economic crisis – AQuAS Blog

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).

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)

“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)

“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.

Wishing you all a Joyous Festive Season from the AQuAS blog

29 Dec

nadal-2016-marta-millaret — Marta Millaret

From the blog AQUAS we hope you are having a good festive season and would like to thank you for reading and following us.

We publish weekly in Catalan, Spanish and English on subjects related to the projects that are being carried out at AQuAS and we also publish contributions from guest authors. The editorial line of the blog includes a focus on assessment from different points of view and areas of the health system.

Along these lines, we have dealt with healthcare and quality results presented by the different agents who make up the healthcare system, the whole range of observatories of the Catalan Health System (including that which deals with the effects of the economic crisis on the health of the population and innovation), qualitative research, integrated care, the assessment of mHealth, inequalities in health, patient involvement, doctor-patient communication, shared decisions, patient and citizen preferences, variations in medical practice, the prevention of low-value clinical practices, the impact of research, information and communications technology, data analysis in research, tools for the visualisation of data, innovation and health management, the gender perspective in science, statistical issues, clinical safety with electronic prescriptions, chronicity (not forgetting chronicity in children), the effects of air pollution in health and current topics.

The most read articles in 2016 have been:

Never before have we been so healthy and at the same time, never before have we been so sick, de Lluís Bohígas
Integrated care: what is the main underlying idea?, de Vicky Serra
Low-value clinical practices: the physicians give their opinion!, de Johanna Caro
When the system hampers innovation in healthcare, de Gemma Bruna
Indicators for the health services assessment, de Mireia Espallargues
Communicate what?? Communication skills for health care professionals, de Carme Carrion

However, we have published many more texts, 51 posts to be precise, without counting this one, with the aim of sharing knowledge and generating a space for reflection, open and useful for everyone.

Thank you very much, a joyous festive season and see you in the new year!

Post written by Marta Millaret (@MartaMillaret), blog AQuAS editor.

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).

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.

Post written by Luis Rajmil (@LuisRajmil).

Public policy in times of crisis

28 Jan

SalutPoblació What has happened in periods of economic crisis has also occurred at other moments in time and in other contexts. It is also a well-known fact that this can lead to an increase in mortality rates among the population (both due to general causes, as well as for certain specific causes, such as suicide), an increase in mental health problems and a worsening of lifestyles. We also know that inequalities in healthcare can increase, particularly as the crisis affects the most vulnerable members of society first.

The second report from the Observatory on the effects of the crisis on public health, publicly presented just before the Christmas holidays, closely monitors the principal socio-economic and health indicators at a territorial level (by regions) and analyses their evolution. It also analyses the relationship between socioeconomic and health indicators and provides information to define, or redefine, strategies aimed at tackling the effects of the crisis based on the needs identified through the report.

In this period of crisis in Catalonia, long-term unemployment, above all, has increased, and production (the gross value added in the economy) has declined. Household income has fallen, the percentage of people living below the poverty line has increased, especially those under 16 years of age, and the percentage of families receiving assistance from the social protection system has increased.

The fall in public revenue triggered a decrease in the budget, including the budget of the Department of Health, which was especially significant between 2011 and 2013. The health sector was forced to adjust, doing the same work but with less resources, improving efficiency while making every effort to do so without hindering the quantity and quality of healthcare service provision. However, in the period 2007-2013, life expectancy increased by 1.8 years (1.5 in women and 2.6 in men), as has been the case for life expectancy in good health.

Nevertheless, the impact of the economic situation on people’s health is evident: the unemployed have worse self-perceived health, especially those who have been out of work for over a year and present a higher risk prevalence of poor mental health. Similarly, tobacco sales, which is on the decline population-wide, increased among the unemployed, especially among men. Excessive alcohol consumption levels are also higher among the unemployed.

Focusing the analysis on the most vulnerable social groups, the report compares the population group aged 15 to 64 years, in other words, those who are exempt from the pharmacy copayment rates (basically unemployed people who have lost the right to unemployment benefits, receiving social insertion benefits, or have non-contributory pensions), with those who are subject to copayment. In Catalonia, in 2014 there were 187,775 people aged between 15 and 64, exempt from copayment rates (2.3% of the population). Those who were exempt are statistically twice as likely to consume psychoactive drugs that people subject to co-payment and have 1.5 times greater likelihood of being admitted to hospital. This group made 1.4 times the number of visits to primary care, and were treated in mental health centres 3.5 times more than the other group.

There is no question that public, social and economic policy has an impact on a population’s level of health and that they modulate the influence of socioeconomic, gender and immigration factors on health inequalities. Social protection policies seem to be effective in cushioning the influence of macroeconomic fluctuations on mortality rates. Policies aimed at equality contribute to improving health inequalities. The consequences of the crisis in Russia in the early 90s had little in comparison with those suffered by Finland during the same period. The main reason for this being the policies implemented by both governments.

Given the complexity and the multiple impacts produced by economic crises, the public policy-centred method to mitigate its effects must be approached from different sectors. Tools like the Interdepartmental Public Health Plan (PINSAP), as per the Catalan acronym, are key to ensuring this cross-sectoral approach, targeting factors which impact health to reduce or eliminate health inequalities. Another fundamental step is to maintain social protection (unemployment benefits, retirement benefits, family assistance, etc.) to mitigate the decline in family income and its consequences. However, this must go hand-in-hand with policy aimed at generating employment and promoting the rapid reintegration into the workplace. Education policy is the other mainstay, given the relationship between education, income and health, and the fact that it acts as a “social ladder” between generations. Policies aimed at the most vulnerable groups, such as lower income families and children, also deserve special attention.

Finally, it is essential that the implementation of these public policies are evaluated in the medium and long-term in order to continually validate their utility and impact, and to enable policymakers to adapt these programs to meet an ever-changing environment.

Post written by Veva Barba, Dolores Ruiz-Muñoz and Anna García-Altés (@annagaal),