Women and science: from photography 51 to the scissor graph. Have we progressed much at all?

28 Apr
Dolores Ruiz Muñoz

On 15 December 2015, the General Assembly of the United Nations declared 11 February as the day to celebrate the Dia International Day of Women and Girls in Science. With all the world days that we have to celebrate it is inevitable to ask ourselves whether this day was necessary, or not.

Today, from this platform, we would like to invite you to accompany us on this reflection.

When talking about the subject of discrimination against women in science, the typical question that is asked to highlight this discrimination is usually: How many women scientists do you know? Now, Marie Curie is usually one of the female scientists most mentioned here. It would seem we are doing well.

Let’s take this a little further: what happens if we pose the question about present day scientists? We might find ourselves in a context where we ourselves are women scientists, or we are all surrounded but women scientists, and think that finding several names would not be that difficult.

However, what about beyond our place of work? It seems as if we are now starting to have some difficulty. Outside of the circles where these women scientists operate it seems that people do not know much about women who do science and that the icon of Rosalind Franklin and her fotografia 51 remains relevant more than ever today.

Image of the Photograph 51 of the blog Centpeus of Daniel Close (@nielo40)

One reason to explain the invisibility of women in science is the fact that there were considerable barriers impeding women from gaining access to academic education for many years. Women were relegated in society to carrying out the role of reproduction, and it was almost impossible for them to get an academic education in equal terms to men, and it was, therefore, normal that later they did not stand out as scientists or let alone managed to become one.

Of course, even so, there have been women such as Nettie Maria Stevens, who have been able to leave their mark. This said, always from a position in the background of the history of science, and without receiving the clear acknowledgment that men in science have in their lifetimes.

And now what? Is the excuse of there being an academic ‘gap’ still true? This reasoning is no longer valid when we see that there are more women than men studying science degrees. Why are women today still absent in positions of responsibility in science? What is happening along the way? How is it possible that in Catalonia there are more women than men studying science but yet only 2 out of the 42 research centres have women as General Managers?

Image of the web Women in Science of the UNESCO

The situation today is known as the scissor graph. Women are left behind along the way in science. Even though the presence of women and men in recent years has tended to converge a little, the difference is still very visible and huge, especially in positions of greatest responsibility. This is a clear reflection of the glass ceiling which acts as an invisible barrier and which women come up against in the majority of fields in the labour market in their quest to attain positions of responsibility.

The Scissor graph (Mujeres y ciencia, CSIC)

The fact, however, that women have less and less presence in science goes beyond social injustice, unless of course there are some at this stage who still believe this happens because they are less capable, and not because of the social obstacles they encounter along the way which go far beyond the wage gap, a fact that has been more than demonstrated. All this signifies a clear loss of talent for science and for society; in short, for everyone.

Image of the report Women, gender, inequality and development

Source: Carme Poveda, Observatory on Women in Business and Economy, Chamber of Commerce of Barcelona

One could think that this may not be happening in the health sciences. In fact, it is one of the most feminised scientific sectors that we have. But is this so? Just thinking about what jobs are occupied by women in the health sciences makes it clear that this sector is not without this problem of, let’s call it defeminisation of power. In fact, the health sciences is one of the areas where the gap between women and men is very much a reality.

Just yesterday, the Ministry of Health launched a campaign aimed at the public in general to promote vaccination and immediately, a strong controversy was generated in the communications media. In the video it stands out that the only health professional in uniform who does not represent their reality is the nurse that appears with a cap and miniskirt. What happened? A possible explanation might be that the images were obtained from a free photo bank that clearly does not reflect the reality of our present day context.

For now, we will set aside writing about quotas according to sex, a concept that is never without controversy nor leaves anyone indifferent. But for the moment it seems that the International Day of Women and Children in Science may be necessary after all and especially of the Girl in Science as well because they are the scientists of the future who we hope will be able to close the gap in the pair of scissors.

We end this note with a very simple question: is there still someone who believes that we have already achieved parity?

Would you like to read more about the subject? Esther Vizcaino published Gender equality, we all win.

Post written by Dolores Ruiz-Muñoz.

Double health insurance cover

20 Apr
Lluís Bohígas

A double health insurance cover occurs when a person that has the right to public healthcare also has a private health insurance which allows them to receive private health services. Anyone can go to private health services if they pay from their own pocket but it is only defined as a double insurance cover when one has taken out a specific private health insurance. The population has a right to healthcare because they have contributed to social security – or they may find themselves in any one of the contexts that gives them the right to access – and this covers almost the entire population but not all; there is a segment that does not have the right to public healthcare and only has private cover if they purchase an insurance.

In the 80s of last century, the self-employed were not covered by social security and the majority had a private insurance. At that time, in Catalonia the Quinta de Salut l’Aliança was very popular. Ernest Lluch, the Minister of Health, made it compulsory for the social security to offer healthcare to the self-employed and, all of a sudden, many of those insured by l’Aliança found themselves having a double insurance. Some left l’Aliança but others stayed on. The public healthcare system and the majority of insurance companies only cover a basic part of dental healthcare. If you want a wider dental healthcare cover you need to purchase a specific insurance. This insurance is not considered to be double cover because it does not cover the services which are covered by the public insurance.

In 2014, the Generalitat recorded 2.032.911 people with a health insurance in Catalonia but not all had double cover. State civil servants and their families can choose to be attended by the autonomous community or by a private insurance and 80%, 160.815, choose private healthcare and so they do not have double cover. The difference between the total number of insured and the civil servants that have chosen a private insurance are 1.872.096 people; that is, 24,9% of the population has double cover.

