Health and poverty are hereditary: can we remedy this?

17 May
Anna Garcia-Altés
Anna García-Altés

In recent years, child poverty has increased in Catalonia as a result of the economic crisis. According to the 2016 figures from the Idescat, the latest figures available, and from 2009, children are the group most at risk of poverty, more than the adult population and also more than the 65-year-old or older population group.

“Child health and poverty. What can we learn from the data?” was the title of the conference held within the framework of the Celebration of the 2018 World Health Day.

Data from the latest report related to children and the effects of the crisis on the health of the population were highlighted at the conference, published by the Observatory of the Health System of Catalonia: children with a lower socio-economic level present up to 5 times more morbidity, consume more pharmaceutical drugs (three times more psychotropic drugs) than the remainder of the child population, visit mental health centres more frequently (5.9% of girls and 11.4% of boys as opposed to 1.3% and 2.2% in girls and boys with a higher socio-economic level) and are admitted more to hospitals (45 girls and 58 boys for every 1000 as opposed to 13 and 26, respectively) especially for psychiatric reasons.

A child’s health largely depends on the economy of their parents and those that belong to families with a lower socio-economic level have more health problems, a fact that can have disastrous consequences in other areas such as education and social life and which condition their future. This fact is exacerbated in the case of children with special needs or chronic diseases where their health suffers even more from the effects of poverty because in some cases their care requires specific products which families cannot afford.

This is one of the problems that we are facing right now. There is growing scientific evidence, both in biology and in social sciences, of the importance of the early years in life (including exposure in the womb) in the development of the capacities that stimulate personal well-being throughout the life cycle. Childhood is also a structural transmitter of inequalities, both from a health and socio-economic point of view. If nothing is done, boys and girls who belong to families with few resources run the risk of growing up into adults with worse health and a lower educational and socio-economic level than others.

What can we do? We can of course strengthen the social welfare state, with structural and institutional reforms which are more than ever necessary. Educational policy is fundamental, especially by reinforcing primary education, guaranteeing equal opportunities and putting the spotlight on those children in a disadvantaged situation. Once they are adult, active labour policies are also needed. And from health policies, despite their eminently palliative nature, primary and community care is particularly important as is guaranteeing care to all children.

Post written by Anna García-Altés (@annagaal).

Crisis, inequalities and policies: proposed intinerary

7 Sep

Unfortunately, inequalities in health are still an issue today including in our country. The crisis of recent years has once again put the spotlight on this subject.

 This is why we propose an itinerary taking us through the different texts which we have published on the subject in this blog and, in particular, we invite you to read the original texts which are mentioned here in more depth, a large proportion of which have been elaborated at the AQuAS.

In September of last year, Luis Rajmil reflected on social inequalities in child health and the economic crisis in this post placing the concepts of equality, equity and reality  on the agenda for discussion.

 “At present, there is enough accumulated information that shows that life’s course and the conditions of prenatal life as well as life during the first few years are very influential factors in the health and social participation of an adult to come.”

At a later date, the Observatory of the effects of the crisis on the health of the population published its third report but prior to that, a post was published with a collection of individual thoughts and reflections on this subject by Xavier Trabado, Angelina González and Andreu Segura focussing on, respectively, the effects of the crisis on the mental health of people, the coordination of different mechanisms in primary and specialised care, the urgency for community health actions and the need to engage in intersectoral actions.

 “It is urgent to put community health processes into action; processes in which the community is the protagonist, which constitute the shift from treating an illness to a bio-psycho-social approach which gives an impulse to intersectoral work in a network with local agents, with who there is the shared aim of improving the community’s well-being. Based on the needs detected and prioritised in a participatory way and with the local assets identified, these processes activate interventions based on evidence which are assessed”

In this other post, Cristina Colls presented an interesting case of the application of scientific evidence to political action which occurred with the revision of the socio-economic dimension of the formula for allocating resources to primary care.

 “Social inequality leads to an unbalanced distribution of the population in a territory, concentrating the most serious social problems in certain municipalities or neighbourhoods having higher needs for social and health services than other territories. In this context, more needs to be done where needs are greater if the aim is to guarantee equality in the allocation of resources”

Finally, the most recent post was written by Anna García-Altés and Guillem López-Casanovas. It is a text that provides food for thought based on the latest report published from the Observatory of the Health System of Catalonia on the effects of the crisis on the health of the population.

