Social Inequalities in Mental Health and Self-Perceived Health in the First Wave of COVID-19 Lockdown in Latin America and Spain: Results of an Online Observational Study.

COVID-19 lockdowns greatly affected the mental health of populations and collectives. This study compares the mental health and self-perceived health in five countries of Latin America and Spain, during the first wave of COVID 19 lockdown, according to social axes of inequality. This was a cross-sectional study using an online, self-managed survey in Brazil, Chile, Ecuador, Mexico, Peru, and Spain. Self-perceived health (SPH), anxiety (measured through GAD-7) and depression (measured through PHQ-9) were measured along with lockdown, COVID-19, and social variables. The prevalence of poor SPH, anxiety, and depression was calculated. The analyses were stratified by gender (men = M; women = W) and country. The data from 39,006 people were analyzed (W = 71.9%). There was a higher prevalence of poor SPH and bad mental health in women in all countries studied. Peru had the worst SPH results, while Chile and Ecuador had the worst mental health indicators. Spain had the lowest prevalence of poor SPH and mental health. The prevalence of anxiety and depression decreased as age increased. Unemployment, poor working conditions, inadequate housing, and the highest unpaid workload were associated with worse mental health and poor SPH, especially in women. In future policies, worldwide public measures should consider the great social inequalities in health present between and within countries in order to tackle health emergencies while reducing the health breach between populations.

[Impact of COVID-19 lockdown on self-perceived health in Chile by gender]. / Impacto del confinamiento por la COVID-19 en la salud autopercibida en Chile según género.

OBJECTIVE: To analyse the social factors associated with self-perceived health during the COVID-19 lockdown in the Chilean resident population according to gender perspective. METHOD: Cross-sectional study conducted during the COVID-19 lockdown between May 17 and August 17, 2020 with an online survey. Self-perceived health was analysed in the population aged 18 years or older in relation to social variables. Multivariate logistic regression models were constructed to assess the association between independent variables with self-perceived health, through adjusted odds ratio (aOR). Analyses were stratified by sex (M: men; W: women). RESULTS: 5981 persons were analysed (women: 63.9%). 29.6% of women and 19.2% of men reported poor self-perceived health. In women it worsens with increasing age. Worse self-perceived health was mainly associated with lack of social support (ORa M: 2.05; ORa W: 2.34), concern about living together at home (ORa M: 1.66; ORa W: 1.38), perceived inadequate housing conditions (ORa M: 1.89; ORa W: 2.63), and disagreement with government measures (ORa M: 2.80; ORa W: 1.82). In women, it was also associated with informal work or being inactive in the labour market (ORa: 2.11). In men worse self-perceived health was associated with being self-employed (ORa: 1.65; confidence interval [CI]: 1.11-2.45) and has secondary education (ORa: 2.81; CI: 1.32-5.98). CONCLUSIONS: The social impact of lockdown in self-perceived health is related to gender, age, care work, and socioeconomic conditions, as well as, by disagreement with the measures implemented to manage the pandemic.

[From theory to practice: the discourse of healthy lifestyles and its application to the daily lives of low-income Chilean women]. / De la teoría a la práctica: el discurso de estilos de vida saludable y su aplicación en la vida cotidiana de mujeres chilenas de sectores populares.

The discourse on healthy lifestyles (HLS) states that a population will remain healthy by adopting such lifestyles, modifying unhealthy and thus morally incorrect individual behaviors. The HLS discourse has been hegemonic in Public Health since the late 20th century. It assumes freedom of choice by individuals, who purportedly make rational decisions, seeking the lowest cost and maximum individual benefit, the neoliberal model's basic premise. It thus overlooks the relevance of living conditions for health and health inequality. The current study focused on the perception of the HLS discourse and its repercussions on the behavior of low-income Chilean women. Semi-structured interviews were held with beneficiaries of a government program (Healthy Life Program), based on the HLS discourse. The study explored the women's discourse on health and its correspondence with the HLS discourse. It also analyzed the possibilities of implementing the discourse in practice, from the women's own perspective. The results showed that the women view health as the result of lifestyle, which can be freely chosen. However, they identify various barriers to implementing healthy lifestyle in practice at the economic, family, and sociocultural levels. The conclusion is that individuals should be considered within the family, social, and structural contexts in which health and disease are produced, while abandoning the moralist perspective that legitimizes the neoliberal definition of health.

