Inequities in the distribution of COVID-19: an adaptation of WHO's conceptual framework / Desigualdades en la distribución de la COVID-19: una adaptación del marco conceptual de la OMS

The COVID-19 pandemic currently affects populations worldwide. Although everyone is susceptible to the virus, there are numerous accounts of the pandemic having a greater impact on lower socioeconomic groups and minorities, which is a ubiquitous phenomenon. It is essential for public health administrations and governments to uncover and understanding these inequities to develop proper intersectoral policies to tackle this crisis. Therefore, developing a conceptual framework on this topic, describing the social mechanisms that explain the unjust distribution of the incidence and mortality of COVID-19, is a key task. The aim of this paper is to adapt the framework on social determinants of health from the World Health Organization to the specifics of COVID-19 pandemic. Thus, it identifies and explains the structural and intermediate determinants involved in this pandemic, and adds some new elements (such as the role of the oppression systems and communication) which may help to understand, and ultimately tackle, social inequities in COVID-19 distribution. (AU)

La pandemia de COVID-19 afecta actualmente a poblaciones de todo el mundo. Aunque todas las personas son susceptibles de contraer la enfermedad, hay numerosos argumentos de que la pandemia tiene un mayor impacto en los grupos socioeconómicos más desfavorecidos y en las minorías, lo que es un fenómeno omnipresente. Es esencial que las Administraciones de salud pública y los gobiernos comprendan las desigualdades para desarrollar políticas intersectoriales adecuadas para hacer frente a esta crisis. Por lo tanto, es clave desarrollar un marco conceptual sobre este tema, que describa los mecanismos sociales que explican la injusta distribución de la incidencia y la mortalidad de la COVID-19. El objetivo de este trabajo es adaptar el marco sobre determinantes sociales de la salud de la Organización Mundial de la Salud a las particularidades de la pandemia de COVID-19, identificar y explicar los determinantes estructurales e intermedios implicados en esta pandemia, así como añadir algunos elementos nuevos (como el papel de los sistemas de opresión y la comunicación) que pueden ayudar a comprender, y en última instancia a abordar, las desigualdades sociales en la distribución de la COVID-19. (AU)

Inequities in the distribution of COVID-19: an adaptation of WHO's conceptual framework.

The COVID-19 pandemic currently affects populations worldwide. Although everyone is susceptible to the virus, there are numerous accounts of the pandemic having a greater impact on lower socioeconomic groups and minorities, which is a ubiquitous phenomenon. It is essential for public health administrations and governments to uncover and understanding these inequities to develop proper intersectoral policies to tackle this crisis. Therefore, developing a conceptual framework on this topic, describing the social mechanisms that explain the unjust distribution of the incidence and mortality of COVID-19, is a key task. The aim of this paper is to adapt the framework on social determinants of health from the World Health Organization to the specifics of COVID-19 pandemic. Thus, it identifies and explains the structural and intermediate determinants involved in this pandemic, and adds some new elements (such as the role of the oppression systems and communication) which may help to understand, and ultimately tackle, social inequities in COVID-19 distribution.

Salud comunitaria confinada: reflexiones y experiencias desde la salud pública local / Confined community health: reflections and experiences from the local public health

Este artículo pretende compartir las reflexiones sobre la acción comunitaria en que la Agència de Salut Pública de Barcelona ha estado involucrada en la emergencia de COVID-19. El trabajo realizado puede ordenarse en tres etapas, frecuentemente solapadas: detectar necesidades o problemas, e informar; contactar con las personas participantes y agentes territoriales para valorar qué hacer y cómo hacerlo; y adaptar las intervenciones a la "nueva normalidad" y generar respuestas con los activos comunitarios a las necesidades detectadas. Los problemas emergentes incluyeron: no poder realizar el confinamiento (por falta de casa, condiciones materiales, vivir en situación de violencia); brecha digital (falta de conocimientos, dispositivos, acceso a Wifi); mayor exposición al COVID-19 en los trabajos esenciales pero precarizados, feminizados y racializados (cuidados, limpieza, alimentación), frecuentes en los barrios en que trabajamos; barreras idiomáticas y culturales para seguir las recomendaciones; pérdida de empleo; ingresos insuficientes para cubrir necesidades básicas; dificultades de conciliación; aislamiento social; y deterioro de la salud emocional provocado por la situación. Durante el proceso, algunas intervenciones se adaptaron para continuar de forma telemática, y se intentaron cubrir las necesidades primarias sobre conocimientos y dispositivos de algunas personas participantes a través de las redes solidarias y recursos existentes. La acción comunitaria en salud, desde una mirada crítica, interseccional y local, mediante trabajo intersectorial y la participación de la comunidad, puede contribuir a: facilitar una respuesta adaptada al contexto en caso de crisis sanitaria y mitigar los efectos derivados de esta crisis económica y social

