Promoción de salud más allá de los estilos de vida saludables: propuestas de actuación en una universidad chilena.

Las intervenciones centradas en cambios de conducta, sumadas a la escasa evidencia de mapeo y dinamización de activos en Universidades Promotoras de Salud (UPS), hacen necesario potenciar enfoques integrales y sistémicos que contribuyan al bienestar y empoderamiento de sus integrantes. El objetivo de este artículo es explorar propuestas de acción que contribuyan a fortalecer activos en una comunidad universitaria chilena. Se desarrolló un estudio cualitativo con 72 hombres/77 mujeres (estudiantes, trabajadores, jubilados y exestudiantes). Se realizaron 48 entrevistas individuales y 14 grupos focales. Se efectuó un análisis de contenido utilizando el software QRS NVivo 12. Las propuestas identificadas se agruparon en: desarrollo de la participación e inclusión, promoción de la salud mental, mantenimiento y mejora de áreas verdes e infraestructura, y fortalecimiento del acceso a actividades deportivas, culturales y de extensión universitaria. Las mujeres valoraron la difusión de activos comunitarios y el cuidado de las personas y el entorno. Y los hombres, el fortalecimiento del capital social, la docencia y la transferencia de conocimiento. Las propuestas de acción tienen una orientación colectiva que favorece el vínculo de las personas con su entorno y el desarrollo del sentido de comunidad. Desde una perspectiva de género, se observa reproducción de roles y estereotipos arraigados en el sistema patriarcal. Esto constituye un desafío para potenciar las UPS en tanto política pública, considerando los principios de participación, justicia social y equidad.

Gender Equality and the Global Gender Gap in Life Expectancy: An Exploratory Analysis of 152 Countries.

When looking at life expectancy (LE) by sex, women live longer than men in all countries. Biological factors alone do not explain gender differences in LE, and examining structural differences may help illuminate other explanatory factors. The aim of this research is to analyse the influence of gender inequality on the gender gap in LE globally. We have carried out a regression analysis between the gender gap in relativised LE and the UN Gender Inequality Index (GII), with a sensitivity analysis conducted for its three dimensions, stratified by the six World Health Organization (WHO) regions. We adjusted the model by taking into consideration gross national income (GNI), democratic status and rural population. The results indicated a positive association for the European region (ß=0.184) and the Americas (ß=0.136) in our adjusted model. Conversely, for the African region, the relations between gender equality and the LE gender gap were found to be negative (ß=-0.125). The findings suggest that in the WHO European region and the Americas, greater gender equality leads to a narrowing of the gender LE gap, while it has a contrary relationship in Africa. We suggest that this could be because only higher scores in the GII between men and women show health benefits.

Advancing gender equ(al)ity, lifting men's health: dealing with the spirit of our time.

In this paper, we jointly address two connected issues that should be addressed together more purposefully within both public health policies and programmes: the health and well-being of men and boys, and the focus on equity versus equality from a gender perspective. Awareness of these issues has boosted the debate on the impacts of gender inequality on health and men's role within it. Although this essay is not intended as an in-depth review on the subject, we provide a brief approach to some critical factors interwoven in the process of achieving greater gender equality. We identify some of the challenges that may arise for both policy and new research that seek to assume a relational gender approach that also pays greater attention to men's health.

[The study of health in men from a gender perspective: where we come from, where are we going]. / El estudio de la salud de los hombres desde una perspectiva de género: de dónde venimos, hacia dónde vamos.

Comprehensive and in-depth analyses of differences and inequalities in health require a broad-based approach to the study of masculinities and men's health. Interest in this issue has grown in parallel to increased concern over specific risks and vulnerabilities faced by men, but also due to the need to involve them in programs capable of promoting progress towards gender-based health equity. This article attempts to reframe these issues from the perspective of public health, providing a wider viewpoint on men's health situated within debates on the social determinants of health and the analysis of health inequalities. Based on a relational gender approach, we formulate some recommendations regarding policy and research agendas, which we argue can contribute to advancing the study and development of programs from a gender-based perspective in health.

Llevar a cabo un análisis más integral y profundo de las diferencias y desigualdades en salud requiere de una aproximación más amplia al estudio de las masculinidades y la salud de los hombres en el momento actual. Estamos ante un tema cuyo interés ha ido a la par de la creciente preocupación por los riesgos y vulnerabilidades específicas de los hombres, pero también de la necesidad de involucrarlos en programas con capacidad de promover cambios positivos en el orden de género hacia la equidad en salud. Este artículo resitúa este campo dentro de la salud pública, proporcionando una visión amplificada sobre la salud de los hombres dentro del debate de los determinantes sociales de la salud y el análisis de las desigualdades. Sobre la base de un enfoque relacional de género, se formulan una serie de recomendaciones orientadas a las políticas y la investigación, que consideramos pueden contribuir a avanzar en el estudio y el desarrollo de programas desde una perspectiva de género en salud.