El discurso de estilos de vida saludable (DEVS) plantea que una población se mantendrá sana si adopta estilos de vida saludable, modificando comportamientos individuales perjudiciales para la salud y, por tanto, moralmente incorrectos. El DEVS ha sido hegemónico en la Salud Pública desde fines del siglo XX. Se basa en el supuesto de libertad de elección de los individuos, que toman decisiones racionales, buscando el menor costo y mayor beneficio individual, premisa básica del modelo neoliberal. Con esto, se omite la importancia que las condiciones de existencia tienen para la salud y la desigualdad en salud. Esta investigación indagó en la percepción del DEVS y su repercusión en el comportamiento de mujeres chilenas residentes en sectores populares. Se realizaron entrevistas semiestructuradas a beneficiarias de un programa gubernamental (Programa Vida Sana), sustentado en el DEVS. Se exploró el discurso de las mujeres sobre la salud y su correspondencia con el DEVS. También, se analizó las posibilidades de poner en práctica dicho discurso, desde la perspectiva de las propias mujeres. Los resultados muestran que las entrevistadas comprenden la salud como resultado del estilo de vida, el cual puede ser libremente elegido. Sin embargo, identifican diversas barreras para ponerlo en práctica, en los planos económico, familiar y sociocultural. Se concluye que las estrategias deben considerar los sujetos en los contextos familiares, sociales y estructurales en los cuales se produce la salud-enfermedad, y abandonar la perspectiva moralizante y legitimadora de la concepción neoliberal de la salud.

O discurso sobre estilos de vida saudáveis (DEVS) propõe que uma população se manterá sã se adotar estilos de vida saudáveis, alterando comportamentos individuais prejudiciais para a saúde e, portanto, moralmente incorretos. O DEVS se tornou hegemônico na Saúde Pública desde o final do século XX. Está alicerçado no princípio de liberdade de escolha dos indivíduos, que tomam decisões racionais buscando o menor custo e o maior benefício individual, premissa básica do modelo neoliberal. Com isso, omite a importância que as condições de vida desempenham para a saúde e a desigualdade na saúde. Esta pesquisa investigou a percepção do DEVS e a sua repercussão no comportamento de mulheres chilenas residentes em bairros populares. Foram realizadas entrevistas semiestruturadas com beneficiárias de um programa de governo (Programa Vida Saudável), sustentado no DEVS. Estudou-se o discurso das mulheres sobre a saúde e o seu alinhamento com o DEVS. Também foram analisadas as possibilidades de implementação deste discurso, do ponto de vista das próprias mulheres. Os resultados mostram que as entrevistadas entendem a saúde como o resultado do estilo de vida, que pode ser livremente escolhido. Entretanto, identificam diversas barreiras para colocá-lo em prática, nos planos econômico, familiar e sociocultural. Daí se conclui que as estratégias devem considerar os sujeitos nos contextos familiares, sociais e estruturais nos quais se gera a saúde-doença, e abandonar a perspectiva moralizante e legitimadora da concepção neoliberal da saúde.

Being for Others and Material Conditions: The Limits of the "Healthy Lifestyles" Notion for Chilean Women.

Public policies to prevent non-communicable diseases (NCDs) by promoting health lifestyles began in Chile in the 1990 s, yet NCDs are still highly prevalent. We draw on the theoretical approaches of the Latin American Collective Health (LACH) and critical medical anthropology (CAM) to elucidate why these polices have not had the desired effects. Women with low socioeconomic status and participating in the Choose Healthy Living Program identified obstacles to healthy living and the subjective tensions resulting from the healthy lifestyles ethic. Their experiences demonstrate how lifestyles emerge from the intersection of agency and structure, so it cannot result from individual action alone.

