
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Affiliation(s)
- Johanna Jonsson
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Alejandra Vives
- Department of Public Health, Pontificia Universidad Catolica de Chile Escuela de Medicina, Santiago, Chile
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
| | - Joan Benach
- Department of Political and Social Sciences, Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Universitat Pompeu Fabra, Barcelona, Spain
- Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autonoma de Madrid, Madrid, Spain
| | - Katarina Kjellberg
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Jenny Selander
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
| | - Gun Johansson
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
| | - Theo Bodin
- Institute of Environmental Medicine, Unit of Occupational Medicine, Karolinska Institutet, Stockholm, Sweden
- Center for Occupational and Environmental Medicine, Stockholm County Council, Stockholm, Sweden
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Delgado I, Cabieses B, Apablaza M, Castillo C, Aguilera X, Matute I, Najera M, Pericàs JM, Benach J. Evaluation of the effectiveness and equity of the maternity protection reform in Chile from 2000 to 2015. PLoS One 2019; 14:e0221150. [PMID: 31509544 PMCID: PMC6738580 DOI: 10.1371/journal.pone.0221150] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2018] [Accepted: 07/31/2019] [Indexed: 11/02/2022] Open
Abstract
INTRODUCTION According to the International Labor Organization, Maternity Protection (MP) policies try to harmonize child care and women's paid work, without affecting family health and economic security. Chile Law 20.545 (2011) increased benefits for economically active women and reduced requirements for accessing these benefits. The goals of the reform included: 1) to increase MP coverage; and 2) to reduce inequities in access to the benefits. METHOD This study uses two data sources. First, using individual data routinely collected from 2000 to 2015, yearly MP coverage access over time was calculated. Second, using national representative household surveys collected before and after the Law (2009 and 2013), coverage and a set of measures of inequality were estimated. To compare changes over time, we used non-experimental, before-after intervention design for independent samples. For each variable, we estimated comparative proportions at 95% confidence interval before and after the intervention. Additionally, we included multivariate and propensity score analysis. RESULTS Between 2000 and 2015, MP coverage grew from 24.4% to 44.8%. Using comparable 2009 and 2013 survey data, we observed the same trend, with 31.6% of estimated MP coverage in 2009, escalating to 39.5% in 2013. We conclude that: 1) after the reform, there was an increase in MP coverage; and, 2) there was no significant reduction of inequities in the distribution of MP benefits. DISCUSSION/CONCLUSION Few scientific evaluations of MP reforms have been conducted worldwide; even fewer including an equity analysis. This study provides an empirically-based evaluation of MP reform from both a population-level and an equity-focused perspective. We conclude that this reform needs to be complemented with other policies to ensure maternity protection in terms of access and equity in a country with deep socioeconomic stratification.
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Affiliation(s)
- Iris Delgado
- Centro de Epidemiología y Políticas de Salud, CEPS, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
- * E-mail:
| | - Baltica Cabieses
- Programa de Estudios Sociales en Salud, Instituto de Ciencias e Innovación en Medicina, ICIM, Universidad del Desarrollo, Santiago, Chile
| | - Mauricio Apablaza
- Centro de Políticas Públicas, Facultad de Gobierno, Universidad del Desarrollo, Santiago, Chile
| | - Carla Castillo
- Centro de Epidemiología y Políticas de Salud, CEPS, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Ximena Aguilera
- Centro de Epidemiología y Políticas de Salud, CEPS, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Isabel Matute
- Centro de Epidemiología y Políticas de Salud, CEPS, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Manuel Najera
- Centro de Epidemiología y Políticas de Salud, CEPS, Facultad de Medicina Clínica Alemana Universidad del Desarrollo, Santiago, Chile
| | - Juan M. Pericàs
- Grupo Desigualdades en Salud (GREDS-EMCONET), Departamento Ciencias Políticas y Sociales, Universitat Pompeu Fabra, Barcelona, España
