Short-term health effects of an urban regeneration programme in deprived neighbourhoods of Barcelona.

Urban regeneration programmes are interventions meant to enhance the wellbeing of residents in deprived areas, although empirical evidence reports mixed results. We evaluated the health impact of a participatory and neighbourhood-wide urban regeneration programme, Pla de Barris 2016-2020, in Barcelona. A pre-post with a comparison group study design. Using data from a cross-sectional survey performed in 2016 and 2021. The health outcomes analysed were mental health, alcohol and psychotropic drug use, perceived health status, physical activity and obesity. Depending on the investment, two intervention groups were defined: moderate- and high-intensity intervention groups. The analysis combined difference-in-difference estimation with an inverse weighting derived from a propensity score to reduce potential biases. The impact of the intervention in percentages and its confidence interval were estimated with a linear probability model with clustered adjusted errors. The intervention had a positive impact on health outcomes in women in the high-intensity intervention group: a reduction of 15.5% in the relative frequency of those experiencing poor mental health, and of 21.7% in the relative frequency of those with poor self-perceived health; and an increase of 13.7% in the relative frequency of those doing physical activity. No positive impact was observed for men, but an increase of 10.3% in the relative frequency of those using psychotropic drugs in the high-intensity intervention group. This study shows positive short-term effects of the urban regeneration programme Pla de Barris 2016-2020 on health outcomes in women in the high-intensity intervention group. These results can guide future interventions in other areas.

Cities and mental health: The role of the built environment, and environmental and lifestyle factors in Barcelona.

Built environment characteristics and related environmental exposures and behaviors have been, separately, implicated in the development of poor mental health. However, it is unclear how these factors act together in relation to mental health. We studied these factors simultaneously to evaluate the impact of the built environment, and the mediating role of environmental exposures and physical activity, on mental health, while also studying moderation by sex, age, and length of residence. We used a cross-sectional population-based sample of 3145 individuals aged 15-97 years from Barcelona, Spain. Time spent walking and mental health status were assessed with validated questionnaires, administered through a face-to-face interview. We characterized the built environment (e.g., building, population and intersection density and green space), road traffic noise, and ambient air pollution at the residential level using land cover maps, remote sensing, noise maps and land use regression models. Adjusted regression models accounting for spatial clustering were analyzed to study associations between built environment attributes and mental health, and mediation and moderation effects. Density attributes were directly or indirectly, through air pollution and less consistently through walking, associated with poor mental health. Green space indicators were associated with lower prevalence of poor mental health, partly through lower air pollution exposure and more walking. In some cases, these associations differed by sex, age or length of residence. Non-linear associations of density indicators with environmental exposures, and of particulate matter with poor mental health indicated threshold effects. We conclude that living in dense areas with high air pollution concentrations was associated with poor mental health. On the other hand, green areas with lower air pollution concentrations were protective against poor mental health. Greater urban density might benefit health, but might only do so when air pollution concentrations are low.

Decision-support tools to build climate resilience against emerging infectious diseases in Europe and beyond.

Climate change is one of several drivers of recurrent outbreaks and geographical range expansion of infectious diseases in Europe. We propose a framework for the co-production of policy-relevant indicators and decision-support tools that track past, present, and future climate-induced disease risks across hazard, exposure, and vulnerability domains at the animal, human, and environmental interface. This entails the co-development of early warning and response systems and tools to assess the costs and benefits of climate change adaptation and mitigation measures across sectors, to increase health system resilience at regional and local levels and reveal novel policy entry points and opportunities. Our approach involves multi-level engagement, innovative methodologies, and novel data streams. We take advantage of intelligence generated locally and empirically to quantify effects in areas experiencing rapid urban transformation and heterogeneous climate-induced disease threats. Our goal is to reduce the knowledge-to-action gap by developing an integrated One Health-Climate Risk framework.

Socioeconomic inequalities in COVID-19 incidence during the first six waves in Barcelona.

