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2.

Enfoque para el análisis de la crisis económica global y la salud/ Approach for analyzing of the global economic crisis and health

Franco Giraldo, Álvaro
| Idioma(s): Español
CONTEXTO: Se parte de reconocer varias áreas para el análisis de la crisis global en relación con la salud. Luego se centra en el análisis de algunos aspectos relativos a la crisis económica, en las alternativas políticas para mitigar la crisis financiera y en la identificación de los indicadores de salud más sensibles a los vaivenes de la economía. OBJETIVO: proponer algunas bases para analizar la crisis financiera del 2008 y sus efectos sobre la salud en el mundo. METODOLOGÍA: Se basó en el análisis de los posibles efectos de la crisis económica sobre la salud luego de considerar cuatro ejes esenciales: las condiciones de vida y los determinantes de la salud, los indicadores socio-demográficos y las variaciones epidemiológicas, el gasto público total y el gasto en salud, y el monitoreo de las políticas encaminadas a mitigar la crisis. CONCLUSIÓN: La primera crisis de la globalización del actual siglo tendrá serias implicaciones sobre la salud y debe llevar al replanteamiento del sistema económico mundial, basándose en el control del Estado y en la regulación de los mercados. Para evitar los efectos negativos sobre el ambiente y la salud, se propone enfrentar las influencias de los determinantes globales, estimular las políticas públicas que inviertan en salud, reforzar acciones de legislación en salud internacional y, finalmente, establecer y poner en marcha un sistema de monitoreo de la crisis y su efecto en la salud. CONTEXT: It begins by recognizing several areas for analysis of the global crisis in relation to health. It then focuses on the analysis of some aspects of the economic crisis, policy alternatives to mitigate the financial crisis and the identification of health indicators more sensitive to the vagaries of the economy. OBJECTIVE: To propose some basis for analyzing the financial crisis of 2008 and its effects on health in the world. METHODOLOGY: it based on the analysis of the possible effects of the economic crisis on health after consider four essential axes: the conditions of life and health determinants, indicators of socio-demographic and epidemiological changes, the total public expenditure and spending on health and monitoring of policies to mitigate the crisis. CONCLUSION: The first crisis of globalization of the present century will have serious health implications and should lead to rethinking the global economic system based on State control and regulation of the markets. To avoid adverse effects on the environment and health, it is proposed addressing the determinants of global influences, to stimulate public policies that invest in health, boost action in international health legislation, and finally, to establish and implement a crisis system monitoring and its effect on health.
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3.

Protocolo del estudio sobre el efecto de la crisis económica en la mortalidad, la salud reproductiva y las desigualdades en salud en España./ [Study protocol on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain].

Pérez, Glòria; Gotsens, Mercè; Palència, Laia; Marí-Dell'Olmo, Marc; Domínguez-Berjón, M Felicitas; Rodríguez-Sanz, Maica; Puig, Vanessa; Bartoll, Xavier; Gandarillas, Ana; Martín, Unai; Bacigalupe, Amaia; Díez, Elia; Ruiz, Miguel; Esnaola, Santiago; Calvo, Montserrat; Sánchez, Pablo; Luque Fernández, Miguel Ángel; Borrell, Carme
| Idioma(s): Español
The aim is to present the protocol of the two sub-studies on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain. Substudy 1: describe the evolution of mortality and reproductive health between 1990 and 2013 through a longitudinal ecological study in the Autonomous Communities. This study will identify changes caused by the economic crisis in trends or reproductive health and mortality indicators using panel data (17 Autonomous Communities per study year) and adjusting Poisson models with random effects variance. Substudy 2: analyse inequalities by socioeconomic deprivation in mortality and reproductive health in several areas of Spain. An ecological study analysing trends in the pre-crisis (1999-2003 and 2004-2008) and crisis (2009-2013) periods will be performed. Random effects models Besag York and Mollié will be adjusted to estimate mortality indicators softened in reproductive health and census tracts.
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4.

