Multi-level policy responses to tackle socioeconomic inequalities in the incidence of COVID-19 in a European urban area.

BACKGROUND: Spain has been hit hard by COVID-19 since March 2020, especially in its metropolitan areas. We share experiences from Barcelona in measuring socioeconomic inequalities in the incidence of COVID-19 in the different waves, and in implementing coordinated and equity-oriented public health policy responses. METHODS: We collected daily data on confirmed COVID-19 cases, geocoded the address of residence to assign each case to one of the 73 neighborhoods and 1068 census tracts, and calculated the cumulative incidence of COVID-19 by neighborhood and five income groups (quintiles of census tracts) by sex across four waves of the pandemic. We adjusted hierarchical Bayesian spatial models to obtain the relative risk (RR) of cumulative incidences in each quintile compared with the richest areas. A variety of public health policies implemented to tackle the pandemic and especially these inequalities in COVID-19 incidence and vaccination are selected and described. RESULTS: Area-level income inequalities in the incidence of COVID-19 were present at different degree in all four waves. In the second wave (10/1/2020 to 12/6/2020), RR for the poorest income quintile census tracts compared with the richest was 1.43 (95% credible interval-CI-: 1.22-1.67) for men and 1.58 (95% CI: 1.35-1.83) for women. Later, inequalities in vaccination coverage also arose. Equity-oriented policy responses included: "health hotels" or home delivery of basic products for individuals with COVID-19 and without adequate conditions for isolation; new emergency facilities for homeless people, including those with active drug use; mass screening in high incidence areas; contingency plans for nursing homes and schools; adapting community health programs for their early reactivation; digital self-appointment support points and community vaccination days. CONCLUSION: COVID-19 hit Barcelona neighborhoods unequally, with variations between waves. The rapid availability of geolocalized data and by socioeconomic level helped public authorities to implement targeted policies and collaborative interventions for the most vulnerable populations. Further studies would be needed to evaluate their impact.

Mental well-being of the general population: direct and indirect effects of socioeconomic, relational and health factors.

PURPOSE: The aim of this study was to analyse the association between individual mental well-being and social, economic, lifestyle and health factors. METHODS: Cross-sectional study on a representative sample of 13,632 participants (> 15y/o) from the Catalan Health Interview Survey 2013-2016 editions. Mental well-being was assessed with the Warwick-Edinburg Mental Well-being Scale (WEMWBS). Linear regressions were fitted to associate well-being and sociodemographic, relational, lifestyle and health variables according to minimally sufficient adjustment sets identified using directed acyclic graphs. Predictors entered the model in blocks of variable types and analysed individually. Direct and total effects were estimated. RESULTS: Health factors significantly contributed to mental well-being variance. Presence of a mental disorder and self-reported health had the largest effect size (eta2 = 13.4% and 16.3%). The higher individual impact from a variable came from social support (ß = - 12.8, SE = 0.48, eta2 = 6.3%). A noticeable effect gradient (eta2 = 4.2%) from low to high mental well-being emerged according to economic difficulties (from ß = 1.59, SE = 0.33 for moderate difficulties to ß = 6.02 SE = 0.55 for no difficulties). Younger age (ß = 5.21, SE = 0.26, eta2 = 3.4%) and being men (ß = 1.32, SE = 0.15, eta2 = 0.6%) were associated with better mental well-being. Direct gender effects were negligible. CONCLUSIONS: This study highlights health and social support as the most associated factors with individual mental well-being over socioeconomic factors. Interventions and policies aimed to these factors for health promotion would improve population mental well-being.

Employment in the neighborhoods of Barcelona: health effects of an active labor market program in Southern Europe.

BACKGROUND: The aim of this study was to analyze the changes in self-perceived health status and mental health among participants in an active labour market policy (ALMP) of Barcelona, and to assess whether the results differed according to the participants' social characteristics and their program trajectories. METHODS: A pre-post intervention study was designed, including unemployed people participating in a return-to-work ALMP in 13 deprived neighborhoods of Barcelona; using one survey upon entering the program (pre), and another 1 year later (post). We assessed the prevalence of poor self-perceived health status and poor mental health (Goldberg-12 questionnaire) in both periods of time. We fit five Poisson regression models using generalized estimating equations (GEE) to measure changes in self-perceived health and mental health between pre- and post-intervention. RESULTS: About 696 individuals (48% women) participated in the study, mainly manual workers. In both sexes, mental health improved (prevalence ratio [PR]-comparing post- and pre-periods for women: 0.49, 95% confidence interval [CI]: 0.39-0.61 and men: PR: 0.41, 95% CI: 0.32-0.53), whereas self-perceived health status remained stable or worsened. Men who remained unemployed reported poorer self-perceived health status, while no such association was observed among women. CONCLUSIONS: This study shows a mental health improvement among male and female participants.