This paper aims to share the reflections related to the community actions in which the Agència de Salut Pública de Barcelona has been involved during the emergency of COVID-19. The tasks carried out can be arranged in three stages, frequently overlapping: detection of needs and problems; contact with key stakeholders to assess what to do and how to do it; adaptation of the interventions to the "new normal" and generation of new responses. The emerging problems included: not being able to do the confinement (due to homelessness, material conditions, living in a situation of violence); digital gap (lack of knowledge, devices, access to Wifi); greater exposure to COVID-19 in the essential but precarious, feminized and racialized jobs (care, cleaning, food shops) that are the most frequent in the neighborhoods in where we work; language and cultural barriers that preclude to follow recommendations; to lose employment; insufficient income to cover basic needs; social isolation; and the deterioration of emotional health caused by the situation. During the process, some interventions were adapted to be delivered on-line. Solidarity networks and local resources were key to meet basic needs, but also other needs related to lack of digital knowledge or device. Community action in health, from a critical, intersectional and local perspective, and with intersectoral work and community participation, can contribute to: facilitate a contextualized response in the event of a health crisis; mitigate the effects derived from its economic and social crisis

Towards a policy relevant neighborhoods and health agenda: engaging citizens, researchers, policy makers and public health professionals. SESPAS Report 2018 / Por una estrategia de barrios saludables políticamente relevante: colaboración entre ciudadanía, personas investigadoras, decisoras políticas y profesionales de la salud pública. Informe SESPAS 2018

A large volume of public health literature has shown how the social and physical features of a neighbourhood affect residents’ health, and how they contribute to health inequalities. In this article, we argue that citizens, researchers, policy makers and health professionals should engage in creating a common, policy-relevant neighbourhood and health agenda to effectively improve population health and reduce health inequalities. We discuss four critical processes for advancing this neighbourhood and health agenda: 1) citizen participation and community empowerment; 2) policy making; 3) producing relevant research; and 4) how to best communicate between stakeholders. Various methodologies and experiences currently exist to secure and promote citizen participation. Sufficient funding of research projects and specific policies, as well as continued communication strategies among stakeholders, are necessary elements of this neighbourhood and health agenda. Establishing collaborative and sustained relationships between citizens, policy makers, health professionals and researchers at local and higher political levels is a challenging but necessary step. Developing participatory action research and local participatory policy efforts are important steps towards developing a policy- relevant neighbourhood and health agenda

Numerosos ejemplos de la literatura en salud pública han puesto de manifiesto el impacto de las características sociales y físicas del barrio sobre el estado de salud de las personas residentes, así como su influencia sobre las desigualdades en salud. En este artículo de posicionamiento sostenemos que ciudadanía, personas investigadoras, decisoras políticas y profesionales de la salud deberían involucrarse en construir una estrategia común en barrios y salud, que promueva mejorar la salud de la población y que disminuya de manera efectiva las desigualdades en salud. Para ello identificamos y discutimos cuatro procesos críticos necesarios para avanzar en esta agenda de barrios y salud: 1) la participación y el fortalecimiento de la comunidad; 2) la elaboración de políticas locales; 3) la realización de investigaciones relevantes; y 4) la comunicación entre estos agentes. Existen diferentes metodologías y experiencias que fomentan y promueven la participación y el fortalecimiento de la ciudadanía. A su vez, se requiere una financiación suficiente de proyectos de investigación, políticas específicas y la puesta en marcha de estrategias continuas de comunicación. Establecer relaciones colaborativas a largo plazo, tanto de ámbito local como a niveles superiores, entre ciudadanía, decisores/as políticos/as, expertos/as e investigadores/as es un paso difícil, pero necesario. Desarrollar proyectos de investigación-acción-participación y políticas locales participativas es un paso fundamental para desarrollar una estrategia de barrios saludables políticamente relevante

Towards a policy relevant neighborhoods and health agenda: engaging citizens, researchers, policy makers and public health professionals. SESPAS Report 2018.

A large volume of public health literature has shown how the social and physical features of a neighbourhood affect residents' health, and how they contribute to health inequalities. In this article, we argue that citizens, researchers, policy makers and health professionals should engage in creating a common, policy-relevant neighbourhood and health agenda to effectively improve population health and reduce health inequalities. We discuss four critical processes for advancing this neighbourhood and health agenda: 1) citizen participation and community empowerment; 2) policy making; 3) producing relevant research; and 4) how to best communicate between stakeholders. Various methodologies and experiences currently exist to secure and promote citizen participation. Sufficient funding of research projects and specific policies, as well as continued communication strategies among stakeholders, are necessary elements of this neighbourhood and health agenda. Establishing collaborative and sustained relationships between citizens, policy makers, health professionals and researchers at local and higher political levels is a challenging but necessary step. Developing participatory action research and local participatory policy efforts are important steps towards developing a policy- relevant neighbourhood and health agenda.