Recesión económica (2006-2012) y cambios en el estado de salud de la población española/ Economic recession (2006-2012) and changes in the health status of the Spanish population

Pérez-Romero, Shirley; Gascón-Cánovas, Juan J; de la Cruz-Sánchez, Ernesto; Monteagudo-Piqueras, Olga; Parra-Hidalgo, Pedro; Sánchez-Ruiz, José F
| Idioma(s): Español
Objetivo. Analizar la relación de los problemas de salud mental en población española con la recesión económica (2006-2012) y establecer en qué sentido afecta a la autopercepción del estado de salud. Material y métodos. Estudio transversal comparativo utilizando la Encuesta Nacional de Salud de España, 2006/2007 y 2011/2012. Mediante modelos de regresión logística, se analizaron tres indicadores relacionados con la salud mental y la salud percibida. Resultados. En 2011/2012 aumentó el consumo de medicamentos ansiolíticos y somníferos en hombres y mujeres. La disfunción mental aumentó durante el periodo de crisis económica en la población de varones. La percepción de una salud óptima no sufrió cambios significativos en hombres ni en mujeres. Conclusiones. La recesión económica mostró una relación variable con la salud mental y general de la población, y coincidió con un aumento de los trastornos de salud mental, como la ansiedad. Objective. To analyze the relationship of mental health problems in Spanish population with the economic recession (2006-2012), and find out how it affects the self-perception of health status. Materials and methods. Cross-sectional study using the National Health Survey of Spain, 2006/2007 and 2011/2012. Using logistic regression models, three indicators linked to mental health and perceived health were analyzed. Results. In 2011/2012 the consumption of anti-anxiety medications and sleeping pills increased in men and women. Mental dysfunction increased during the economic crisis in the male population. The perception of optimal health did not suffer significantly in either men or women. Conclusions. The economic recession showed a changing relation to the mental and general health of the population, coinciding with an increase in mental health disorders, such as anxiety.
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5.

The global financial crisis and health equity: early experiences from Canada.

Ruckert, Arne; Labonté, Ronald
| Idioma(s): Inglés
BACKGROUND: It is widely acknowledged that austerity measures in the wake of the global financial crisis are starting to undermine population health results. Yet, few research studies have focused on the ways in which the financial crisis and the ensuing 'Great Recession' have affected health equity, especially through their impact on social determinants of health; neither has much attention been given to the health consequences of the fiscal austerity regime that quickly followed a brief period of counter-cyclical government spending for bank bailouts and economic stimulus. Canada has not remained insulated from these developments, despite its relative success in maneuvering the global financial crisis. METHODS: The study draws on three sources of evidence: A series of semi-structured interviews in Ottawa and Toronto, with key informants selected on the basis of their expertise (n = 12); an analysis of recent (2012) Canadian and Ontario budgetary impacts on social determinants of health; and documentation of trend data on key social health determinants pre- and post the financial crisis. RESULTS: The findings suggest that health equity is primarily impacted through two main pathways related to the global financial crisis: austerity budgets and associated program cutbacks in areas crucial to addressing the inequitable distribution of social determinants of health, including social assistance, housing, and education; and the qualitative transformation of labor markets, with precarious forms of employment expanding rapidly in the aftermath of the global financial crisis. Preliminary evidence suggests that these tendencies will lead to a further deepening of existing health inequities, unless counter-acted through a change in policy direction. CONCLUSIONS: This article documents some of the effects of financial crisis and severe economic decline on health equity in Canada. However, more research is necessary to study policy choices that could mitigate this effect. Since the policy response to a similar set of economic shocks has globally varied and led to differential health and health equity outcomes, comparative studies are now possible to assess the successes and failures of specific policy responses. This raises the question of what types of public policy can mitigate against the negative health equity effects of severe economic recessions.
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6.

The differential impact of the financial crisis on health in Ireland and Greece: a quasi-experimental approach.