BACKGROUND: The emergence of SARS-CoV-2 affected urban areas. In Barcelona, six waves of COVID-19 hit the city between March 2020 and March 2022. Inequalities in the incidence of COVID-19 have been described. However, no studies have examined the daily trends of socioeconomic inequalities and how they changed during the different phases of the pandemic. The aim of this study is to analyse the dynamic socioeconomic inequalities in the incidence of COVID-19 during the six waves in Barcelona. METHODS: We examined the proportion of daily cases observed in the census tracts in the lower income tercile compared with the proportion of daily cases observed in the sum of the lower and higher income terciles. Daily differences in these proportions were assessed as a function of the epidemic waves, sex, age group, daily incidence and daily change in the incidence. A logistic regression model with an autoregressive term was used for statistical analysis. RESULTS: A time-dynamic effect was found for socioeconomic inequalities in the incidence of COVID-19. In fact, belonging to a lower-income area changed from being a risk factor (Waves 1, 2, 4 and 5) to being a protective factor in the sixth wave of the pandemic. Age also had a significant effect on incidence, which also changed over the different waves of the pandemic. Finally, the lower-income areas showed a comparatively lower incidence during the ascending phase of the epidemic waves. CONCLUSION: Socioeconomic inequalities in COVID-19 changed by wave, age group and wave phase.

[The need for university links for public health professionals]. / La necesaria vinculación universitaria de los profesionales de salud pública.

There needs to be a bidirectional relationship between the public health profession and academia. This will enhance their professional practice and the academy will be able to carry out practice-based teaching and research. This field note explains a legislative advance in this direction. So that professionals from public health institutions can access permanent positions as university professors, as well as the professionals in the clinical field, we ask several deputies from some parliamentary groups of the Universities Commission to include a reform that modifies article 70 of the project of Organic Law of the University System (LOSU in Spanish acronym) with this possibility. Ultimately, LOSU was approved in March 2023 with the requested amendment, providing a great opportunity for both public health institutions and academia to advance a bidirectional relationship.

Trends and determinants of social inequities in cardiovascular risk factors in Spain: a mixed-methods study.

This sequential mixed-methods study aims to: 1) assess spatial and temporal trends in cardiovascular risk factors by socioeconomic position from 2001 to 2020 in Spain; 2) explore public health professionals' perspectives regarding interventions that might have impacted these inequities; and 3) analyze determinants on social inequities in cardiovascular risk factors. First, we will measure the change in absolute and relative social inequities in eight cardiovascular risk factors through time trend analysis using repeated cross-sectional data from both National and European Health Surveys for Spain from 2001 to 2020. Second, we will interview key informants -both at the regional and national level-, to contextualize data obtained in phase 1 and capture the content and variation of policies across regions. Third, we will use econometric methods to analyze how these identified interventions have impacted these social inequities within and across regions.

A City Surveillance System for Social Health Inequalities: The Case of Barcelona.

INTRODUCTION: In the past, health inequalities were not prioritised in the political agenda of Barcelona. The change of city government (2015) was an opportunity to develop a Surveillance System for Social Health Inequalities in the city, which is described in this article. METHODS: The design of the Surveillance System formed part of the Joint Action for Health Equity in Europe (JAHEE), funded by the European Union. Various steps were considered by the experts to set up the System: define its objectives, target population, domains and indicators, and sources of information; perform data analysis; implement and disseminate the system; define the evaluation; and perform regular data updates. RESULTS: The System considers the following domains: social determinants of health, health-related with behaviours, use of healthcare, and health outcomes, and includes eight indicators. As axes of inequality, the experts chose sex, age, social class, country of origin, and geographical area. The Surveillance System for Social Health Inequalities is presented on a website including different types of figures. CONCLUSION: The methodology used to implement the Surveillance System can be used to implement similar systems in other urban areas around the world.

Trends and determinants of social inequities in cardiovascular risk factors in Spain: a mixed-methods study / Tendencias y determinantes de las inequidades sociales en el riesgo cardiovascular en España: estudio de métodos mixtos

This sequential mixed-methods study aims to: 1) assess spatial and temporal trends in cardiovascular risk factors by socioeconomic position from 2001 to 2020 in Spain; 2) explore public health professionals’ perspectives regarding interventions that might have impacted these inequities; and 3) analyze determinants on social inequities in cardiovascular risk factors. First, we will measure the change in absolute and relative social inequities in eight cardiovascular risk factors through time trend analysis using repeated cross-sectional data from both National and European Health Surveys for Spain from 2001 to 2020. Second, we will interview key informants —both at the regional and national level—, to contextualize data obtained in phase 1 and capture the content and variation of policies across regions. Third, we will use econometric methods to analyze how these identified interventions have impacted these social inequities within and across regions. (AU)