 “Understanding the mechanisms  by which social inequalities have an impact on the health of the population, so as to know how best to counter or neutralise them, in any place and at any time, is an issue that must still be addressed by our social policies”

We hope that you this very short itinerary through these texts, initiatives and analyses that aim to be useful in tackling inequalities has been of interest.

Post written by Marta Millaret (@MartaMillaret)

Crisis and health: the opinion of some experts

16 Feb

In the next few weeks, a new report will be published by the Observatory on the effecs of the crisis in the health of the population, drafted at the Observatory of the Catalan Health System. Based on experience and with the aim of providing some things to reflect on at an individual and community level, we would like to share some words by Xavier Trabado, Angelina González Viana and Andreu Segura about the initiative that was begun three years ago (you can consult the 2014 and 2015 reports).

Crisi i salut

Xavier Trabado
Xavier Trabado

“Precarious employment, changes in the labor system, unemployment, evictions, debt, household instability and poverty directly affect the mental health of people. The latest Health Survey of Catalonia shows the percentage of people have some kind of risk for of mental health problems. To prevent this number from increasing and working for itstowards decrease reducing it we need programs supporting prevention, to better detect cases that could go unnoticed. It is essential to act in the initial stagesearly to prevent worsening situations  from getting worse, by providing support and appropriate tools. There are programs such as the one supporting primary care, which has been evaluated with very positive results, but not yet deployed on in the whole territory. The training of the primary care professionals allows for a quick and preventive approach, and an intervention  to provide solutions. Finally, the coordination between specialized and primary care resources is key to make making an initial diagnosis and to continue monitoring the  cases detected.  We need a change in the way healthcare services are provided, enabling and integrating the efforts of different work areas and professionals, providing tools to the affected person, seizing it , informing the family and accompanying them during the process through psycho-educational groups and support groups”. (Xavier Trabado is spokesperson for the Federation of Mental Health in Catalonia)

Angelina González Viana

“The report by the Observatory on the effects of the crisis on health highlights the communities which have borne the brunt of the crisis and how it has affected their health. It is urgent to initiate community health actions: actions in which the community is the protagonist and which are the transition from the attention given to an illness to a bio-psycho-social approach where these actions promote inter-sectorial work and that done in networks with local agents who share the aim of improving the welfare of the community. Based on the needs detected and then prioritised, with all involved participating, and having identified the local assets, these agents initiate interventions supported by evidence which are later assessed. Ultimately, community health is the application of all these policies at a local level.” (Angelina González Viana coordinates community projects such as COMSalut, at the general Sub-directorate for the Promotion of Health of the catalan Public Health Agency)

Andreu Segura
Andreu Segura

“The ongoing crisis has increased income inequality, income poverty and the risk of social exclusion. All this generates anxiety, distress and despair, mood disorders which are not unhealthy, at least initially , and healthcare services not cure . The health of the population has a lot to do with the living conditions of people and their ability to cope with the  ups and downs. Hence the importance of the level of education level and purchasing power – work, and pensions and subsidies, if needed – and other social support measures that make us feel part of a healthy community. The Interdepartmental Public Health of Catalonia wants to contribute to that purpose through via intersectoral actions to increase the efficiency of coordinated government and civil society initiatives of the government and civil society in all fields that have a significant influence on the health of individuals and the population as a whole.” (Andreu Segura was Secretary of the Interdepartmental Commission  for Public Health and coordinator of the COMSalut project. At present he is retired, is Spokesperson for the Public Health Advisory Board and for the Bioethical Committee of Catalonia)

If the you are interested in this subject, you can read more in this post which was published last year in connection with the previous report: Les polítiques públiques en temps de crisi.

The “perfect” health system

20 Oct
Joan MV Pons
Joan MV Pons

Mark Britnell is an international expert in health systems having held several senior positions in the NHS and currently provides consulting services for several countries. With this wealth of experience, Britnell wrote a book in 2015 with the inspiring title of, In search of the perfect health care system (1). In it, Britnell examines the dilemmas facing governments, the global challenges such as demographic, epidemiological, technological and economic transitions, as well as the more specific cases facing each country.