Hessel, P; Vandoros, S; Avendano, M
| Idioma(s): Inglés
OBJECTIVES: Greece and Ireland suffered an economic recession of similar magnitude, but whether their health has deteriorated as a result has not yet been well established. STUDY DESIGN: Based on five waves (2006-2010) of the European Union Statistics of Income and Living Conditions (EU-SILC) survey a (DID) approach was implemented that compared trends in self-rated health in Greece and Ireland before and after the crisis with trends in a 'control' population (Poland) that did not experience a recession and had health trends comparable to both countries before the crisis. METHODS: Logistic regression using a (DID) approach. RESULTS: A simple examination of trends suggests that there was no significant change in health in Greece or Ireland following the onset of the financial crisis. However, DID estimates that incorporated a control population suggest an increase in the prevalence of poor self-rated health in Greece (OR = 1.216; CI = 1.11-1.32). Effects were most pronounced for older individuals and those living in high-density areas, but effects in Greece were overwhelmingly consistent in different population sub-groups. In contrast, DID estimates revealed no effect of the financial crisis on the prevalence of poor self-rated health in Ireland (OR = 0.97; CI = 0.81-1.16). CONCLUSIONS: DID estimates suggest that the financial crisis led to higher prevalence of reporting poor health in Greece but not in Ireland. Although the research design does not allow the authors to directly assess the role of specific policies, contextual factors including policy responses may have contributed to the different effect of the crisis on the health of the two countries.
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7.

Protección de las conquistas de la salud pública cubana ante la crisis financiera y económica mundial/ Protection of the Cuban public health achievements in the face of the world economic and financial crisis

Marimón Torres, Néstor; Martínez Cruz, Evelyn
| Idioma(s): Español
Objetivos Analizar la repercusión de la crisis financiera y económica mundial sobre el Sistema Nacional de Salud y la preparación necesaria para preservar y mantener sus conquistas y logros. Métodos Investigación cualitativa descriptiva detipo documental. Se analizaron documentos y publicaciones relacionados con el tema. Resultados La crisis financiera tiene serias afectaciones sobre la salud de las poblaciones, se demostró que la mejor vía para enfrentarlas es a través de sistemas de salud con base en la atención primaria de salud, más equitativos y solidarios; con apropiado abordaje de los determinantes sociales e inversión en la formación de recursos humanos con otros valores éticos y morales. El ejemplo de Cuba con su Sistema Único de Salud y el nuevo modelo de formación de médicos corroboraron esta afirmaciones. Conclusiones Las crisis que vive el mundo repercuten en la salud, más aún en la económica financiera. Se requieren sistemas de salud con cobertura universal que permitan alcanzar las metas propuestas. La experiencia cubana de crisis anteriores demuestra que un país requiere de inversión social, para mejorar la salud y sus determinantes y enfrentar y mitigar los efectos que ellas producen. Se requiere de solidaridad internacional, compartir lecciones aprendidas y unidad para enfrentar las consecuencias. El bloqueo económico y comercial que el gobierno de EE.UU. ejerce sobre Cuba, refuerza los efectos negativos de la crisis económica global Objectives To analyze the impact of the world economic and financial crisis on the national healthcare system, and the required preparedness for preserving (protecting) and keeping its achievements. Methods Documentary-type descriptive qualitative research. Documents and publications related to this issue were reviewed. Results The financial crisis has severe impact on the population's health. It was demonstrated that the best way to face these negative effects is to develop more equitable and solidarity primary care-based health systems with adequate approach to social determinants and suitable level of investment in the formation of human resources fitted with ethical and moral values. The unique healthcare system and the new model of medical formation in Cuba is an example that confirms the above-mentioned statements. Conclusions The world financial and economic crisis affects health; therefore, health systems with universal coverage are required to reach the suggested goals. The Cuban experience gained in previous crisis demonstrates that a country needs social investment to improve health and its determinants, and to face and mitigate the effects of such crisis. International solidarity is needed, sharing of learned lessons and unity of actions to face the consequences are required. The economic and commercial blockade imposed on Cuba by the US government reinforces the negative effects of the global economic crisis
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8.

La protección social en salud como enfrentamiento a una crisis económica/ Social protection on health as a way of confronting the economic crisis