Este estudio tiene por objetivos: 1) evaluar las tendencias espacio-temporales de los factores de riesgo cardiovascular en España, por posición socioeconómica, entre 2001 y 2020; 2) explorar las perspectivas de profesionales salubristas con respecto a las intervenciones que pueden influir en estas inequidades; 3) analizar los determinantes de las inequidades sociales en los factores de riesgo cardiovascular. Primero se medirá el cambio en las desigualdades, en términos absolutos y relativos, según ocho factores de riesgo mediante un análisis de tendencias temporales y datos de las encuestas nacionales y europeas de salud para España entre 2001 y 2020. Después se entrevistará a informantes clave, en los ámbitos de comunidad autónoma y nacional, para contextualizar los datos obtenidos en la primera fase y explorar la variabilidad entre comunidades autónomas. Por último, se analizará mediante métodos econométricos cómo influyen dichas intervenciones en las desigualdades sociales entre comunidades autónomas. (AU)

La necesaria vinculación universitaria de los profesionales de salud pública / The need for university links for public health professionals

Es necesario que exista una relación bidireccional entre la profesión de salud pública y el ámbito académico. Así, la salud pública mejorará su práctica profesional y la academia podrá realizar una docencia basada en la práctica. Esta nota de campo explica un avance legislativo en esta dirección. Con la finalidad de que las personas profesionales de instituciones sanitarias de salud pública puedan acceder a plazas permanentes de profesorado universitario, igual que acceden los profesionales del ámbito clínico, solicitamos a las personas diputadas de todos los grupos parlamentarios de la Comisión de Universidades incluir una enmienda modificando el artículo 70 del borrador de la Ley Orgánica del Sistema de Universidades (LOSU) con esta posibilidad. Finalmente, la LOSU se ha aprobado en marzo de 2023 con la modificación solicitada, lo que brinda una enorme oportunidad tanto a las instituciones de salud pública como al ámbito académico para avanzar en su relación bidireccional.(AU)

There needs to be a bidirectional relationship between the public health profession and academia. This will enhance their professional practice and the academy will be able to carry out practice-based teaching and research. This field note explains a legislative advance in this direction. So that professionals from public health institutions can access permanent positions as university professors, as well as the professionals in the clinical field, we ask several deputies from some parliamentary groups of the Universities Commission to include a reform that modifies article 70 of the project of Organic Law of the University System (LOSU in Spanish acronym) with this possibility. Ultimately, LOSU was approved in March 2023 with the requested amendment, providing a great opportunity for both public health institutions and academia to advance a bidirectional relationship.(AU)

Social inequalities in utilization of a feminist telehealth abortion service in Brazil: A multilevel analysis.

The disruption caused by the COVID-19 pandemic on health services around the world boosted interest over telehealth models of care. In Brazil, where abortion is heavily restricted, abortion seekers have long relied on international telehealth services to access abortion pills. We conducted a cross-sectional multilevel study to assess the effect of individual and contextual social factors on utilization of one such service. For the individual-level, we analyzed data from the records of abortion seekers contacting this feminist international telehealth organization during 2019 (n = 25,920). Individual-level variables were age, race, education level and pregnancy length. Contextual-level units were states, for which we used data from the national Demographic Census and Household Surveys. Contextual-level variables were household income per capita, adjusted net school attendance rate, percentage of racialized women and income Gini Index. We fitted five multilevel Poisson Mixed-effects models with robust variance to estimate prevalence ratios (PR) of service utilization, which was defined as receiving abortion pills through the service. We found that only 8.2% of requesters got abortion pills through the service. Utilization was higher among women who were older, white, more educated and 5-8-weeks pregnant. Independently of this, service utilization was higher in states with higher income and education access, with lower proportions of racialized women, and located in the South, Southeast and Central-West regions. We concluded that while feminist telehealth abortion initiatives provide a life-saving service for some abortion seekers, they are not fully equipped to overcome entrenched social inequalities in their utilization, both at individual and contextual levels.

