Time poverty, health and health-related behaviours in a Southern European city: a gender issue.

BACKGROUND: Despite its growing interest, time poverty is a neglected issue in public health analysis and policies. The objectives of this study were: (1) to analyse gender differences in paid, unpaid and total working time; (2) to identify gender differences in the factors related to time poverty; and (3) to examine gender differences in the relationship between time poverty, health and health-related behaviours in the city of Barcelona (Spain). METHODS: Cross-sectional study based on salaried workers aged 16-64 years interviewed in the 2021 Barcelona Health Survey (695 men and 713 women). Time poverty was defined as the top tercile of the total paid and unpaid work. Dependent variables were self-perceived health status, mental health, sleep time, sleep quality and leisure time physical activity. RESULTS: Women were more likely to be time poor. In both sexes, time poverty was related to the number of children. Whereas among men time poverty was not associated with any health indicators, among women it was related to poor mental health status (aOR=2.11, 95% CI 1.39 to 3.20), short sleep (aOR=1.54, 95% CI 1.05 to 2.25), poor sleep quality (aOR=1.83, 95% CI 1.25 to 2.68) and low leisure time physical activity (aOR=1.50, 95% CI 1.00 to 2.26). CONCLUSIONS: This study suggests that time use can be an important social determinant of health and of gender inequalities in health. At the local level, in many European cities, time poverty could be reduced, among other interventions, by increasing affordable and good quality public services for the care of dependent persons.

Financial Strain and Health Status Among European Workers: Gender and Welfare State Inequalities.

Objectives: Although in-work poverty has been increasing, in Europe policy about poverty and social exclusion tends to focus on labor market participation, independently of the level of remuneration and the quality of work, and studies about financial strain among workers, as well as on its relationship with health status, are still scarce. The objectives of this study were: (1) to compare the prevalence of financial strain among workers among different welfare state typologies, and (2) to examine whether the relationship between financial strain and health status differs by welfare state regime. For both objectives we examined whether there were gender differences. Methods: We conducted a cross-sectional study using data from the 6th European Working Conditions Survey of 2015 and selected a subsample of all employees from the EU28 aged 16-64 years (13,156 men and 13,225 women). Results: There were large differences in the prevalence of financial strain between welfare state typologies, which were not explained by individual factors. Additionally, differences across welfare regimes were greater among women. Nordic countries had the lowest prevalence (12.1% among men and 12.3% among women) whereas Southern European countries had the highest (49.5% among men and 47.9% among women). In both sexes and in all welfare state typologies, financial strain was associated with poor self-perceived health status and poor psychological well-being. Whereas, Southern European countries had the highest prevalence of financial strain, the magnitude of the association with health status was smaller than in other country typologies. Conclusion: In Europe, policies are needed to address the specific structural factors leading to financial strain as well as its relationship with health status among workers.

Necesidades y dificultades de los/las profesionales sanitarios/as de los servicios de prevención de riesgos laborales de Cataluña / Needs and barriers of medical personnel in Catalonian occupational health services

Objetivo: conocer las dificultades y necesidades del personal de medicina de los servicios de prevención de riesgos laborales de Cataluña para desarrollar sus funciones sanitarias descritas por la ley. Métodos: estudio Delphi en tres rondas. La selección de participantes se realizó diferenciadamente para servicios de prevención propios y ajenos. La primera ronda incluyó dos preguntas abiertas: ¿Qué dificultades tiene para realizar las funciones sanitarias de su SPRL? y ¿Qué necesidades tiene para realizar las funciones sanitarias de su SPRL? En la segunda y tercera ronda las personas participantes puntuaron las categorías identificadas en la primera ronda según su importancia y relevancia. Se calcularon un índice de acuerdo interjueces (ICC) y un “índice de preocupación (IP)”. Resultados: la gestión de las personas trabajadoras con limitaciones y la vigilancia colectiva de la salud de baja calidad son las dificultades más importantes para los Servicios de Prevención Propios. Para los Ajenos, la falta de comunicación con otros organismos, la preeminencia de los criterios económicos y de rentabilidad asociado al alto volumen de trabajo son las más relevantes. La necesidad de establecer canales de comunicación con otras instituciones u organismos como la Atención Primaria, las Mutuas, el Instituto de Evaluaciones Médicas y las Unidades de Salud Laboral es común a ambos grupos. Conclusiones: la diferente naturaleza de las actividades preventivas que realizan los servicios de prevención determina diferencias importantes en las dificultades expresadas, no así en las necesidades identificadas donde se encuentran puntos en común (AU)