El estudio de la salud de los hombres desde una perspectiva de género: de dónde venimos, hacia dónde vamos / The study of men's health from a gender-based perspective: where we come from, where we are going

RESUMEN Llevar a cabo un análisis más integral y profundo de las diferencias y desigualdades en salud requiere de una aproximación más amplia al estudio de las masculinidades y la salud de los hombres en el momento actual. Estamos ante un tema cuyo interés ha ido a la par de la creciente preocupación por los riesgos y vulnerabilidades específicas de los hombres, pero también de la necesidad de involucrarlos en programas con capacidad de promover cambios positivos en el orden de género hacia la equidad en salud. Este artículo resitúa este campo dentro de la salud pública, proporcionando una visión amplificada sobre la salud de los hombres dentro del debate de los determinantes sociales de la salud y el análisis de las desigualdades. Sobre la base de un enfoque relacional de género, se formulan una serie de recomendaciones orientadas a las políticas y la investigación, que consideramos pueden contribuir a avanzar en el estudio y el desarrollo de programas desde una perspectiva de género en salud.

ABSTRACT Comprehensive and in-depth analyses of differences and inequalities in health require a broad-based approach to the study of masculinities and men's health. Interest in this issue has grown in parallel to increased concern over specific risks and vulnerabilities faced by men, but also due to the need to involve them in programs capable of promoting progress towards gender-based health equity. This article attempts to reframe these issues from the perspective of public health, providing a wider viewpoint on men's health situated within debates on the social determinants of health and the analysis of health inequalities. Based on a relational gender approach, we formulate some recommendations regarding policy and research agendas, which we argue can contribute to advancing the study and development of programs from a gender-based perspective in health.

Punching above their weight: a network to understand broader determinants of increasing life expectancy.

BACKGROUND: Life expectancy initially improves rapidly with economic development but then tails off. Yet, at any level of economic development, some countries do better, and some worse, than expected - they either punch above or below their weight. Why this is the case has been previously researched but no full explanation of the complexity of this phenomenon is available. NEW RESEARCH NETWORK: In order to advance understanding, the newly formed Punching Above Their Weight Research Network has developed a model to frame future research. It provides for consideration of the following influences within a country: political and institutional context and history; economic and social policies; scope for democratic participation; extent of health promoting policies affecting socio-economic inequities; gender roles and power dynamics; the extent of civil society activity and disease burdens. CONCLUSION: Further research using this framework has considerable potential to advance effective policies to advance health and equity.

[Towards a social determinants-oriented approach to public health: workshop report]. / Hacia una salud pública orientada desde los determinantes sociales de la salud: informe de un taller.

This article is the result of a workshop with public health experts held in Granada (Spain) in October 2015 in order to reflect upon the components of the framework that should be part of a public health approach based on the social determinants of health. Advocacy and training professionals in health advocacy were identified as key elements where this was needed. During the workshop, it was agreed that the gender perspective, the salutogenic approach, interdisciplinary work and particular attention to disadvantaged groups are crucial. The importance of working from a human rights' framework and promoting legislative changes were also mentioned. Moreover, the group mentioned that even though much progress has been made identifying social determinants of health and creating conceptual frameworks, there is limited knowledge about how to intervene to reduce health inequality gaps in our societies.

Gender norms among "Landless" youth: evidence for the social practice of nursing.

Objective Analyzing the relationship between socio-demographic characteristics of youth from the Landless Rural Workers' Movement in Brazil (MST) regarding the prevalence ratio being in accordance with gender norms. Method A cross-sectional study conducted during a Journey of Agroecology carried out in the State of Paraná with young people (15 to 29 years) of both genders. Data collection was conducted through questionnaires. Data analysis compared variables regarding gender norms with sociodemographic variables, and a Prevalence Ratio (PR) was calculated with a confidence interval (CI) set at 95% in order to determine this relationship. Results The study sample was comprised of 147 young people. A higher prevalence was found in accordance with gender norms (PR with CI at 95%) among women compared to men, and that sociodemographic characteristics (lower education level, those living in occupation camps, who do not have white skin and with religious belief) were social indicators for such positioning among both genders. Conclusion The byproduct of a patriarchal gender system has led more young girls to internalization and a reaffirmation of gender norms, highlighting an important field for social nursing practices in order to contribute to the transformation of this reality.