| | - Joan Benach
- Grupo Desigualdades en Salud (GREDS-EMCONET), Departamento Ciencias Políticas y Sociales, Universitat Pompeu Fabra, Barcelona, España
- JHU-UPF Public Policy Center, Universitat Pompeu Fabra, Barcelona, España
- Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, España
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Jacques-Aviñó C, Dvorzak JL, Marí-Dell'Olmo M, Arjona DR, Peralta A, Carrere J, Benach J, Ramos C, Plana M, López MJ. Qualitative evaluation of an intervention to reduce energy poverty. Rev Saude Publica 2019; 53:62. [PMID: 31483004 PMCID: PMC6707618 DOI: 10.11606/s1518-8787.2019053001212] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Accepted: 11/14/2018] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE To evaluate the “ Energía, la justa ” program, aimed at reducing energy poverty in the city of Barcelona, from the point of view of the target population and the workers involved in the intervention. METHODS A qualitative, descriptive and exploratory pilot study was carried out, with a phenomenological approach. Twelve semi-structured interviews were conducted: to three users, three energy agents who performed interventions in the homes, and six professionals who participated in the program coordination. A thematic content analysis was carried out using Atlas-ti software . Interviews were conducted between October 2016 and March 2017. RESULTS Trust in a contact person (e.g. social workers) facilitated the participation, although there were difficulties reaching people who had illegal energy supplies, immigrant women or immigrants who subrent properties. Regarding implementation, home visits, energy efficiency advice and the relationship with energy agents were the best assessed aspects. However, not being able to carry out reforms in deteriorated dwellings was considered a limitation. The program also contributed to raise awareness on energy rights, to save on utility bills and to generate tranquility and social support. CONCLUSIONS Programs such as this one can promote energy empowerment and improve psychosocial status. However, strategies with a gender and equity perspective should be considered to reach other vulnerable groups.
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Affiliation(s)
- Constanza Jacques-Aviñó
- Servei d'Avaluació i Mètodes d'Intervenció. Agència de Salut Pública de Barcelona. Barcelona, España
| | - José Luis Dvorzak
- Servicio de Medicina Preventiva y Salud Pública. Hospital Universitario de Bellvitge.,Hospitalet de Llobregat. Barcelona, España
| | - Marc Marí-Dell'Olmo
- Servei de Qualitat i Intervenció Ambiental (SEQUIA). Agència de Salut Pública de Barcelona. Barcelona, España.,CIBER de Epidemiolgía y Salud Pública, (CIBERESP). Barcelona, España
| | | | - Andrés Peralta
- Servei de Qualitat i Intervenció Ambiental (SEQUIA). Agència de Salut Pública de Barcelona. Barcelona, España
| | - Juli Carrere
- Servei de Sistemes d'Informació Sanitària. Agència de Salut Pública de Barcelona. Barcelona, España
| | - Joan Benach
- Universidad Pompeu Fabra. GREDS-EMCONET Grupo de Investigación en Desigualdades en Salud - Employment Conditions Network. Departamento de Ciencias Politicas y Sociales. Barcelona, España
| | | | - Mònica Plana
- Asociación Bienestar y Desarrollo. Barcelona, España
| | - María José López
- Servei d'Avaluació i Mètodes d'Intervenció. Agència de Salut Pública de Barcelona. Barcelona, España.,CIBER de Epidemiolgía y Salud Pública, (CIBERESP). Barcelona, España
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Ruiz ME, Vives A, Puig-Barrachina V, Benach J. Unravelling Hidden Informal Employment in Chile: Towards a New Classification and Measurements to Study Its Public Health Impact. Int J Health Serv 2019; 49:817-843. [PMID: 31366269 DOI: 10.1177/0020731419866305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study aims to assess differences in the working population of Chile under the definition of informal employment. A new categorization of informal employment is proposed, with a focus on social protection as a key element in the definition of informal employment status, thereby making visible different groups of workers that until now remained hidden. From a mixed methodological strategy that combines literature review, key informant interviews, and quantitative data analysis, the researchers seek to understand the complexity of the social phenomenon of informality.