Objective: to identify the difficulties and needs of medical professionals in occupational health services in Catalonia with respect to carrying out their functions, as prescribed by law. Methods: Delphi study in three rounds. The selection of participants was carried out separately for in-house versus outsourced occupational health services. The first round included two open-ended questions: What difficulties do you encounter when performing your duties in your occupational health service? And, what are your needs in terms of being able to perform your duties in your occupational health service? In the second and third rounds, participants ranked the categories identified in the first round according to their importance and relevance. We calculated an inter-rater agreement index (ICC) and an "index of concern (IP)". Results: Among in-house occupational health services, the most highly ranked difficulties were case management of workers with limitations and the low quality of medical surveillance systems. Among outsourced occupational health services, the most notable difficulties were the lack of communication with other organizations and the prioritization of economic and profitability criteria associated with the high work volume. For both types of services, there was a clear need to establish communication channels with other institutions or organizations such as primary care, mutual insurance companies, public medical evaluation units and public occupational health units. Conclusions: The different type of occupational health services reflects important differences in the types of difficulties encountered, but not in needs, where there are more points in common (AU)

[Needs and barriers of medical personnel in Catalonian occupational health services]. / Necesidades y dificultades de los/las profesionales sanitarios/as de los servicios de prevención de riesgos laborales de Cataluña.

OBJECTIVE: to identify the difficulties and needs of medical professionals in occupational health services in Catalonia with respect to carrying out their functions, as prescribed by law. METHODS: Delphi study in three rounds. The selection of participants was carried out sepa - rately for in-house versus outsourced occupational health services. The first round included two open-ended questions: What difficulties do you encounter when performing your duties in your occupational health service? And, what are your needs in terms of being able to per - form your duties in your occupational health service? In the second and third rounds, partic - ipants ranked the categories identified in the first round according to their importance and relevance. We calculated an inter-rater agreement index (ICC) and an "index of concern (IP)". RESULTS: Among in-house occupational health services, the most highly ranked difficulties were case management of workers with limitations and the low quality of medical sur - veillance systems. Among outsourced occupational health services, the most notable dif - ficulties were the lack of communication with other organizations and the prioritization of economic and profitability criteria associated with the high work volume. For both types of services, there was a clear need to establish communication channels with other institu - tions or organizations such as primary care, mutual insurance companies, public medical evaluation units and public occupational health units. CONCLUSIONS: The different type of occupational health services reflects important differ - ences in the types of difficulties encountered, but not in needs, where there are more points in common.