How does a targeted active labour market program impact on the well-being of the unemployed? A concept mapping study on Barcelona "Employment in the Neighbourhoods".

BACKGROUND: The "Employment in the neighbourhoods" program is an innovative, tailor-made Active Labour Market Program that has been implemented in 12 neighbourhoods in Barcelona (Spain). Its goal is to get people from deprived, high-unemployment neighbourhoods back to work. The aim of this study was to describe the effects of the program on participants' quality of life, and identify the mechanisms underlying these effects, according to their own perception and the perception of technical staff who assisted them. METHODS: We used Concept Mapping, a mixed methods approach combining qualitative and quantitative analysis, to develop a conceptual map of the participants' and technical staffs' perceptions about changes in the participants' quality of life. Data collection occurred within the generation and structuring steps where participants brainstormed answers to a focus question, and then rated and sorted the responses. To create maps, we used Concept Systems Incorporated software, which conducted two main forms of analysis, a multidimensional scaling analysis, and a hierarchical cluster analysis. RESULTS: Study participants reported several positive effects on mental health and emotional wellbeing, including self-esteem and empowerment, and considered that this was achieved through strengthened social networks, skills acquisition, emotional coaching, and personalized technical assistance. They also described some negative impacts, mainly related to the labour market situation. We observed marked gender differences in the discourses of program participants. CONCLUSIONS: The results obtained have allowed us to identify different perceived effects and mechanisms by which the "Employment in the Neighbourhoods" Active Labour Market Programme can influence quality of life of participants from the most deprived areas of Barcelona.

Inequalities by immigrant status in depressive symptoms in Europe: the role of integration policy regimes.

PURPOSE: We aimed to study whether country integration policy models were related to inequalities by immigrant status in depressive symptoms in Europe. METHODS: This is a cross-sectional study using data from 17 countries in the sixth wave of the European Social Survey (2012), comparing subjects born either in the country of residence (non-immigrants, N = 28,333) or in a country not classified as "advanced economy" by the IMF (immigrants, N = 2041). Depressive symptoms were assessed with the eight-item version of the Center for Epidemiologic Studies Depression scale. Countries were grouped into three integration policy regimes (inclusive, assimilationist, and exclusionist). Linear regressions were fitted adjusting first by age, sex, and education level, then sequentially by citizenship, perceived discrimination, and socio-economic variables. RESULTS: In all integration regimes, immigrants report significantly more depressive symptoms than non-immigrants. The gap is the largest in exclusionist countries (immigrants score 1.16, 95% CI 0.65-1.68, points higher than non-immigrants in the depression scale), followed by assimilationist countries (0.85 and 0.57-1.13) and inclusive countries (0.60 and 0.36-0.84). Financial strain explains all the associations in inclusive countries, most of it in assimilationist countries, but only a small part in exclusionist countries. CONCLUSIONS: Across most European countries, immigrants seem to experience more depressive symptoms than the population born in the country, mostly reflecting their poorer socio-economic situation. Inequalities are larger in countries with more restrictive policies. Despite some limitations, this study adds new evidence to suggest that immigrants' health is shaped by integration policies in their host country.

Gender and socio-economic inequalities in health and living conditions among co-resident informal caregivers: a nationwide survey in Spain.