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Affiliation(s)
- Marisol E Ruiz
- 1 Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,2 Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain
| | - Alejandra Vives
- 1 Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,3 Departamento de Salud Pública, Escuela de Medicina, Pontificia Universidad Católica de Chile, Santiago, Chile
| | | | - Joan Benach
- 1 Health Inequalities Research Group - Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain.,2 Johns Hopkins University - Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain.,5 Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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Abstract
BACKGROUND In high-income countries, the prevalence of blindness and visual impairment is higher among women, regardless of age although the mechanisms that produce these gender inequalities are not well understood. The objectives of this study were to analyse gender inequalities in the prevalence of blindness and visual impairment, age of onset, diagnosed and undiagnosed status and related eye diseases among visually impaired individuals. METHODS Data were obtained from the 2008 Spanish Survey on 'Disability, Personal Autonomy and Dependency Situations' (n = 213 626) participants 360 blind (160 men and 200 women), and 5560 with some visual impairment (2025 men and 3535 women). The prevalence of blindness and visual impairment, age of onset of visual impairment and diagnosed and undiagnosed eye diseases was calculated. Hierarchical multiple logistic regression models were fit to test gender differences. RESULTS Women were more likely to report visual impairment (crude OR = 1.6 [95% CI: 1.56-1.74]). Prevalence of diagnosed cataract was higher among visually impaired women (crude OR = 1.4 [95% CI: 1.25-1.67]) whereas undiagnosed eye disease (crude OR = 0.7 [95% CI: 0.64-0.81]) or diagnosed glaucoma (aORsex = 0.8 [95% CI: 0.65-0.93]) were more frequent among visually impairment men. These associations were not explained by age or educational level. CONCLUSIONS Strong gender inequalities were observed, with a higher prevalence of visual impairment and related cataracts among women, which could be related to gender inequalities in access to health care, and undiagnosed eye disease and related glaucoma among men, which could be related to their gender socialization resulting in less frequent and effectively use of health care services.
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Affiliation(s)
- Anna Rius Ulldemolins
- Department of Optometry and Optics, Universitat Politècnica de Catalunya; Institut de les Desigualtats, Barcelona, Spain
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
| | - Laura Guisasola
- Department of Optometry and Optics, Universitat Politècnica de Catalunya; Institut de les Desigualtats, Barcelona, Spain
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Benach J, Díaz MR, Muñoz NJ, Martínez-Herrera E, Pericàs JM. What the Puerto Rican hurricanes make visible: Chronicle of a public health disaster foretold. Soc Sci Med 2019; 238:112367. [PMID: 31213368 DOI: 10.1016/j.socscimed.2019.112367] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2018] [Revised: 06/09/2019] [Accepted: 06/11/2019] [Indexed: 11/16/2022]
Abstract
García Márquez's novel, "Chronicle of a Death Foretold", narrates the multiple strands of a story leading up to a murder in a small Caribbean village. The novel shows both the incredulity of those who do not believe it possible that this tragic death could occur, and the impotence of those who see it coming but can do nothing to prevent it. Something akin to this double incapacity seems to be occurring today in Puerto Rico. In September 2017, the passage of Hurricanes Irma and María caused a public health disaster with large-scale death and destruction. Paradoxically, this catastrophe has made visible the need to evaluate the critical socio-environmental situation of this country, and to analyse the underlying social factors contributing to the problems caused by the hurricanes. Why did neither the US nor the Puerto Rican government react as expected when faced with such a serious situation? For decades, this country has been suppressed by colonial domination, exploitation of the workforce, and health discrimination. It has been a "laboratory", where colonial practices have institutionalized social control, racism, and inequality, with profound negative effects on society, quality of life and health equality. Poverty and unemployment have always been very high, and thousands of families live in precarious housing situations. Additionally, current labour reforms imposed as part of a neoliberal agenda, are eroding the job security and protections of the working population, while education, health, housing, pensions, energy, and land are being progressively privatized. What are the root causes of this situation? What future does the country await? To answer these questions, critical and comprehensive scrutiny of history showing what the hurricanes have helped to make visible is required. This shows that neoliberal colonialism has shaped the social features behind the principle health and inequality problems of the Puerto-Rican population.