OBJETIVO: conocer las dificultades y necesidades del personal de medicina de los servicios de prevención de riesgos laborales de Cataluña para desarrollar sus funciones sanitarias descritas por la ley. MÉTODOS: estudio Delphi en tres rondas. La selección de participantes se realizó diferenciadamente para servicios de prevención propios y ajenos. La primera ronda incluyó dos preguntas abiertas: ¿Qué dificultades tiene para realizar las funciones sanitarias de su SPRL? y ¿Qué necesidades tiene para realizar las funciones sanitarias de su SPRL? En la segunda y tercera ronda las personas participantes puntuaron las categorías identificadas en la primera ronda según su importancia y relevancia. Se calcularon un índice de acuerdo interjueces (ICC) y un "índice de preocupación (IP)".  RESULTADOS: la gestión de las personas trabajadoras con limitaciones y la vigilancia colectiva de la salud de baja calidad son las dificultades más importantes para los Servicios de Prevención Propios. Para los Ajenos, la falta de comunicación con otros organismos, la preeminencia de los criterios económicos y de rentabilidad asociado al alto volumen de trabajo son las más relevantes. La necesidad de establecer canales de comunicación con otras instituciones u organismos como la Atención Primaria, las Mutuas, el Instituto de Evaluaciones Médicas y las Unidades de Salud Laboral es común a ambos grupos. CONCLUSIONES: la diferente naturaleza de las actividades preventivas que realizan los servicios de prevención determina diferencias importantes en las dificultades expresadas, no así en las necesidades identificadas donde se encuentran puntos en común.

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

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

The impact of Active Labour Market Policies on health outcomes: a Scoping review.

BACKGROUND: Since the last Western great recession of 2008, an increasing interest on the effects of Active Labour Market Policies (ALMPs) on improving health has emerged. The aim of our review is to synthesize evidence on the effectiveness of ALMPs and whether some types of ALMP are more effective. METHODS: Using the Scoping review methodology, we conducted a literature review in PubMed/MEDLINE, Scopus and Web of Science and selected articles published between 1990 and 2017 in high income countries. We applied four sequential phases of document screening to the list of retrieved articles. RESULTS: Of the 416 documents detected in the search, 36 documents were finally selected. Most of them focused on mental health and related components (72.2%) and found positive results at least in one outcome (80.6%). The ALMPs reported mainly attempt to build capacity through job search assistance (31.6%) with a component on mental health, showing positive results on health; some offer job training (16.7%) and few subsidized employment (8.3%), showing more controversial results, although mostly positive. The rest include a combination of different types of ALMPs. CONCLUSIONS: This review shows that ALMPs have a positive impact on health and quality of life. There are relatively few studies of the impact of ALMPs on general health, and most of the studies found are focused on Anglo-Saxon and Nordic countries. The most significant knowledge gaps are the mechanisms involved in achieving this improvement, and above all the differential health impacts according to axes of inequality and welfare state.

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

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

Is Being Employed Always Better for Mental Wellbeing Than Being Unemployed? Exploring the Role of Gender and Welfare State Regimes during the Economic Crisis.

The growth of poor jobs related to economic crisis adds to its increase since the mid-1970s as a result of new forms of flexible employment. In Europe, there is no clear evidence on whether working in a poor-quality job is better for mental wellbeing than being unemployed. The objectives of this study were to compare mental wellbeing between the unemployed and those working in jobs with different quality levels and to examine gender and welfare state differences in Europe. We selected 8324 men and 7496 women from the European Social Survey, 2010. Hierarchical multiple logistic regression models were fitted, separated by sex and country group. No significant differences in mental wellbeing were shown between unemployed-non-active, unemployed-active, and those working in low-quality jobs in either sex. Only men from Conservative countries in low-quality jobs had better mental wellbeing than unemployed (non-active) men. Only having a good-quality job reduced the likelihood of poor mental wellbeing compared with being unemployed (non-active) among men in all countries (except Social-Democratic) and among women in Eastern and Southern European countries. No differences were observed among men or women in Social-Democratic countries, while strong gender differences were found in Conservative and Liberal countries. Our study indicates the need to take job quality into account, in addition to creating jobs during economic crises. The main mechanisms to explain the strong gender and welfare state differences identified could be social protection for unemployed, labor market regulations, and family models.

Long Working Hours and Job Quality in Europe: Gender and Welfare State Differences.