AIMS: To explore the associations between social determinants, caregiver's network support, burden of care and their consequences in health and living conditions of informal caregivers. BACKGROUND: The socio-demographic trends regarding population ageing and changes in family models trigger an increased demand for care. DESIGN: Cross-sectional study based on the 2008 edition of the National Disability, Independence and Dependency Situations Survey (DIDSS-2008) conducted by the National Statistics Institute in Spain. METHODS: Analyses focused on persons identified as primary caregivers who co-reside with the dependent person. The associations between social determinants of caregivers, burden of care, support network and problems attributed to informal care (impaired health, depression, professional, economic and personal issues) were estimated by fitting robust Poisson regression models. Analyses were conducted separately for women and men. RESULTS: The study sample included 6923 caregivers, 73% of women and 27% of men. Gender and socio-economic inequalities were found in assumption of responsibilities and burden of caring for dependents, which tend to fall more on women and persons of lower socio-economic level, who in turn have less access to formal support. These aspects translate into a higher prevalence of health, professional, economic and personal problems. CONCLUSIONS: The study highlights gender and socio-economic inequalities in informal caregiving and its negative consequences. These findings may be useful in the design of policies and support programmes targeting the most affected groups of informal caregivers.

New perspectives on occupational health and safety in immigrant populations: studying the intersection between immigrant background and gender.

OBJECTIVES: Few studies investigating health inequalities pay attention to the intersection between several social determinants of health. The purpose of this article is to examine the relation between perceptions of work-related health and safety risk (WHSR) and (1) immigrant background and (2) gender in the EU-15. The effects are controlled for educational attainment, the quality of work (QOW) and occupation. DESIGN: Pooled data from the European Social Survey 2004 and 2010 are used in this study. The sample is restricted to respondents of working age (16-65 years) (N = 17,468). The immigrants are divided into two groups according to their country of origin: (semi-)periphery and core countries. Both groups of immigrants are compared to natives. Additionally, the research population is stratified by gender. Descriptive statistics and logistic regression analyses are used. RESULTS: Core immigrants (both men and women) do not differ from natives in terms of QOW. (Semi-)periphery immigrants (both men and women) are employed in jobs with lower QOW. While no differences in WHSR are found among men, female immigrants (both (semi-)periphery and core) have significantly more WHSR compared to native women. Although WHSR is generally lower in women, (semi-)periphery women have a similar prevalence of WHSR as men. CONCLUSION: (Semi-)periphery immigrants are employed in lower quality jobs, while core immigrants do not differ from natives in that regard. Female immigrant workers--especially those from (semi-)periphery countries--have higher WHSR compared to native women. Our findings highlight the importance of an intersectional approach in the study of work-related health inequalities.

How substandard dwellings and housing affordability problems are associated with poor health in a vulnerable population during the economic recession of the late 2000s.

INTRODUCTION: Given the increasing number of people in Spain struggling to pay housing-related costs during the economic recession, it is important to assess the health status of these communities as compared to the general population and to better understand the different housing dimensions that are related with poor mental health. This study aims to describe the housing conditions and health status of a sample of people assisted by Caritas Barcelona (Spain) and living in inadequate housing and/or struggling to pay their rent or mortgage, to compare the health outcomes of this population with those of the overall population of Barcelona, and to analyze the association between housing dimensions and mental health. METHODS: We used a cross-sectional design. The participating adults (n = 320) and children (n = 177) were those living in the dioceses of Barcelona, Sant Feliu and Terrassa (Spain) in 2012 and assisted by Cáritas. They were asked to answer to three questionnaires on housing and health conditions. Eight health related variables were used to compare participants with Barcelona's residents and associations between housing conditions and poor mental health were examined with multivariate logistic regression models. RESULTS: In Barcelona, people seeking Caritas's help and facing serious housing problems had a much poorer health status than the general population, even when compared to those belonging to the most deprived social classes. For example, 69.4 % of adult participants had poor mental health compared to 11.5 % male and 15.2 % female Barcelona residents. Moreover, housing conditions were associated with poor mental health. CONCLUSIONS: This study has shown how, in a country hit by the financial recession, those people facing housing problems have much worse health compared to the general population.

Health and health behaviours before and during the Great Recession, overall and by socioeconomic status, using data from four repeated cross-sectional health surveys in Spain (2001-2012).