Inequalities in life expectancy by educational level and its decomposition in Barcelona, 2004-2018 / Desigualdades en la esperanza de vida por nivel educativo y su descomposición en Barcelona, 2004-2018

Objective: To analyse the gap in life expectancy by educational level in the city of Barcelona from 2004 to 2018 and to decompose this gap by age and causes of death. Method: We computed abridged life tables at the age of 25 years by sex from 2004 to 2018 using standard methods. Educational level was categorised in two groups (lower secondary or less vs. upper secondary or higher education). The life expectancy gap was further decomposed by age and by causes of death based in Arriaga's method in 5-year age blocks up to the age of ≥ 90 years and broad causes of death using ICD-10 codes. Results: The life expectancy gap at 25 years by educational level oscillated without trend at around 3.08 years for men and 1.93 years for women. Decomposition by age showed a favourable significant shift in the contribution to this gap from young to older ages for men, with few changes for women. Decomposition by causes of death showed that the diseases concentrating the largest share of the contribution were neoplasms and respiratory and circulatory disease. There was a significant downward trend in external causes for men and in infectious diseases for both men and women but a significant upward trend for respiratory disease for both sexes. Conclusions: The stability of the life expectancy gap by educational level during the period analysed resulted from a combination of divergent trends by age and causes of death among high and low educational levels. (AU)

Objetivo: Analizar la brecha en la esperanza de vida por nivel educativo en la ciudad de Barcelona desde 2004 hasta 2018, y descomponer esta brecha por edad y causas de muerte. Método: Se calcularon tablas de vida abreviadas a la edad de 25 años por sexo desde 2004 hasta 2018 utilizando métodos estándar. El nivel educativo se clasificó en dos grupos: secundaria inferior o menor frente a secundaria superior o educación superior. La brecha de la esperanza de vida se descompuso además por edad y por causas de muerte según el método de Arriaga en bloques de edad de 5 años hasta la edad de ≥90 años y causas amplias de muerte utilizando los códigos de la CIE-10. Resultados: La brecha de la esperanza de vida a los 25 años por nivel educativo osciló sin tendencia en torno a los 3,08 años para los hombres y 1,93 años para las mujeres. La descomposición por edad mostró un cambio favorable a esta brecha desde las edades jóvenes a las mayores en los hombres, con pocos cambios en las mujeres. La descomposición por causas de muerte mostró una mayor contribución de las neoplasias y las enfermedades respiratorias y circulatorias. Hubo una tendencia a la baja en las causas externas en los hombres, y en las enfermedades infecciosas tanto en los hombres como en las mujeres, pero al alza en las enfermedades respiratorias para ambos sexos. Conclusiones: La estabilidad de la brecha de la esperanza de vida por nivel educativo durante el periodo analizado fue el resultado de una combinación de tendencias divergentes por edad y causas de muerte entre los niveles educativos altos y bajos. (AU)

Neighbourhood income inequalities in mental health in Barcelona 2001-2016: a Bayesian smoothed estimate / Desigualdades de renta por barrios en salud mental en Barcelona 2001-2016: una estimación de alisado bayesiano

Objective: Obtaining reliable health estimates at the small area level (such as neighbourhoods) using survey data usually poses the problem of small sample sizes. To overcome this limitation, we explored smoothing techniques in order to estimate poor mental health prevalence at the neighbourhood level and analyse its profile by income in Barcelona city (Spain). Method: A Bayesian smoothing model with a logit-normal transformation was applied to four repeated cross-sectional waves of the Barcelona health survey for 2001, 2006, 2011 and 2016. Mental health status was identified from the 12-item General Health Questionnaire. Income inequalities were analysed with neighbourhood income in quantiles for each year and trends in the pooled analysis. Results: The prevalence of poor mental health ranged from 14.6% in 2001 to 18.9% in 2016. The yearly difference between neighbourhoods was 12.4% in 2001, 16.7% in 2006, 14.2% in 2011, and 20.0% in 2016. The odds ratio and 95% credible interval (95%CI) of experiencing poor mental health was 1.40 times higher (95%CI: 1.02-1.91) in less advantaged neighbourhoods than in more advantaged neighbourhoods in 2001, 1.61 times higher (95%CI: 1.01-2.59) in 2006 and 2.31 times higher (95%CI: 1.57-3.40) in 2016. Conclusions: This study shows that the Bayesian smoothed techniques allows detection of inequalities in health in neighbourhoods and monitoring of interventions against them. In Barcelona, mental health problems are more prevalent in low-income neighbourhoods and raised in 2016. (AU)