De la teoría a la práctica: el discurso de estilos de vida saludable y su aplicación en la vida cotidiana de mujeres chilenas de sectores populares / From theory to practice: the discourse of healthy lifestyles and its application to the daily lives of low-income Chilean women / Da teoria à prática: o discurso de estilos de vida saudáveis e a sua aplicação no dia-a-dia de mulheres chilenas de bairros populares

Resumen: El discurso de estilos de vida saludable (DEVS) plantea que una población se mantendrá sana si adopta estilos de vida saludable, modificando comportamientos individuales perjudiciales para la salud y, por tanto, moralmente incorrectos. El DEVS ha sido hegemónico en la Salud Pública desde fines del siglo XX. Se basa en el supuesto de libertad de elección de los individuos, que toman decisiones racionales, buscando el menor costo y mayor beneficio individual, premisa básica del modelo neoliberal. Con esto, se omite la importancia que las condiciones de existencia tienen para la salud y la desigualdad en salud. Esta investigación indagó en la percepción del DEVS y su repercusión en el comportamiento de mujeres chilenas residentes en sectores populares. Se realizaron entrevistas semiestructuradas a beneficiarias de un programa gubernamental (Programa Vida Sana), sustentado en el DEVS. Se exploró el discurso de las mujeres sobre la salud y su correspondencia con el DEVS. También, se analizó las posibilidades de poner en práctica dicho discurso, desde la perspectiva de las propias mujeres. Los resultados muestran que las entrevistadas comprenden la salud como resultado del estilo de vida, el cual puede ser libremente elegido. Sin embargo, identifican diversas barreras para ponerlo en práctica, en los planos económico, familiar y sociocultural. Se concluye que las estrategias deben considerar los sujetos en los contextos familiares, sociales y estructurales en los cuales se produce la salud-enfermedad, y abandonar la perspectiva moralizante y legitimadora de la concepción neoliberal de la salud.

Abstract: The discourse on healthy lifestyles (HLS) states that a population will remain healthy by adopting such lifestyles, modifying unhealthy and thus morally incorrect individual behaviors. The HLS discourse has been hegemonic in Public Health since the late 20th century. It assumes freedom of choice by individuals, who purportedly make rational decisions, seeking the lowest cost and maximum individual benefit, the neoliberal model's basic premise. It thus overlooks the relevance of living conditions for health and health inequality. The current study focused on the perception of the HLS discourse and its repercussions on the behavior of low-income Chilean women. Semi-structured interviews were held with beneficiaries of a government program (Healthy Life Program), based on the HLS discourse. The study explored the women's discourse on health and its correspondence with the HLS discourse. It also analyzed the possibilities of implementing the discourse in practice, from the women's own perspective. The results showed that the women view health as the result of lifestyle, which can be freely chosen. However, they identify various barriers to implementing healthy lifestyle in practice at the economic, family, and sociocultural levels. The conclusion is that individuals should be considered within the family, social, and structural contexts in which health and disease are produced, while abandoning the moralist perspective that legitimizes the neoliberal definition of health.

Resumo: O discurso sobre estilos de vida saudáveis (DEVS) propõe que uma população se manterá sã se adotar estilos de vida saudáveis, alterando comportamentos individuais prejudiciais para a saúde e, portanto, moralmente incorretos. O DEVS se tornou hegemônico na Saúde Pública desde o final do século XX. Está alicerçado no princípio de liberdade de escolha dos indivíduos, que tomam decisões racionais buscando o menor custo e o maior benefício individual, premissa básica do modelo neoliberal. Com isso, omite a importância que as condições de vida desempenham para a saúde e a desigualdade na saúde. Esta pesquisa investigou a percepção do DEVS e a sua repercussão no comportamento de mulheres chilenas residentes em bairros populares. Foram realizadas entrevistas semiestruturadas com beneficiárias de um programa de governo (Programa Vida Saudável), sustentado no DEVS. Estudou-se o discurso das mulheres sobre a saúde e o seu alinhamento com o DEVS. Também foram analisadas as possibilidades de implementação deste discurso, do ponto de vista das próprias mulheres. Os resultados mostram que as entrevistadas entendem a saúde como o resultado do estilo de vida, que pode ser livremente escolhido. Entretanto, identificam diversas barreiras para colocá-lo em prática, nos planos econômico, familiar e sociocultural. Daí se conclui que as estratégias devem considerar os sujeitos nos contextos familiares, sociais e estruturais nos quais se gera a saúde-doença, e abandonar a perspectiva moralizante e legitimadora da concepção neoliberal da saúde.