BACKGROUND: The objective of this study was to estimate changes over time in health status and selected health behaviours during the Great Recession, in the period 2011/12, in Spain, both overall, and according to socioeconomic position and gender. METHODS: We applied a before-after estimation on data from four editions of the Spanish National Health Survey: 2001, 2003/04, 2006/07 and 2011/12. This involved applying linear probability regression models accounting for time-trends and with robust standard errors, using as outcomes self-reported health and health behaviours, and as the main explanatory variable a dummy "Great Recession" for the 2011/12 survey edition. All the computations were run separately by gender. The final sample consisted of 47,156 individuals aged between 25 and 64 years, economically active at the time of the interview. We also assessed the inequality of the effects across socio-economic groups. RESULTS: The probability of good self-reported health increased for women (men) by 9.6 % (7.6 %) in 2011/12, compared to the long term trend. The changes are significant for all educational levels, except for the least educated. Some healthy behaviours also improved but results were rather variable. Adverse dietary changes did, however, occur among men (though not women) who were unemployed (e.g., the probability of declaring eating fruit daily changed by -12.1 %), and among both men (-21.8 %) and women with the lowest educational level (-15.1 %). CONCLUSIONS: Socioeconomic inequalities in health and health behaviour have intensified, in the period 2011/12, in at least some respects, especially regarding diet. While average self-reported health status and some health behaviours improved during the economic recession, in 2011/12, this improvement was unequal across different socioeconomic groups.

Immigrants' health and health inequality by type of integration policies in European countries.

BACKGROUND: Recent efforts to characterize integration policy towards immigrants and to compare immigrants' health across countries have rarely been combined so far. This study explores the relationship of country-level integration policy with immigrants' health status in Europe. METHODS: Cross-sectional study with data from the 2011 European Union Survey on Income and Living Conditions. Fourteen countries were grouped according to a typology of integration policies based on the Migrant Integration Policy Index: 'multicultural' (highest scores: UK, Italy, Spain, Netherlands, Sweden, Belgium, Portugal, Norway, Finland), 'exclusionist' (lowest scores: Austria, Denmark) and 'assimilationist' (high or low depending on the dimension: France, Switzerland, Luxembourg). People born in the country (natives, n = 177 300) or outside the European Union with >10 years of residence (immigrants, n = 7088) were included. Prevalence ratios (PR) of fair/poor self-rated health between immigrants in each country cluster, and for immigrants versus natives within each, were computed adjusting by age, education, occupation and socio-economic conditions. RESULTS: Compared with multicultural countries, immigrants report worse health in exclusionist countries (age-adjusted PR, 95% CI: men 1.78, 1.49-2.12; women 1.58, 1.37-1.82; fully adjusted, men 1.78, 1.50-2.11; women 1.47, 1.26-1.70) and assimilationist countries (age-adjusted, men 1.21, 1.03-1.41; women 1.21, 1.06-1.39; fully adjusted, men 1.19, 1.02-1.40; women 1.22, 1.07-1.40). Health inequalities between immigrants and natives were also highest in exclusionist countries, where they persisted even after adjusting for differences in socio-economic situation. CONCLUSION: Immigrants in 'exclusionist' countries experience poorer socio-economic and health outcomes. Future studies should confirm whether and how integration policy models could make a difference on migrants' health.

Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis.

BACKGROUND: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. METHODS: Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15-64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). RESULTS: Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24-1.56, PR2012 = 1.56; 95% CI: 1.33-1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86-1.40, PR2012 = 1.34; 95% CI: 1.06-1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11-0.43, PR2012 = 1.20; 95% CI: 0.73-2.01). CONCLUSIONS: Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants' health status.

Influence of macrosocial policies on women's health and gender inequalities in health.

Gender inequalities in health have been widely described, but few studies have examined the upstream sources of these inequalities in health. The objectives of this review are 1) to identify empirical papers that assessed the effect of gender equality policies on gender inequalities in health or on women's health by using between-country (or administrative units within a country) comparisons and 2) to provide an example of published evidence on the effects of a specific policy (parental leave) on women's health. We conducted a literature search covering the period from 1970 to 2012, using several bibliographical databases. We assessed 1,238 abstracts and selected 19 papers that considered gender equality policies, compared several countries or different states in 1 country, and analyzed at least 1 health outcome among women or compared between genders. To illustrate specific policy effects, we also selected articles that assessed associations between parental leave and women's health. Our review partially supports the hypothesis that Nordic social democratic welfare regimes and dual-earner family models best promote women's health. Meanwhile, enforcement of reproductive policies, mainly studied across US states, is associated with better mental health outcomes, although less with other outcomes. Longer paid maternity leave was also generally associated with better mental health and longer duration of breastfeeding.

The evolution of mental health in Spain during the economic crisis.