The Experience of Implementing Urban HEART Barcelona: a Tool for Action.

Urban Health Equity Assessment and Response Tool (HEART) is a tool developed by the World Health Organization whose objective is to provide evidence on urban health inequalities so as to help to decide the best interventions aimed to promote urban health equity. The aim of this paper is to describe the experience of implementing Urban HEART in Barcelona city, both the adaptation of Urban HEART to the city of Barcelona, its use as a means of identifying and monitoring health inequalities among city neighbourhoods, and the difficulties and barriers encountered throughout the process. Although ASPB public health technicians participated in the Urban HEART Advisory Group, had large experience in health inequalities analysis and research and showed interest in implementing the tool, it was not until 2015, when the city council was governed by a new left-wing party for which reducing health inequalities was a priority that Urban HEART could be used. A provisional matrix was developed, including both health and health determinant indicators, which allowed to show how some neighbourhoods in the city systematically fare worse for most of the indicators while others systematically fare better. It also allowed to identify 18 neighbourhoods-those which fared worse in most indicators-which were considered a priority for intervention, which entered the Health in the Barcelona Neighbourhoods programme and the Neighbourhoods Plan. This provisional version was reviewed and improved by the Urban HEART Barcelona Working Group. Technicians with experience in public health and/or in indicator and database management were asked to indicate suitability and relevance from a list of potential indicators. The definitive Urban HEART Barcelona version included 15 indicators from the five Urban HEART domains and improved the previous version in several requirements. Several barriers were encountered, such as having to estimate indicators in scarcely populated areas or finding adequate indicators for the physical context domain. In conclusion, the Urban HEART tool allowed to identify urban inequalities in the city of Barcelona and to include health inequalities in the public debate. It also allowed to reinforce the community health programme Health in the Barcelona Neighbourhoods as well as other city programmes aimed at reducing health inequalities. A strong political will is essential to place health inequalities in the political agenda and implement policies to tackle them.

Evaluación de un programa comunitario para reducir el aislamiento de personas mayores debido a barreras arquitectónicas / Evaluation of a community program to reduce isolation in older people due to architectural barriers

Objetivo. Se llevó a cabo una intervención comunitaria para reducir el aislamiento de las personas mayores debido a barreras arquitectónicas. Este estudio evalúa sus efectos. Métodos. Estudio cuasiexperimental antes-después. Se localizaron en la comunidad personas mayores aisladas en tres zonas desfavorecidas en 2009-11. Salieron quincenalmente con voluntariado y una silla-oruga motorizada. Se estudió la satisfacción y se comparó, con pruebas de McNemar, su estado de salud percibido, su calidad de vida y su salud mental antes y después de cuatro salidas. Resultados. Participaron 74 personas (edad mediana: 83 años; rango intercuartílico: 78-89). La salud percibida mejoró un 21%, la mental un 24% y el malestar psicológico se redujo un 16%. El 98% estaban satisfechas. Conclusiones. La intervención mejoró la salud percibida y la salud mental de las personas participantes. Debería evitarse que estas personas residan en edificios con barreras arquitectónicas, y si no es posible, implementar programas similares a éste (AU)

Objective. Social isolation impairs health. An intervention to reduce isolation due to architectural barriers in elderly persons was carried out in Barcelona (Spain). This study aimed to evaluate its effects on health. Methods. We conducted a quasi-experimental before-after study. Isolated older people were identified in three deprived urban areas from 2009 to 2011. Participants had twice-weekly outings with volunteers in a stair-climbing power wheelchair. User satisfaction was evaluated and perceived health status, quality of life, and mental health before and after four outings were compared with McNemar tests. Results. There were 74 participants (median age: 83 years; IQR: 78-89). Perceived health improved by 21%, mental health by 24%, and psychological distress was reduced by 16%. Most participants (98%) were satisfied. Conclusion. The intervention improved perceived health and mental health. Elderly people with impaired mobility should not live in buildings with architectural barriers and, if this cannot be avoided, similar programs should be implemented (AU)

[Evaluation of a community program to reduce isolation in older people due to architectural barriers]. / Evaluación de un programa comunitario para reducir el aislamiento de personas mayores debido a barreras arquitectónicas.