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Affiliation(s)
- Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain; Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma Madrid, 28049 Madrid, Spain.
| | - Marinilda Rivera Díaz
- Social Sciences Research Center, College of Social Sciences, University of Puerto Rico, Rio Piedras Campus, Puerto Rico; Post Doctoral Master in Clinical & Translational Research Program, School of Health Professionals & School of Medicine, University of Puerto Rico, Medical Sciences Campus, Puerto Rico; International Health and Sanitary Sovereign Working Group, Latin-American Council of Social Sciences (CLACSO), Puerto Rico
| | - Nylca J Muñoz
- Social Determinants of Health Doctoral Program, School of Public Health, University of Puerto Rico, Puerto Rico
| | - Eliana Martínez-Herrera
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain; Epidemiology Research Group, National School of Public Health, University of Antioquia (UdeA), Medellín, Colombia
| | - Juan Manuel Pericàs
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain; Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain; Translational Research Group on Infectious Diseases of Lleida (TRIDLE), IRB Lleida, Clinical Direction of Infectious Diseases and Clinical Microbiology of Lleida, Hospital Universitari Arnau de Vilanova, Lleida, Spain
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Peralta A, Benach J, Borrell C, Espinel-Flores V, Cash-Gibson L, Queiroz BL, Marí-Dell'Olmo M. Correction to: Evaluation of the mortality registry in Ecuador (2001-2013) - social and geographical inequalities in completeness and quality. Popul Health Metr 2019; 17:5. [PMID: 30999921 PMCID: PMC6474044 DOI: 10.1186/s12963-019-0185-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2019] [Accepted: 03/29/2019] [Indexed: 11/15/2022] Open
Affiliation(s)
- Andrés Peralta
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain. .,Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain. .,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain.
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma Madrid, 28049, Madrid, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Verónica Espinel-Flores
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Lucinda Cash-Gibson
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Bernardo L Queiroz
- Department of Demography and Cedeplar, Faculdade de Ciências Econômicas, FACE/UFMG, Campus Pampulha, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, CEP 31270-901, Brazil
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
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Peralta A, Benach J, Borrell C, Espinel-Flores V, Cash-Gibson L, Queiroz BL, Marí-Dell'Olmo M. Evaluation of the mortality registry in Ecuador (2001-2013) - social and geographical inequalities in completeness and quality. Popul Health Metr 2019; 17:3. [PMID: 30922340 PMCID: PMC6437878 DOI: 10.1186/s12963-019-0183-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 02/06/2019] [Indexed: 01/08/2023] Open
Abstract
Background Mortality registries are an essential data source for public health surveillance and for planning and evaluating public policy. Nevertheless, there are still large inequalities in the completeness and quality of mortality registries between and within countries. In Ecuador, there have been few nationwide evaluations of the mortality registry and no evaluations of inequalities between provinces. This kind of analysis is fundamental for strengthening the vital statistics system. Methods Ecological study assessing the completeness, quality and internal consistency of mortality data in the provinces of Ecuador, using 13 years of mortality data (2001–2013). Completeness was assessed using three types of death distribution methods (DDMs), quality by estimating the percentages of garbage codes and deaths with unspecified age or sex in the registered deaths, and internal consistency by estimating the percentage of deaths with reported causes of deaths considered impossible in some age–sex combinations. Finally, we propose a classification of the mortality registry in the studied areas based on completeness and quality. Results Completeness estimates (mean of the three methods used) in the provinces ranged from 21 to 87% in women and from 35 to 89% in men. The percentage of garbage codes in the provinces ranged from 21 to 56% in women and from 25 to 52% in men. Garbage coding was higher in women and in older age groups. The percentage of deaths with unspecified age or sex, and the percentage of deaths with reported causes of deaths considered impossible in some age–sex combinations was low in all the studied areas. The mortality registry could only be classified as acceptable in one area for men and one area for women. Conclusions We found substantial inequalities by sex, geographical areas and age in the completeness and quality of the mortality registry of Ecuador. The findings of this study will be helpful to direct measures to improve Ecuador’s vital statistics system and to generate strategies to reduce bias when using mortality data to analyse health inequalities in the country. Electronic supplementary material The online version of this article (10.1186/s12963-019-0183-y) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Andrés Peralta
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain. .,Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain. .,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain.