[Women's work and double workload as conditioning factors for family nutritional strategies and lifestyles in Santiago, Chile]. / Trabajo femenino y doble presencia como condicionante de las estrategias alimentarias familiares y los estilos de vida en hogares de Santiago de Chile.

Lifestyles have been highlighted as the main risk factor for noncommunicable diseases in the 21st century, often leaving aside the role of material conditions of reproduction of daily life in modeling of habits and behaviors. The article addresses the tensions and transactions in family nutrition in the city of Santiago, Chile, in which mothers do paid work and are simultaneously in charge of housework and family care. An ethnographic focus was used in interviews with mothers, in addition to passive and participant observation in 20 households in the years 2015 and 2017 to reconstruct the nutritional strategies and reconciliation of women's paid work with family demands. Such strategies link material, cultural, class, and gender aspects on a daily basis at both the micro and macrosocial levels, in a kind of puzzle that stabilizes preferences, dispositions, and decisions (habitus). The results indicate that mothers model the family lifestyles through such strategies, modulating and taking responsibility for structural aspects that transcend them, producing tension and precariousness in their personal and family life.

Los estilos de vida han sido señalados como el principal factor de riesgo para el desarrollo de las enfermedades no transmisibles del siglo XXI, dejando frecuentemente de lado el papel de las condiciones materiales de reproducción de la vida cotidiana en el modelamiento de los hábitos y los comportamientos. Este artículo aborda las tensiones y transacciones en torno a la alimentación de familias de la ciudad de Santiago de Chile, en las que las mujeres-madres trabajan remuneradamente y a la vez son las principales responsables del trabajo doméstico y de cuidado. Por medio de un enfoque etnográfico se realizaron entrevistas a las mujeres-madres y observación pasiva y participante en 20 hogares entre los años 2015 y 2017, para reconstruir, utilizando teoría fundamentada, las estrategias alimentarias y de conciliación trabajo-familia. Dichas estrategias articulan cotidianamente aspectos materiales, culturales, de clase y de género, tanto de nivel micro como macrosocial, una suerte de puzzle que estabiliza preferencias, disposiciones y decisiones (habitus). Los resultados indican que las mujeres-madres modelan los modos y estilos de vida familiares por medio de dichas estrategias, modulando y responsabilizándose de aspectos estructurales que las trascienden, lo que tensiona y precariza tanto su vida personal, como la familiar.

Os estilos de vida foram apontados como o principal fator de risco para o desenvolvimento das doenças não transmissíveis do século XXI, deixando frequentemente de lado o papel das condições materiais de reprodução da vida cotidiana na modelagem dos hábitos e comportamentos. Este artigo aborda as tensões e transações em torno da alimentação de famílias da cidade de Santiago, Chile, nas quais as mulheres-mães têm um emprego remunerado e são, ao mesmo tempo, as principais responsáveis pelo trabalho doméstico e a criação. Por meio de um enfoque etnográfico, foram realizadas entrevistas das mulheres-mães, com observação passiva e participativa, em 20 famílias, entre os anos 2015 e 2017, para reconstruir, lançando mão de uma teoria fundamentada, as estratégias alimentares e de conciliação trabalho-família. Tais estratégias articulam no dia a dia aspectos materiais, culturais, de classe e de gênero, tanto no nível micro como macrossocial, um tipo de quebra-cabeça que estabiliza preferências, atitudes e decisões (habitus). Os resultados indicam que as mulheres-mães moldam os modos e estilos de vida familiais por meio das estratégias, modulando e responsabilizando-se pelos aspectos estruturais que as transcendem, o que tensiona e precariza tanto a sua vida pessoal como familial.