OBJECTIVE: Social isolation impairs health. An intervention to reduce isolation due to architectural barriers in elderly persons was carried out in Barcelona (Spain). This study aimed to evaluate its effects on health. METHODS: We conducted a quasi-experimental before-after study. Isolated older people were identified in three deprived urban areas from 2009 to 2011. Participants had twice-weekly outings with volunteers in a stair-climbing power wheelchair. User satisfaction was evaluated and perceived health status, quality of life, and mental health before and after four outings were compared with McNemar tests. RESULTS: There were 74 participants (median age: 83 years; IQR: 78-89). Perceived health improved by 21%, mental health by 24%, and psychological distress was reduced by 16%. Most participants (98%) were satisfied. CONCLUSION: The intervention improved perceived health and mental health. Elderly people with impaired mobility should not live in buildings with architectural barriers and, if this cannot be avoided, similar programs should be implemented.

Prevención del deterioro cognitivo: características de los talleres de memoria en Barcelona / Cognitive impairment prevention: characteristics of memory workshops in Barcelona

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Low back pain in adolescents: is quality of life poorer in those seeking medical attention?

STUDY DESIGN: Paired case-control study. OBJECTIVE: To assess health-related quality of life (HRQOL) and disability in adolescents with low back pain (LBP) referred to a hospital and compare it with adolescents with and without LBP from the general population. SUMMARY OF BACKGROUND DATA: Recent studies show that the effect of LBP on HRQOL of adolescents from the general population is insignificant. Poorer HRQOL is attributed to those soliciting specialized medical attention. No study has evaluated HRQOL in adolescents with LBP who seek specialized attention. METHODS: All consecutive adolescents with nonspecific LBP referred to a hospital outpatient clinic (cases-patients) between January 2006 and October 2007 were compared to two control groups: adolescents with LBP and adolescents without LBP from a representative sample of students. Two controls from each group were randomly paired with each case by city of residence, sex, and age. Cases and controls completed the same self-administered questionnaires, including a generic quality-of-life (KIDSCREEN-52) and two LBP-specific (Roland-Morris Disability Questionnaire, Hannover Functional Ability Questionnaire) instruments. A group of teenagers with juvenile idiopathic arthritis completing the same questionnaire was used as external reference. The sample was calculated to detect a difference of more than 4.68 units in KIDSCREEN scores. Comparisons were made using t tests and effect size estimation. RESULTS: Patients (n = 76) had more frequent (P = 0.005) and intense (P < 0.001) LBP than adolescents with LBP in the general population (n = 152) and a poorer score on the Roland-Morris (5.5 vs. 4.3, P = .023) and Hanover (4.5 vs. 3.5, P = 0.032) questionnaires. Nonetheless, in all KIDSCREEN dimensions, patient scores and scores of adolescents with juvenile idiopathic arthritis were similar or better than those of the general adolescent population with or without LBP (n = 152). CONCLUSION: Adolescents with LBP seeking specialized medical attention have better HRQOL than symptomatic peers from the general population but report worse clinical and functional status.

Prevalence of low back pain and its effect on health-related quality of life in adolescents.

OBJECTIVES: To assess the prevalence of low back pain (LBP) in adolescents and the clinical features of LBP in 2 European countries and to evaluate the effect of LBP on health-related quality of life (HRQOL) using standardized validated generic and disease-specific instruments. DESIGN: Cross-sectional study. SETTING: Secondary schools of Barcelona, Spain, and Fribourg, Switzerland. PARTICIPANTS: Representative sample of adolescents from the 2 cities. Intervention Selected adolescents completed a questionnaire including a generic HRQOL (KIDSCREEN-52) and 2 LBP-specific instruments. MAIN OUTCOME MEASURES: Results of KIDSCREEN-52, the Roland-Morris Disability Questionnaire, and the Hanover Functional Ability Questionnaire. RESULTS: A total of 1470 adolescents (52.6% male) with a mean (SD) age of 15.05 (1.17) years completed the questionnaires (response rate, 85.1%). Low back pain was reported by 587 adolescents (39.8%): isolated LBP in 250 (42.6%), LBP plus other pain in 271(46.2%), LBP plus whole-body pain in 50 (8.5%, and unclassifiable LBP in 16 (2.7%). Five hundred adolescents (34.7%) reported no pain, and 369 (25.6%) reported other pain without LBP. In those with isolated LBP, the percentage of adolescent boys was higher (54.6%; P < .001) and the LBP was mildest. In those with LBP plus whole-body pain, the percentage of adolescent girls was higher (62%; P < .001) and LBP was most severe. All KIDSCREEN scores in the group with LBP plus whole-body pain were significantly lower than in the other groups (effect size, 0.52-1.24). No differences were found between the groups who reported isolated pain, no pain, or other pain with no LBP. On the LBP-specific instruments, adolescents who reported LBP plus other pain had significantly poorer scores (P < .001) compared with those with isolated LBP but better scores (P < .001) than those with LBP plus whole-body pain. CONCLUSIONS: Low back pain in adolescents is a prevalent symptom with overall low associated disability and little effect on health-related quality of life. A subset of adolescents in whom LBP is associated with whole-body pain report significant impairment and deserve more attention.