A significant portion of the book, more than half, is dedicated to examining individual countries grouped by continent: the Asian region including Australia (with large countries from Japan, China and India, to small densely populated enclaves such as Singapore and Hong Kong) Africa and the Middle East (just three very different examples such as Qatar, Israel and South Africa), Europe (from Portugal to Russia via the Nordic countries, Germany, Italy, France and the English) and the Americas (from the north; Canada, USA and Mexico and the south, such as Brazil). Too bad that the section on the Iberian Peninsula only speaks of our western neighbours (the eastern side but a general walk through).

There is no questioning that Britnells’ knowledge has been acquired first hand, given his worldwide expertise in conferences and consultancy. As the author mentions, he is often asked which country has the best health care system? Since the WHO report, Health systems: Improving performance (2), published in 2000, several country rankings have been published according to the assessment of their health systems using a variety of methodologies and outcomes. The table below serves as an example.

pons-comparison-health-systems

Nowadays, rankings proliferate as can be seen in universities and research institutions/centres. The indicators may be different, but it seems that one may always end up finding the most favourable ranking for them. Catalan public universities are a good example, given that centre advertises their position – besides that of excellence in comparison to other universities which are not necessarily British –  in the ranking system which makes it stand out to a greater degree that other Catalan universities.

Britnell, getting back to our point, after so many rankings, lectures and consulting, make a proposal on what the best health system might be by taking the best areas from the different countries. If the world could have a perfect health system, it would have to possess the following characteristics:

–    Universal healthcare values (UK)
–    Primary health care (Israel)
–    Community services (Brazil)
–    Mental health and welfare (Australia)
–    Promoting health (Scandinavian countries)
–    Empowerment of patients and communities (certain African nations)
–    Research and development (USA)
–    Innovation and new ways of doing things (India)
–    IT and Communication technologies (Singapore)
–    The capacity of choice (France)
–    Funding (Switzerland)
–    Care for the elderly (Japan)

References

(1) Britnell M. In Search of the Perfect Health System. London (United Kingdom): Palgrave Macmillan Education; 2015.

(2) The World Health Report 2000. Health systems: improving performance. Geneva (Switzerland): World Health Organization (WHO); 2000.

(3) Where do you get the most for your health care dollar?. Bloomberg Visual Data; 2014.

(4) Davis K, Stremikis K, Squires D, Schoen C. 2014 Update. Mirror, mirror on the wall. How the performance of the U.S. Health Care System Compares Internationally. New York, NY (US): The Commonwealth Fund; 2014.

(5) Health outcomes and cost: A 166-country comparison. Intelligence Unit. The Economist; 2014.

Post written by Joan MV Pons.

Equality, fairness, reality: social inequalities in child health

29 Sep

– Your post code is more important than your genetic code when it comes to children’s health (Anonymous).
– It takes the whole tribe to raise the children (African proverb).

luis-rajmil Currently, there is a wealth of accumulated information to show that life experience and living conditions during prenatal and early life are extremely influential factors when it comes to the health and social participation of the future adult. The World Health Organization (WHO) Commission on Social Determinants of Health (CSDH) has proposed eliminating the health gap within a generation noting that inequalities during the early growth and development of children are one of the main contributing factors in creating and perpetuating inequalities in health in adulthood. According to the CSDH, the academic level of a family, education in the school-going years and academic performance all play a crucial role, in addition to exposure to a situation of family economic vulnerability.

The UNICEF Innocenti Report Card 13 shows that among developed countries, Spain rates very poorly in relation to the state’s capacity to reduce the socioeconomic inequality gap since the beginning of the Great Recession.

Children are the most vulnerable population risk group and the worst affected by the current economic crisis: in Catalonia it is estimated that one in three children live at risk of poverty, according to data from the Statistical Institute of Catalonia (IEC) for 2015. The IEC data reflects the serious impact of unemployment, household employment insecurity and the impact of the historical public investment deficit in child protection policies (or lack thereof) on the lives of children. In Spain, the number of families who turn to non-governmental organizations in search for assistance to cover their basic needs has tripled since 2007.