| | - Joan Benach
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain.,Transdisciplinary Research Group on Socioecological Transitions (GinTRANS2), Universidad Autónoma Madrid, 28049, Madrid, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Verónica Espinel-Flores
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Lucinda Cash-Gibson
- Health Inequalities Research Group, Employment Conditions Knowledge Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Ramon Trias Fargas, 25-27, 08005, Barcelona, Spain.,Johns Hopkins University, Pompeu Fabra University Public Policy Center, Barcelona, Spain
| | - Bernardo L Queiroz
- Department of Demography and Cedeplar, Faculdade de Ciências Econômicas, FACE/UFMG, Campus Pampulha, Av. Antônio Carlos, 6627, Pampulha, Belo Horizonte, MG, CEP 31270-901, Brazil
| | - Marc Marí-Dell'Olmo
- Agència de Salut Pública de Barcelona, Plaça Lesseps 1, 08023, Barcelona, Catalonia, Spain.,CIBER Epidemiología y Salud Pública (CIBERESP), Madrid, Spain.,Institut d'Investigació Biomèdica (IIB Sant Pau), Barcelona, Spain.,Department of Experimental and Health Sciences, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
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Alzate Angel JC, Pericàs JM, Taylor HA, Benach J. Systemic Factors and Barriers That Hamper Adequate Data Collection on the HIV Epidemic and Its Associated Inequalities in Countries With Long-Term Armed Conflicts: Lessons From Colombia. Am J Public Health 2018; 108:1341-1344. [PMID: 30138065 PMCID: PMC6137797 DOI: 10.2105/ajph.2018.304505] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/20/2018] [Indexed: 11/04/2022]
Abstract
Although advances in treatment and diagnosis have transformed HIV into a chronic disease in high-income countries, a spectrum of structural, political, sociocultural, and health system barriers hamper early diagnosis and timely treatment of HIV in many middle- and low-income countries. In most Latin American countries, in spite of the great improvement in access to antiretroviral therapy, a large proportion of individuals infected with HIV do not know their status. In Colombia, the Joint United Nations Programme on HIV/AIDS currently estimates a much larger number of HIV cases than the number reported by Colombian authorities. Potential reasons for underdiagnosis and underreporting include sociocultural factors such as social stigma, restrictions in access to health care, a lack of public health research and robust surveillance systems, and the particular recent history and social situation related to the armed conflict the country has suffered through for several decades. Lessons from Colombia may be helpful in monitoring, understanding, and tackling the HIV epidemic in countries with long-term armed conflicts.
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Affiliation(s)
- Juan C Alzate Angel
- Juan C. Alzate Angel is with the Clinical Research Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia. Juan M. Pericàs is with ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain. Holly A. Taylor is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Joan Benach is with the Health Inequalities Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona
| | - Juan M Pericàs
- Juan C. Alzate Angel is with the Clinical Research Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia. Juan M. Pericàs is with ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain. Holly A. Taylor is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Joan Benach is with the Health Inequalities Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona
| | - Holly A Taylor
- Juan C. Alzate Angel is with the Clinical Research Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia. Juan M. Pericàs is with ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain. Holly A. Taylor is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Joan Benach is with the Health Inequalities Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona
| | - Joan Benach
- Juan C. Alzate Angel is with the Clinical Research Unit, Corporación para Investigaciones Biológicas, Medellín, Colombia. Juan M. Pericàs is with ISGlobal, Hospital Clínic de Barcelona, University of Barcelona, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona, Spain. Holly A. Taylor is with the Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD. Joan Benach is with the Health Inequalities Research Group, Department of Political and Social Sciences, Universitat Pompeu Fabra, and Johns Hopkins University-Universitat Pompeu Fabra Public Policy Center, Barcelona
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50