Objetivo: Obtener estimadores de salud en áreas pequeñas (como los barrios) utilizando datos de encuestas supone hacer frente al problema de insuficiente tamaño muestral. Para superar esta limitación exploramos técnicas de alisado con el fin de estimar la prevalencia de mala salud mental a nivel de barrio y analizar su patrón por renta en la ciudad de Barcelona (España). Método: Se aplicó un modelo de alisado bayesiano con transformación logística-normal a cuatro muestras transversales repetidas de la Encuesta de Salud de Barcelona para los años 2001, 2006, 2011 y 2016. La salud mental fue identificada con el Cuestionario General de Salud de 12-items. Las desigualdades de ingreso se analizaron por cuantiles de la renta por barrio para cada año y las tendencias en el análisis conjunto. Resultados: La prevalencia de mala salud mental oscila entre el 14,6% en 2001 y el 18,9% en 2016. La diferencia entre barrios fue del 12,4% en 2001, del 16,7% en 2006, del 14,2% en 2011 y del 20,0% en 2016. La odds ratio y el intervalo creíble al 95% (IC95%) de experimentar mala salud mental fue 1,4 veces superior (IC95%: 1,02-1,91) en los barrios menos aventajados respecto de los más aventajados en 2001, de 1,61 (IC95%: 1,01-2,59) en 2006 y de 2,31 (IC95%: 1,57-3,40) en 2016. Conclusiones: Este estudio muestra que las técnicas de alisado bayesiano permiten la detección de desigualdades en salud a nivel de barrios para su monitorización e intervención con el fin de reducirlas. En Barcelona, los problemas de salud mental son más prevalentes en los barrios de menor renta y se incrementaron en 2016. (AU)

Climate Change and Health in Urban Areas with a Mediterranean Climate: A Conceptual Framework with a Social and Climate Justice Approach.

The consequences of climate change are becoming increasingly evident and highlight the important interdependence between the well-being of people and ecosystems. Although climate change is a global phenomenon, its causes and consequences vary dramatically across territories and population groups. Among settings particularly susceptible to health impacts from climate change are cities with a Mediterranean climate. Here, impacts will put additional pressure on already-stressed ecosystems and vulnerable economies and societies, increasing health inequalities. Therefore, this article presents and discusses a conceptual framework for understanding the complex relationship between climate change and health in the context of cities with Mediterranean climate from a social and climate justice approach. The different elements that integrate the conceptual framework are: (1) the determinants of climate change; (2) its environmental and social consequences; (3) its direct and indirect impacts on health; and (4) the role of mitigation and adaptation policies. The model places special emphasis on the associated social and health inequalities through (1) the recognition of the role of systems of privilege and oppression; (2) the distinction between structural and intermediate determinants of climate change at the root of health inequalities; (3) the role of individual and collective vulnerability in mediating the effects of climate change on health; and (4) the need to act from a climate justice perspective to reverse health inequities.

The evaluation of the 3-30-300 green space rule and mental health.