Hadad Hadad, Jorge Luis; Valdés Llanes, Elías
| Idioma(s): Español
Las crisis económicas y financieras se hacen cada vez más frecuentes, profundas y globales, su repercusión ocurre fundamentalmente en los sectores sociales y, como parte de ellos, en la salud. De manera especial estas afectaciones se producen en los grupos más vulnerables y de riesgo, en servicios y programas de salud. A partir de la experiencia vivida por Cuba en la década de los noventa, se estudió la repercusión de las crisis sobre la salud y sus determinantes, las políticas e intervenciones adoptadas y se evaluaron sus efectos. Se alcanzaron juicios conclusivos que permiten conocer mejor estas crisis, su repercusión sobre la salud y las mejores políticas y estrategias para minimizar sus efectos. Sin pretender proponer un modelo de enfrentamiento, se logra identificar las políticas y acciones que más contribuyen a preservar la salud de la población The economic and financial crises are increasingly frequent, deep and global; they mainly affect social sectors, and among them, healthcare. These effects are particularly seen in the most vulnerable and risky groups, and in health services and programs. On the basis of the Cuban experience in the 90ïs, the impact of crisis on health and its determiners and the adopted policies and interventions were studied. Also their effects were assessed. The conclusive criteria of this paper allowed knowing these crises better, their impact on health, and the best policies and strategies to reduce the effects. This paper was not intended to submit a model of confrontation to the crisis, but it managed to identify the policies and actions that would greatly contribute to the preservation of the population's health
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9.

Measuring recession severity and its impact on healthcare expenditure.

Keegan, Conor; Thomas, Steve; Normand, Charles; Portela, Conceição
| Idioma(s): Inglés
The financial crisis that manifested itself in late 2007 resulted in a Europe-wide economic crisis by 2009. As the economic climate worsened, Governments and households were put under increased strain and more focus was placed on prioritising expenditures. Across European countries and their heterogeneous health care systems, this paper examines the initial responsiveness of health expenditures to the crisis and whether recession severity can be considered a predictor of health expenditure growth. In measuring severity we move away from solely gross domestic product (GDP) as a metric and construct a recession severity index predicated on a number of key macroeconomic indicators. We then regress this index on measures of total, public and private health expenditure to identify potential relationships. Analysis suggests that for 2009, the Baltic States, along with Ireland, Italy and Greece, experienced comparatively severe recessions. We find, overall, an initial counter-cyclical response in health spending (both public and private) across countries. However, our analysis finds evidence of a negative relationship between recession severity and changes in certain health expenditures. As a predictor of health expenditure growth in 2009, the derived index is an improvement over GDP change alone.
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10.

La crisis y la salud. ¿La salud en crisis?/ Crisis and health. Health in crisis?

Thielmann, Klaus; Illnait Ferrer, José
| Idioma(s): Español
La crisis económica y financiera que envuelve al mundo, también afecta la salud, porque los servicios de salud, tal y como se practican hoy dependen cada día más del mercado. En estas circunstancias la salud es convertida en una mercancía que se encarece en la medida en que también lo hacen los productos dedicados al diagnóstico y tratamiento de las enfermedades. Ello genera, a su vez, desigualdad de acceso a la medicina entre grupos de países ricos y países pobres e igualmente entre los ciudadanos al interior de todos aquellos países sometidos a regímenes neoliberales, o constituyen una carga adicional para los países donde los servicios médicos son financiados por la sociedad. El reto de las enfermedades crónicas no transmisibles impone la necesidad de una estrategia proactiva y salutogénica, basada en el fortalecimiento de la salud a través de sus determinantes como contribución no solo a la sostenibilidad y racionalidad de los servicios médicos, sino también al acceso igualitario allí donde se requiera. Un proyecto denominado Determinantes Individuales y Sociales de la Salud en la Medicina Familiar, se ha iniciado en La Habana Vieja aprovechando la vocación preventiva de la medicina cubana y la preparación de sus médicos en esta práctica y que pretende estudiar la factibilidad y los beneficios de esta estrategia médica The global financial and economic crisis also affects health because the health services increasingly depend on the market nowadays. Health is considered a commodity and becomes expensive due to rising prices of diagnostic and therapeutic products and services. At the same time, this exacerbates the inequality of access to health care between rich and poor countries and among the citizens within countries of neoliberal economic orientation. Health care turns into an additional burden for countries where the medical health services are financed by the society as a whole. The growing impact of chronic non-communicable diseases calls for a proactive and health-oriented strategy based on the health improvement through its determinants as a contribution to the efficiency and sustainability of medical care services and to equal access wherever is required. A project called Individual and Social Health Determinants in Family Medicine was started in Old Havana, which is intended to demonstrate the feasibility and benefit of a health driven medical strategy. It builds on the genuine preventive orientation of Cuban medical practice, education and training
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