The short-term effects of the economic crisis on children’s health depends on the degree of exposure to material deprivation, family living conditions and access to basic minimum services as well as the family’s economic capacity to meet the children’s needs. As a result of the crisis, the already existing social gradients in health have increased. Thus, the inequality in life expectancy at birth of a child between the more and less prosperous districts of Barcelona has grown to 8 years’ difference (thereby reinforcing the claim that post code is more important in children’s health that genetic code). The evidence shows generally poorer health and worse mental health in children of at-risk families who require assistance to maintain their homes or have been evicted, according to a study carried out by the SOPHIE project and Caritas of people at-risk of eviction or who have been evicted. Evidence also shows an increase in obesity and overweight children in the general population of Catalonia but this increase cannot be attributed solely to the economic crisis as it had been detected before the onset of the recession. However, obesity is linked to important social gradients and these have increased in recent years. The perception of quality of life related to health has deteriorated for children of families with primary level studies in comparison with those with third-level education between 2006 and 2012. Studies have also detected an impact on perinatal health with decreased fertility and increased maternity age, above all for the first child, an increase in abortions among women aged 15-24, and an increase in low birthweight among young women in Spain.

The policies implemented to deal with the situation however have not resolved the problem, but instead they are helping to increase the gap. Investment in public policies targeting children in Spain is the lowest in the European Union. Local scientific societies such as the Catalan Paediatric Society (SCP), state bodies such as Spanish Society of Public Health and Administration (SESPAS) and international organisations like the International Society of Social Paediatrics (ISSOP), NGOs such as UNICEF and other organizations are calling on governments to ensure that vulnerable children are not subject to further disadvantages due to cutback policies. These bodies propose the following measures: suspend evictions of families with children / ensure basic measures against energy poverty and housing for all families; promote quality employment for young people and parents; maintain and finance school canteens throughout the year; ensure a guaranteed minimum income for families with fewer resources; and reduce regional disparities prioritizing disadvantaged districts and municipalities.

Early enrolment has shown a positive impact on cognitive development, academic level and future possibilities for social insertion of the general population and which has a particularly positive effect on the members of society who are not as well educated and have fewer resources. The proposals regarding education are summarized in ensuring children’s access to education; universal access to educational material and activities and early detection and intervention in cases of children with disadvantages.

As far as health policy is concerned, the objectives include fostering healthy nutrition and eating habits, promoting breastfeeding, extending programs and policies that have shown greater effectiveness, ensuring the rights of children with and without disabilities and complying with The United Nations Convention on the Rights of the Child, and guaranteeing universal access to effective health services for the entire population and the repeal of Royal Decree Law 16/2012 regarding exclusion from healthcare.

It is essential that all professionals responsible for the care of children and families become aware of and take an active role in reducing social inequalities in health and education if the goal is to ensure future generations of adults with equal opportunities to healthcare.

igualtat-equitat-realitat

Post written by Luis Rajmil (@LuisRajmil).

Results Centre. Mental Health and Addictions Areas. 2014 data.

27 Aug

AGA2Anna García-Altés, Head of the Catalan Health System Observatory

This report presents the results of all SISCAT mental health centres for 2014. This year, the structure of the report is slightly different from previous years. It deals with fewer topics but in a more concrete, in depth manner. A special effort has been made to include new indicators such as the age of the first visit, or the percentage of patients with Severe Mental Disorders (SMD) in the AMHC requiring hospitalization during the year. However, The tables with the values ​​of all indicators centre by centre -the distinguishing feature of the Results Centre- remain. As in previous years, all reports include innovative experiences that provide good care results, included in the Observatori d’Innovació en Gestió de la Sanitat in Catalonia as well as the experts’ opinions. Continue reading

Can unnecessary hospitalizations be avoided?

18 Jun

Jordi VarelaJordi Varela, Editor of the blog “Advances in Clinical Management

It is said that the best savings in health is in avoidable hospitalisation that doesn’t occur, especially since the use of a hospital bed is the most expensive health resource of all the health offers, but also because if one person, let’s imagine an elderly one with several chronic conditions, can avoid being admitted in hospital, his/her health will suffer less compromising situations. For this reason, all health systems are very active in trying to launch all kinds of measures to reduce the admission of chronic and frail patients.

Dr. Sara Purdy, family physician and Senior Consultant at the University of Bristol, published under the auspices of the King’s Fund, in late 2010, an analysis of what actions reduce the unnecessary hospital admissions and which ones do not. The work of Dr. Purdy is focused only on organisational actions such as home hospitalisation or case management, and, in contrast, does not include strictly clinical factors such as the impact of a new drug for asthma conditions.

Continue reading