BACKGROUND AND AIMS: Urban green space has many health benefits, but it is still unclear how much actually is needed for better health. Recently a new 3-30-300 rule of thumb for urban forestry and urban greening has been proposed, but this rule has not been evaluated for benefits on health. The rule requires that every citizen should be able to see at least three trees from their home, have 30 percent tree canopy cover in their neighbourhood and not live more than 300 m away from the nearest park or green space. The aim of this study was to evaluate the relationship between the 3-30-300 green space rule and its components in relation to mental health. METHODS: We conducted a cross-sectional study based on a population-based sample of 3145 individuals aged 15-97 years from in Barcelona, Spain who participated in the Barcelona Health Survey (2016-2017). We created 3-30-300 green space indicators using questionnaire data, GIS, remote sensing and land cover maps. Mental health status was assessed with the 12-item General Health Questionnaire (GHQ-12) and also the use of tranquilizer/sedatives or antidepressants and psychiatrist or psychologist visits. Analyses were conducted using mixed effects logistic regression models with districts as the random effect, adjusted for relevant covariates. RESULTS: We found that people in Barcelona had relatively little exposure to green space, whether through window view, living in an area with sufficient greenness, or access to a major green space, and only 4.7% met a surrogate 3-30-300 green space rule. Residential surrounding greenness, but not tree window view or access to major green space, was significantly associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits. Meeting the full surrogate 3-30-300 green space rule was associated with better mental health, less medication use, and fewer psychologist or psychiatrist visits, but only for the latter combined the association was statistically significant (Odds ratio = 0.31, 95% CI: 0.11, 0.91). CONCLUSION: Few people achieved the 3-30-300 green space in Barcelona and we used a surrogate measure. We observed health benefits when the full surrogate rule was met.

Tackling health inequalities in a public health organization: the case of the Barcelona Public Health Agency.

BACKGROUND: Municipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions. METHODS: The ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) a Quick and Colorful voting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%). RESULTS: Semi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities. CONCLUSIONS: The participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health.

Socioeconomic inequalities in self-assessed health and mental health in Barcelona, 2001-2016 / Desigualdades socioeconómicas en salud percibida y salud mental en Barcelona, 2001-2016

Objective: Previous research has found persistent socioeconomic inequalities in health outcomes at the national level, with different patterns after the economic crisis. However, inequalities in urban areas are also important. This study analyses socioeconomic inequalities in self-assessed health and mental health in the city of Barcelona. Method: Repeated cross-sectional design using quinquennial data from the Barcelona Health Surveys carried out in 2001, 2006, 2011 and 2016 for the population older than 22 years. Robust Poisson regressions models were used to compute socioeconomic gradients and relative (RII) and slope indexes of inequality (SII) by occupational social class, with stratification by sex. RII and SII were also obtained with further adjustment by employment situation. Results: A consistent socioeconomic gradient was found for all years except for 2011. Relative and absolute inequalities followed a V-shape, showing a drop during the economic crisis but widening thereafter to recover pre-crisis figures for self-assessed health and widening for mental health, in both relative and absolute terms in 2016. Adjustment for employment situation reduces inequalities but a large part of these inequalities remains, with variability across years. Conclusions: The lasting effects of the 2008 economic crisis and the austerity programmes imposed since then may have contributed to the persistence of socioeconomic inequalities in self-assessed health and the widening of those for mental health. (AU)

Objetivo: La investigación previa ha reportado desigualdades socioeconómicas persistentes en salud en el territorio nacional, con diferentes patrones después de la crisis económica. Sin embargo, las desigualdades en las áreas urbanas son también importantes. Este estudio analiza las desigualdades en salud autopercibida y salud mental en la ciudad de Barcelona. Método: Diseño de corte transversal con datos quinquenales de la Encuesta de Salud de Barcelona llevada a cabo en 2001, 2006, 2011 y 2016 para la población mayor de 22 años. Se utilizan modelos de regresión robusta de Poisson para calcular el gradiente social y los riesgos relativo (RII) y absoluto de desigualdad (SII) por clase social ocupacional, estratificando por sexo. El RII y el SII se obtienen también ajustando adicionalmente por situación laboral. Resultados: Se encuentra un gradiente social para todos los años excepto para 2011. Se observan desigualdades relativas y absolutas en forma de V para la salud autopercibida, con una reducción durante la crisis económica, pero recuperándose a partir de esta para volver a los valores anteriores a la crisis para salud autopercibida y ampliándose para la salud mental, tanto en términos relativos como absolutos, en 2016. Ajustar por la situación laboral reduce las desigualdades, pero una gran parte de estas desigualdades permanece, con variabilidad, en los años. Conclusiones: Los efectos duraderos de la crisis económica de 2008 y los programas de austeridad impuestos desde entonces pueden haber contribuido a la persistencia de las desigualdades socioeconómicas en salud autopercibida y a su ampliación en la salud mental. (AU)

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)