Chronic extreme long working hours (LWH) have been found consistently associated with poor health status. However, the evidence for moderately LWH (41⁻60 h a week) is contradictory. Although poor job quality has been proposed as one of the mechanisms of this relationship, there are almost no studies about LWH and job quality. The objectives of this study were to analyze the association between moderately LWH and job quality in the EU27, as well as to examine differences by welfare regimes and gender. This is a cross-sectional study based on data from the 2010 European Working Conditions Survey. A subsample of employees from the EU27 aged 16⁻64 years who worked 30⁻60 h a week was selected (12,574 men and 8787 women). Overall, moderately LWH were not consistently associated with poor job quality except among women from Eastern European countries. Therefore, in the EU27 poor job quality does not seem to explain the relationship between moderately LWH and poor health status. The findings among women from Eastern European countries may be related to their weakened position in the labor market and to their work-family conflict resulting from a process of re-familisation that constrains their choices for a good job.

Social and material determinants of health in participants in an active labor market program in Barcelona.

BACKGROUND: Unemployment affects the physical and mental health of affected individuals, which can be explained by its direct effect on worsening finances due to the lack of income as well as by its negative psychosocial effects. "Employment in the Neighborhoods" return to work program was implemented in Barcelona specifically in the neighborhoods characterized with a greater economic deprivation and by high unemployment to improve personal and occupational abilities and skills of the participants to reintegrate them into the workforce. The aim of this study is to determine the association between the lack of economic resources and psychosocial factors with respect to mental health and self-rated health in unemployed persons participating in the program "Employment in the Neighborhoods". METHODS: Cross-sectional study. Data collected from a self-administered questionnaire. Generalized linear models were constructed, adjusted by age and social class, to estimate prevalence ratios and analyze any possible association between economic resources, psychosocial factors and poor self-rated health and mental health. RESULTS: Nine hundred forty-eight persons of 2763 participants in the "Employment in the Neighborhoods" program completed the questionnaire. 46.9% were women. 72.5% of women and 61.9% of men were at risk of poor mental health and 25.5% of women and 21.1% of men reported poor self-rated health. Low self-esteem [women: PR 1.88 95%CI (1.24-2.84); men: PR 2.51 95%CI (1.57-4.02)] and medium social support [2.01 (1.30-3.09)], in men, and low social support [1.74 (1.13-2.68)] in women are associated with worsening of self-rated health. In men, low self-esteem [1.40 (1.19-1.64)] and delay in paying bills [1.38 (1.17-1.64)] were associated with the risk of poor mental health; in women were associated low self-esteem [1.27 (1.11-1.44)] and received a non-contributory allowance [1.37 (1.09-1.74)]. CONCLUSIONS: Economic resources, self-esteem and social support are necessary for good general and mental health among unemployed persons. The high prevalence of poor mental health among persons participating in the active labor market program "Employment in the Neighborhoods" could be due to a substantial deficit in these factors.

Employment stability and mental health in Spain: towards understanding the influence of gender and partner/marital status.

BACKGROUND: The growing demand for labour flexibility has resulted in decreasing employment stability that could be associated with poor mental health status. Few studies have analysed the whole of the work force in considering this association since research on flexible forms of employment traditionally analyses employed and unemployed people separately. The gender division of work, and family characteristics related to employment situation, could modify its association with mental wellbeing. The objective of the study was to examine the relationship between a continuum of employment stability and mental health taking into account gender and partner/marital status. METHODS: We selected 6859 men and 5106 women currently salaried or unemployed from the 2006 Spanish National Health Survey. Employment stability was measured through a continuum from the highest stability among employed to lowest probability of finding a stable job among the long-term unemployed. Mental health was measured with the 12-item version of the General Health Questionnaire. Logistic regression models were fitted for each combination of partner/marital status and gender. RESULTS: In all groups except among married women employment stability was related to poor mental health and a gradient between a continuum of employment stability and mental health status was found. For example, compared with permanent civil servants, married men with temporary contract showed an aOR = 1.58 (95%CI = 1.06-2.35), those working without a contract aOR = 2.15 (95%CI = 1.01-4.57) and aOR = 3.73 (95%CI = 2.43-5.74) and aOR = 5.35 (95%CI = 2.71-10.56) among unemployed of up to two years and more than two years, respectively. Among married and cohabiting people, the associations were stronger among men. Poor mental health status was related to poor employment stability among cohabiting women but not among married ones. The strongest association was observed among separated or divorced people. CONCLUSIONS: There is a rise in poor mental health as the distance from stable employment grows. This result differs according to the interaction with gender and partner/marital status. In Spain this relationship seems to follow a pattern related to the gender division of work in married people but not in other partner/marital situations. Family and socioeconomic context can contribute to explain previous mixed results. Recommendations for research and for action are given.