Trabajo femenino y doble presencia como condicionante de las estrategias alimentarias familiares y los estilos de vida en hogares de Santiago de Chile / Women's work and double workload as conditioning factors for family nutritional strategies and lifestyles in Santiago, Chile / Trabalho feminino e dupla presença como condicionante das estratégias alimentares familiais e os estilos de vida em famílias de Santiago, Chile

Los estilos de vida han sido señalados como el principal factor de riesgo para el desarrollo de las enfermedades no transmisibles del siglo XXI, dejando frecuentemente de lado el papel de las condiciones materiales de reproducción de la vida cotidiana en el modelamiento de los hábitos y los comportamientos. Este artículo aborda las tensiones y transacciones en torno a la alimentación de familias de la ciudad de Santiago de Chile, en las que las mujeres-madres trabajan remuneradamente y a la vez son las principales responsables del trabajo doméstico y de cuidado. Por medio de un enfoque etnográfico se realizaron entrevistas a las mujeres-madres y observación pasiva y participante en 20 hogares entre los años 2015 y 2017, para reconstruir, utilizando teoría fundamentada, las estrategias alimentarias y de conciliación trabajo-familia. Dichas estrategias articulan cotidianamente aspectos materiales, culturales, de clase y de género, tanto de nivel micro como macrosocial, una suerte de puzzle que estabiliza preferencias, disposiciones y decisiones (habitus). Los resultados indican que las mujeres-madres modelan los modos y estilos de vida familiares por medio de dichas estrategias, modulando y responsabilizándose de aspectos estructurales que las trascienden, lo que tensiona y precariza tanto su vida personal, como la familiar.

Lifestyles have been highlighted as the main risk factor for noncommunicable diseases in the 21st century, often leaving aside the role of material conditions of reproduction of daily life in modeling of habits and behaviors. The article addresses the tensions and transactions in family nutrition in the city of Santiago, Chile, in which mothers do paid work and are simultaneously in charge of housework and family care. An ethnographic focus was used in interviews with mothers, in addition to passive and participant observation in 20 households in the years 2015 and 2017 to reconstruct the nutritional strategies and reconciliation of women's paid work with family demands. Such strategies link material, cultural, class, and gender aspects on a daily basis at both the micro and macrosocial levels, in a kind of puzzle that stabilizes preferences, dispositions, and decisions (habitus). The results indicate that mothers model the family lifestyles through such strategies, modulating and taking responsibility for structural aspects that transcend them, producing tension and precariousness in their personal and family life.

Os estilos de vida foram apontados como o principal fator de risco para o desenvolvimento das doenças não transmissíveis do século XXI, deixando frequentemente de lado o papel das condições materiais de reprodução da vida cotidiana na modelagem dos hábitos e comportamentos. Este artigo aborda as tensões e transações em torno da alimentação de famílias da cidade de Santiago, Chile, nas quais as mulheres-mães têm um emprego remunerado e são, ao mesmo tempo, as principais responsáveis pelo trabalho doméstico e a criação. Por meio de um enfoque etnográfico, foram realizadas entrevistas das mulheres-mães, com observação passiva e participativa, em 20 famílias, entre os anos 2015 e 2017, para reconstruir, lançando mão de uma teoria fundamentada, as estratégias alimentares e de conciliação trabalho-família. Tais estratégias articulam no dia a dia aspectos materiais, culturais, de classe e de gênero, tanto no nível micro como macrossocial, um tipo de quebra-cabeça que estabiliza preferências, atitudes e decisões (habitus). Os resultados indicam que as mulheres-mães moldam os modos e estilos de vida familiais por meio das estratégias, modulando e responsabilizando-se pelos aspectos estruturais que as transcendem, o que tensiona e precariza tanto a sua vida pessoal como familial.