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Vergara-Duarte M, Borrell C, Pérez G, Martín-Sánchez JC, Clèries R, Buxó M, Martínez-Solanas È, Yasui Y, Muntaner C, Benach J. Sentinel Amenable Mortality: A New Way to Assess the Quality of Healthcare by Examining Causes of Premature Death for Which Highly Efficacious Medical Interventions Are Available. Biomed Res Int 2018; 2018:5456074. [PMID: 30246022 PMCID: PMC6139231 DOI: 10.1155/2018/5456074] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2017] [Revised: 02/08/2018] [Accepted: 05/09/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Amenable mortality, or premature deaths that could be prevented with medical care, is a proven indicator for assessing healthcare quality when adapted to a country or region's specific healthcare context. This concept is currently used to evaluate the performance of national and international healthcare systems. However, the levels of efficacy and effectiveness determined using this indicator can vary greatly depending on the causes of death that are included. We introduce a new approach by identifying a subgroup of causes for which there are available treatments with a high level of efficacy. These causes should be considered sentinel events to help identify limitations in the effectiveness and quality of health provision. METHODS We conducted an extensive literature review using a list of amenable causes of death compiled by Spanish researchers. We complemented this approach by assessing the time trends of amenable mortality in two high-income countries that have a similar quality of healthcare but very different systems of provision, namely, Spain and the United States. This enabled us to identify different levels of efficacy of medical interventions (high, medium, and low). We consulted a group of medical experts and combined this information to help make the final classification of sentinel amenable causes of death. RESULTS Sentinel amenable mortality includes causes such as surgical conditions, thyroid diseases, and asthma. The remaining amenable causes of death either have a higher complexity in terms of the disease or need more effective medical interventions or preventative measures to guarantee early detection and adherence to treatment. These included cardiovascular diseases, diabetes, hypertension, all amenable cancers, and some infectious diseases such as pneumonia, influenza, and tuberculosis. CONCLUSIONS Sentinel amenable mortality could act as a good sentinel indicator to identify major deficiencies in healthcare quality and provision and detect inequalities across populations.
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Affiliation(s)
- Montse Vergara-Duarte
- CAP El Clot and Unitat d'Avaluació, Sistemes d'Informació i Qualitat Assistencial, Gerència Territorial de Barcelona, Institut Català de la Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Spain
| | - Carme Borrell
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Glòria Pérez
- Agència de Salut Pública de Barcelona, Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- Sant Pau Biomedical Research Institute (IIB Sant Pau), Barcelona, Spain
| | - Juan Carlos Martín-Sánchez
- Biostatistics Unit, Department of Basic Sciences, Universitat Internacional de Catalunya, Sant Cugat del Vallès, Spain
| | - Ramon Clèries
- Pla Director d'Oncología, IDIBELL, Hospitalet de Llobregat, Barcelona, Spain
- Departament de Ciències Clíniques, Universitat de Barcelona, Barcelona, Spain
| | - Maria Buxó
- Girona Biomedical Research Institute (IDIBGI), Salt, Spain
| | - Èrica Martínez-Solanas
- CIBER Epidemiology and Public Health (CIBERESP), Barcelona, Spain
- Universitat Pompeu Fabra, Barcelona, Spain
- ISGlobal, Center for Research in Environmental Epidemiology (CREAL), Spain
| | - Yutaka Yasui
- Department of Epidemiology & Cancer Control (S6050), St. Jude Children's Research Hospital, Memphis, TN, USA
- School of Public Health, University of Alberta, 4-274, Edmonton Clinic Health Academy, Edmonton, AB, Canada
| | - Carles Muntaner
- Bloomberg Faculty of Nursing and Dalla Lana School of Public Health, University of Toronto, Canada
| | - Joan Benach
- Health Inequalities Research Group-Employment Conditions Network (GREDS-EMCONET), Department of Political and Social Sciences, Universitat Pompeu Fabra, Barcelona, Spain
- Johns Hopkins University, Public Policy Center, Barcelona, Spain
- Grupo de Investigación Transdisciplinar sobre Transiciones Socioecológicas (GinTRANS2), Universidad Autónoma de Madrid, Madrid, Spain
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