Why do one out of every four Catalans buy a private health insurance, despite having the right to public healthcare?

There are several reasons for this. On the one hand, a private insurance gives them access to private health centres and to independent doctors who are sometimes doctors that work in a public centre in the morning and a private centre in the afternoon. In the afternoon, one can choose the doctor that it wasn’t possible to choose in the morning. Another reason is waiting times. Private centres and independent doctors have shorter waiting times than in public centres. And another frequent argument is that private doctors spend more time on each patient and that private centres provide better attention to patients.

These are the reasons that have usually been given to justify a person spending more than 700€ a year on average on a private insurance to benefit from services they in fact have access to in the public system.

But there are also other arguments. One is to see an insurance as a salary paid in kind and another is the response people have to cuts in public health. Some companies give their employees a private insurance as a complement to their salaries, partly for tax reasons but also as an incentive for some employees and for managers. 31,6% of people insured in Catalonia in 2014 were insured by their companies.

During the period 2009-2013, while cuts were being made in public health, health insurance companies grew in Catalonia and in Spain as a whole. During this period the insurance companies raised their rates quite considerably but despite this rise, and despite a decrease in the purchasing power of families, health insurance policies didn´t so much as become cheaper but rather increased in price.

More women than men have a double cover, are between 45 and 64, have a university qualification and belong to the upper social class according to the Generalitat’s health survey. Notwithstanding, 11% are older than 75 and 10% have no higher education qualifications or only have primary education and 11,5% belong to the lower social class.

The Generalitat’s statistics tell us which services are paid for privately in hospitals. Thus, for example, 31% of births are private and a large part of surgery is private: 35% of elective surgery and 25,8% of major outpatient surgery. 26% of hospital admissions and 21% of emergencies are also private.

Some of these private services in hospitals are paid for directly by the user but the greater part is financed by health insurances. Statistics only provide us with information of hospital services but it is probable that the private part is even greater in visits to doctors and other services.

Proposals have been made in the past to offer tax incentives to people purchasing a private insurance who waive their right to have access to public services. The aim would be to reduce waiting lists in the public system. I do not think that this would work because the majority of people that have a double cover do not relinquish access to public services but rather want to be able to choose between receiving private or public care.

Double cover is a stable data in the Catalan health system. It already existed when INSALUD managed public health and continues to exist. The number of insured may vary in time but the phenomenon is constant: an important part of the population, those who can afford it, prefer being able to choose between public or private healthcare.

Nowadays, one needs the other: if there were no private healthcare, the public system would collapse; if there was not a public system, the private sector would be incapable of providing the care it does at the price it does. The usual discourse is an ideological criticism of the other, the public system criticises the private and vice versa. I think it would be better for Catalan health as a whole to reach an agreement.

Post written by Lluís Bohígas (@bohigasl), economist.

An indicator for a more fairly funded primary care

7 Apr
Cristina Colls

The Catalan government has recently expressed its willingness to increase the importance ascribed to the socio-economic level of regions when calculating the budget for each primary care team.

This fact invites us to ask ourselves a question: why is it important to bear in mind the economic inequality in the funding of primary care teams?

The influence of socio-economic inequalities on the health of the population is a fact that has been widely studied since the 60s of last century and of which there is evidence both in the international and national context.

We know that people with a lower socio-economic status have more probability of dying before the age of 65 and that they show more physical and mental health problems during their lives. It is logical, therefore, to conclude that they need to make a more intensive use of health resources.

We also know that social inequality is a recipe for an unbalanced distribution of the population in a territory leading to an accumulation of the most serious social problems in specific municipalities or neighbourhoods that have a greater need for social and healthcare than other regions.

It is in this context that more needs to be done where there is greater necessity if equity in the allocation of resources is to be guaranteed. But where should more resources be provided?

The professionals of primary care teams are those closest to the citizen and therefore, have a comprehensive view of the health needs of the population in their territory.

In addition, the primary environment is the reference in prevention activities, in controlling chronic diseases and from which a large part of community activity is coordinated. For all these reasons, the provision for primary care teams must bear in mind the socio-economic conditions of the population they serve.

How can we find out what the socio-economic situation is of territories in which a primary care primary care team works? Many variables exist which give us indirect information (income, occupation, education, housing conditions, among others) but if we are looking for only one classification we need a unique index that synthesises all these aspects; it is what we call a deprivation index.

Deprivation indexes have been widely used as a tool in social policies because they allow an objective prioritisation to be established in small regions, ranging from a low to high socio-economic status. The concept of “deprivation” refers to unmet needs as a result of a lack of resources, not exclusively economic.

All indexes of deprivation are built by adding up the results of different socio-economic status indicators. The weight given to each indicator could be theoretical, that is, based on what a particular indicator is thought to contribute to the phenomenon of deprivation; or otherwise, the result of a multivariate statistical model.

To be able to classify the basic areas of health (reference territories of a primary care team) according to their socio-economic level, AQuAS has built an index called a composite socio-economic status indicator which synthesises seven indicators: population exempt from drug co-payment, population with incomes lower than 18,000€, population with incomes higher than 100,000€, population with manual jobs, population with insufficient educational attainment, premature deaths or potentially avoidable hospitalisations.

The statistical methodology used for calculating this indicator has been that of principal component analysis. The application of this methodology has allowed us to obtain a socio-economic status map of Catalonia.

The application of the composite socio-economic status indicator has been done within the framework of the redefinition of the model of allocation of resources for primary care and has enabled the identification of those primary care teams which will increase their budgets in coming years.

This new model of allocating resources for primary care is an experience in applying scientific evidence to political action.

Post written by Cristina Colls.