We analyse how mental health and socioeconomic inequalities in the Spanish population aged 16-64 years have changed between 2006-2007 and 2011-2012. We observed an increase in the prevalence of poor mental health among men (prevalence ratio = 1.15, 95% CI 1.04-1.26], especially among those aged 35-54 years, those with primary and secondary education, those from semi-qualified social classes and among breadwinners. None of these associations remained after adjusting for working status. The relative index of inequality by social class increased for men from 1.02 to 1.08 (P = 0.001). We observed a slight decrease in the prevalence of poor mental health among women (prevalence ratio = 0.92, 95% CI 0.87-0.98), without any significant change in health inequality.

Different patterns by age-group and gender of socioeconomic inequalities in smoking in Colombia.

INTRODUCTION: Evidence on socioeconomic inequalities in smoking from low- and middle-income countries has shown some inconsistency between countries. We have studied the socioeconomic inequalities in current smoking, ever smoking, and smoking cessation in Colombia by age-group and gender. METHODS: Sixty thousand, three hundred and forty-nine Colombian men and women aged 12-69 years were selected at random from the results of a national survey. We used Pearson's chi-square and Robust Poisson regression analyses to estimate adjusted prevalence ratios between smoking behaviors and 2 indicators of socioeconomic position; individuals' educational level and household socioeconomic stratum. RESULTS: In men aged 45-69 years, higher socioeconomic stratum and higher education were associated with a lower rate of current smoking (PR = 0.49 [95% CI, 0.32-0.73] and PR = 0.64 [95% CI, 0.47-0.86], respectively), a history of smoking (PR = 0.67 [95% CI, 0.53-0.85] and PR = 0.75 [95% CI, 0.63-0.90], respectively), or a higher rate of smoking cessation (PR = 1.37 [95% CI, 1.09-1.72] and PR = 0.18 [95% CI, 0.99-1.72], respectively). In men aged 18-44 years, higher education was associated with lower odds of current and history of smoking (PR = 0.75 [95% CI, 0.61-0.92 and PR = 0.81 [95% CI, 0.67-0.98], respectively). Results in women and adolescents were mixed. CONCLUSIONS: In Colombia, the overall declining prevalence of smoking in men seems to be accompanied by a narrowing of smoking inequalities in successive birth cohorts, suggesting a favorable evolution of the tobacco epidemic. Further research will be required to identify factors that have contributed these optimal circumstances in tobacco control.

Perception or real illness? How chronic conditions contribute to gender inequalities in self-rated health.

BACKGROUND: In Spain, as in many countries, women report poorer general health and more daily activity limitations due to health reasons when compared with men. This study aims to examine whether these poorer indicators are due to a greater prevalence of health problems and to identify the types of problems that contribute most to gender inequalities. METHODS: Cross-sectional study on the population aged >15 years and residing in Spain, with data from the 2006 National Health Survey (n = 29139). The sex prevalence ratios (PR) of poor self-rated health and chronic limitation of activity are sequentially adjusted by age and the presence of 27 chronic conditions by means of robust Poisson regression. RESULTS: At equal number of disorders, women reported equal or even better health than men. The excess of poor health in women (age-adjusted PR and 95% CI: self-rated health = 1.36, 1.29-1.41; chronic limitation = 1.25, 1.18-1.32) disappeared when adjusting for the number of chronic diseases (self-rated health = 1.00, 0.96-1.04; chronic limitation = 0.90, 0.85-0.96). Musculoskeletal, mental and other pain disorders accounted for most of the association. The results were consistent in different strata of age, social class, and type of country of birth. CONCLUSION: These results suggest that the poorer self-rated health of women is a reflection of the higher burden of disease they suffer. A health system responsive to gender inequalities should increase its efforts in addressing and resolving musculoskeletal, mental and other pain disorders, usually less considered in favour of disorders with greater impact on mortality.

Beyond Rose's strategies: a typology of scenarios of policy impact on population health and health inequalities.

There is growing interest and debate in the area of policy strategies to tackle health inequalities, as well as the impact of health policies and non-health-sector policies on the health of populations. Geoffrey Rose's milestone idea of a population strategy to "shift the curve" has provided key insights for both research and policy on social determinants of health. However, changes that occur both in the overall shift and in the shape of the curve (i.e., in inequality) should also be considered. This article presents a classification of policies and interventions based on all possible outcome scenarios of changes in population health and health inequalities, with examples of real policies.