[Contextual indicators to assess social determinants of health and the Spanish economic recession]. / Indicadores contextuales para evaluar los determinantes sociales de la salud y la crisis económica española.

OBJECTIVE: To provide indicators to assess the impact on health, its social determinants and health inequalities from a social context and the recent economic recession in Spain and its autonomous regions. METHODS: Based on the Spanish conceptual framework for determinants of social inequalities in health, we identified indicators sequentially from key documents, Web of Science, and organisations with official statistics. The information collected resulted in a large directory of indicators which was reviewed by an expert panel. We then selected a set of these indicators according to geographical (availability of data according to autonomous regions) and temporal (from at least 2006 to 2012) criteria. RESULTS: We identified 203 contextual indicators related to social determinants of health and selected 96 (47%) based on the above criteria; 16% of the identified indicators did not satisfy the geographical criteria and 35% did not satisfy the temporal criteria. At least 80% of the indicators related to dependence and healthcare services were excluded. The final selection of indicators covered all areas for social determinants of health, and 62% of these were not available on the Internet. Around 40% of the indicators were extracted from sources related to the Spanish Statistics Institute. CONCLUSIONS: We have provided an extensive directory of contextual indicators on social determinants of health and a database to facilitate assessment of the impact of the economic recession on health and health inequalities in Spain and its autonomous regions.

Assessment of the association of health with the liberalisation of trade in services under the World Trade Organisation.

BACKGROUND: The liberalisation of trade in services which began in 1995 under the General Agreement on Trade in Services (GATS) of the World Trade Organisation (WTO) has generated arguments for and against its potential health effects. Our goal was to explore the relationship between the liberalisation of services under the GATS and three health indicators--life expectancy (LE), under-5 mortality (U5M) and maternal mortality (MM)--since the WTO was established. METHODS AND FINDINGS: This was a cross-sectional ecological study that explored the association in 2010 and 1995 between liberalisation and health (LE, U5M and MM), and between liberalisation and progress in health in the period 1995-2010, considering variables related to economic and social policies such as per capita income (GDP pc), public expenditure on health (PEH), and income inequality (Gini index). The units of observation and analysis were WTO member countries with data available for 2010 (n = 116), 1995 (n = 114) and 1995-2010 (n = 114). We conducted bivariate and multivariate linear regression analyses adjusted for GDP pc, Gini and PEH. Increased global liberalisation in services under the WTO was associated with better health in 2010 (U5M: -0.358 p<0.001; MM: -0.338 p = 0.001; LE: 0.247 p = 0.008) and in 1995, after adjusting for economic and social policy variables. For the period 1995-2010, progress in health was associated with income equality, PEH and per capita income. No association was found with global liberalisation in services. CONCLUSIONS: The favourable association in 2010 between health and liberalisation in services under the WTO seems to reflect a pre-WTO association observed in the 1995 data. However, this liberalisation did not appear as a factor associated with progress in health during 1995-2010. Income equality, health expenditure and per capita income were more powerful determinants of the health of populations.

[RIU project: perceived changes by health agents and professionals after a health intervention in an urban area of socioeconomic disadvantage]. / Projecte RIU: cambios percibidos por agentes de salud y profesionales tras una intervención en salud en un barrio en situación de vulnerabilidad.

OBJECTIVE: To describe how health agents and professionals working in a community project perceive the changes related to the population health status and their use of health-care services after the RIU intervention in an urban area of socioeconomic disadvantage. DESIGN: A qualitative descriptive study based on individual and group interviews and participant observation conducted between October 2008-July 2009. LOCATION: Raval (Algemesí-Valencia) PARTICIPANTS: We selected by purposive sample 7 women health agents, all persons who completed the intervention, and 10 professionals for their involvement in the intervention. METHOD: We conducted a group interview with the women at 6 months and a group and 7 individuals interviews both at 9 months of intervention. We realized a thematic descriptive analysis from health promotion framework. We used participant observation in a meeting with professionals at 9 months and analyzed field notes as: appraisal project, detected changes, challenges and recommendations. RESULTS: Women acquired information about health, contraception, pregnancy and heath services; they noted changes in self-care and social skills and leadership; they internalized the role of health worker disseminating what they learned and showed improvement in self-esteem and social recognition. They caused changes in the people related on health care and access to services. Professionals didn't incorporate at their work the community perspective; they valued positively the project; professionals and women agreed on improving access and use of services and closeness population-professionals. CONCLUSIONS: RIU increases the capabilities of the participants, their social recognition and improves access and use of health services.