Estrategias familiares de provisión de alimentos en hogares de mujeres-madres trabajadoras de la ciudad de Santiago de Chile / Families' food provisioning strategies among households headed by working mothers in Santiago of Chile

RESUMEN El objetivo de esta investigación fue estudiar las estrategias familiares de provisión de alimentos en hogares con hijosy/o hijas menores en que las madres son trabajadoras de la ciudad de Santiago de Chile. Se utilizó un enfoque etnográfico y se realizaron 20 entrevistas en profundidad a las mujeres-madres y observación pasiva (17 hogares) y participante (3 hogares). Los resultados mostraron que el abastecimiento y la provisión de alimentos es una actividad de la cual se hacen cargo mayoritariamente las mujeres-madres, y la forma en que se lleva a cabo, tendría una estrecha relación con su ocupación y el grupo socioeconómico al que pertenece la familia. En ocupaciones más flexibles en términos de horarios e ingresos y grupos socioeconómicos menos favorecidos, se flexibilizaría la provisión de alimentos, dándole preferencia a productos no perecibles que son parte de lo que las informantes llaman "mercadería", teniendo un papel secundario la compra de otros alimentos como frutas, verduras y carnes. Cuando la ocupación es más formal y estable, en términos de horarios e ingresos, y el grupo socioeconómico de la familia más favorable, se observa una rutinización mayor de las estrategias que incluye tanto la "mercadería" como los otros tipos de alimentos.

ABSTRACT Our objective was to explore families' food provisioning strategies among households headed by working mothers in Santiago of Chile, through qualitative and ethnographical methods. We used in-depth individual interviews (20), observations of provisioning practices (17) and participant observation (3) in houses and market places, carried out over a period of two weeks. Food provisioning was an activity mainly performed by the mother, and it was strongly shaped by the type of employment and the socioeconomic level of the family. Women of disadvantaged socioeconomic groups and employed in more flexible jobs - in terms of time and income-, engaged in more flexible provisioning practices, prioritizing non-perishable products - what informants call 'mercaderia'- over perishable foods such as fruits, vegetables and meats, which were of secondary relevance. Women of higher socioeconomic groups and employed in more formal and stable jobs, showed greater routine in their provisioning strategies, which included both, 'mercadería' and perishable foods.

Alimentación de estudiantes de pregrado chilenos en el contexto de la modernidad alimentaria / Nutritional habits of chilean university students in the context of alimentary modernity

The nutritional habits in Chile, has been affected by the "alimentary modernity". This phenomenon is understood as the transformation of what we eat - how food products are produced, distributed, prepared and consumed - as a consequence of food industrialization, economy and mass media globalization. This process has generated many changes in lifestyle with substantial differences depending on the context in which they operate socioeconomic grounds, age and gender. This article is based on a study undertook in Santiago of Chile from 2008 to 2010, through qualitative methodology. It explores university student's perception of their diet focusing on their relationship with food and their bodies. The main results and conclusions show that the university students feel discomfort with their nutritional habits, mainly the women, students who live alone and who have scanty money for their personal expenses.

La alimentación en Chile se ha visto afectada por la "modernidad alimentaria", entendida como la transformación de lo que se come, la forma de producirlo, de distribuirlo, de prepararlo y de consumirlo, producto de un conjunto de procesos vinculados a la industrialización de los alimentos, la mundialización de la economía y la globalización de los medios masivos de comunicación. Esta situación ha generado cambios en los estilos de vida con diferencias sustantivas según el contexto en el que las personas se desenvuelven, la procedencia socio-económica, la edad y el género. La presente investigación realizada entre el 2008 y el 2010, indaga mediante una metodología cualitativa, las percepciones que tienen respecto de su alimentación estudiantes universitarios de Santiago de Chile enfocándose en la relación que establecen con los alimentos que consumen y con su propio cuerpo. Los principales resultados y conclusiones indican que habría insatisfacción respecto de su alimentación en los/las estudiantes universitarios, sobre todo en mujeres, quienes han migrado desde regiones y viven solos/as y quienes cuentan con menos dinero semanal para su gastos personales.