Monitoring social determinants of health inequalities: the impact of unemployment among vulnerable groups.

Surveillance of social determinants of health inequalities is an essential but still underdeveloped issue in public health. Existing research has identified unemployment as an important social determinant of health inequalities. This cross-sectional study investigates the impact of unemployment on mental health outcomes among vulnerable groups, using the 2006 Catalonian Health Survey (N=8591). The authors estimate the prevalence ratios and differences (excess of prevalence) for poor mental health in the unemployed and employed, with 95 percent confidence intervals. After taking into account the interactions among social mechanisms of inequality and related factors, the authors identified seven vulnerable groups to monitor. Primary findings indicate that unemployment has a greater adverse effect on the mental health of male manual workers, single mothers, main-earner women, and manual workers without unemployment benefits for both sexes. Findings support the need to devote more research to the surveillance of unemployment as a social determinant of health inequalities, to identify additional unemployment indicators, and to consider how various social mechanisms of inequality interact with each other to produce health inequalities among vulnerable groups.

[Health inequalities as a political priority in Barcelona]. / Las desigualdades en salud como prioridad política en Barcelona.

There is a wealth of information and research on health inequalities in Barcelona, but this issue has not been clearly prioritised on the political agenda. The arrival in government of a new left-wing party (Barcelona en Comú) in 2015, gave an important boost to the political agenda to reduce inequalities and health inequalities. The aim of this review is to describe the progress made in relation to health inequalities in these four years and especially in the areas involving public health. With respect to evidence and communication on health inequalities, the progress made is presented in the Barcelona annual health report and the creation of the Observatory on Health, Inequalities and Impacts of Municipal Policies. The policies presented refer to different municipal strategies, the Health Plan, the promotion of the Barcelona Health in the Neighbourhoods programme and the Plan for Tackling Inequalities in the Barcelona Public Health Agency. The combination of political will, technical capacity and the drive of citizens have facilitated progress in the city of Barcelona in policies to reduce social inequalities in health.

Psychotic symptoms and general health in a socially disadvantaged migrant community in Bologna.

BACKGROUND AND AIMS: Social exclusion and reduced access to community health services can lead to urgent health problems among immigrants; this may explain their increasing rate of admittance to psychiatric inpatient units. This cross-sectional study aims to evaluate the prevalence of psychotic symptoms among Romanian immigrants living in very poor conditions at an abandoned hotel in Bologna and to highlight the possible correlation with general health status, distress and socio-demographic characteristics. METHODS: The Psychosis Screening Questionnaire (PSQ) and General Health Questionnaire-12 (GHQ-12) were administered to all immigrants residing at the hotel during two index days with the help of a cultural mediator. Socio-demographic, migration and health characteristics were also collected. RESULTS: Sixty eight subjects were evaluated. More than 80% had left Romania for economic reasons. Of immigrants, 57% exceeded the four-point GHQ-12 threshold of potential mental disorder and 19% scored positively at the PSQ. Immigrants with positive PSQ showed higher mean GHQ-12 scores (5.9 +/- 3.5 vs. 3.8 +/- 2.75; p = 0.02). The development of post-migration health problems significantly predicts positive PSQ cases even after adjusting for age, sex and GHQ-12 dichotomized score (OR = 21.2, CI = 1.1-169.4). CONCLUSION: This community of immigrants living in deprived conditions showed a high prevalence of distress and psychotic symptoms, related to health problems. Preventing excess of psychosis among immigrants and ethnic minorities in critical socio-economic conditions should mean, first and foremost, facilitating social integration and access to primary care.

Social and Economic Policies Matter for Health Equity: Conclusions of the SOPHIE Project.

Since 2011, the SOPHIE project has accumulated evidence regarding the influence of social and economic policies on population health levels, as well as on health inequalities according to socioeconomic position, gender, and immigrant status. Through comparative analyses and evaluation case studies across Europe, SOPHIE has shown how these health inequalities vary according to contexts in macroeconomics, social protection, labor market, built environment, housing, gender equity, and immigrant integration and may be reduced by equity-oriented policies in these fields. These studies can help public health and social justice advocates to build a strong case for fairer social and economic policies that will lead to the reduction of health inequalities that most governments have included among their policy goals. In this article, we summarize the main findings and policy implications of the SOPHIE project and the lessons learned on civil society participation in research and results communication.