Mielofibrosis primaria en una trabajadora de la limpieza expuesta a benzeno / Myelofibrosis in a benzene-exposed cleaning worker

La exposición crónica al benceno se asocia con una variedad de enfermedades hematológicas que incluyen anemia aplásica, neoplasias mieloproliferativas y varias formas de leucemia. Se presenta un caso de mielofibrosis primaria en una mujer de 59 años que estuvo trabajando de limpiadora en un concesionario de automóviles y taller mecánico. Durante 25 años utilizó diariamente la gasolina, como desengrasante y disolvente para la limpieza de las piezas de los motores de los coches, los suelos y las mesas de trabajo. Fue derivada desde la Atención Primaria a la Unidad de Salud Laboral de Barcelona para valorar si su enfermedad estaba relacionada con su trabajo. A partir de la historia médico y las condiciones de trabajo, se detectó una exposición crónica al benceno y una falta de medidas de prevención. Se estableció una asociación entre la exposición al benceno y la enfermedad mieloproliferativa, lo cual sugería una posible enfermedad profesional

Long-term exposure to benzene has been associated with several blood malignancies, including aplastic anemia, myeloproliferative neoplasms, and different leukemias. We present a case of primary myelofibrosis in a 59-year-old woman who worked as a cleaner at a car dealership and automobile mechanic shop. For 25 years, she used gasoline as a degreaser and solvent to clean engine parts, floors and work desks on a daily basis. She was referred by her primary care provider to the Occupational Health Unit of Barcelona to assess whether her illness was work-related. Review of her job history and working conditions revealed chronic exposure to benzene in the absence of adequate preventive measures. An association between benzene exposure and myeloproliferative disease was established, suspicious for an occupational disease

[Myelofibrosis in a benzene-exposed cleaning worker]. / Mielofibrosis primaria en una trabajadora de la limpieza expuesta a benzeno.

Long-term exposure to benzene has been associated with several blood malignancies, including aplastic anemia, myeloproliferative neoplasms, and different leukemias. We present a case of primary myelofibrosis in a 59-year-old woman who worked as a cleaner at a car dealership and automobile mechanic shop. For 25 years, she used gasoline as a degreaser and solvent to clean engine parts, floors and work desks on a daily basis. She was referred by her primary care provider to the Occupational Health Unit of Barcelona to assess whether her illness was work-related. Review of her job history and working conditions revealed chronic exposure to benzene in the absence of adequate preventive measures. An association between benzene exposure and myeloproliferative disease was established, suspicious for an occupational disease.

La exposición crónica al benceno se asocia con una variedad de enfermedades hematológicas que incluyen anemia aplásica, neoplasias mieloproliferativas y varias formas de leucemia. Se presenta un caso de mielofibrosis primaria en una mujer de 59 años que estuvo trabajando de limpiadora en un concesionario de automóviles y taller mecánico. Durante 25 años utilizó diariamente la gasolina, como desengrasante y disolvente para la limpieza de las piezas de los motores de los coches, los suelos y las mesas de trabajo. Fue derivada desde la Atención Primaria a la Unidad de Salud Laboral de Barcelona para valorar si su enfermedad estaba relacionada con su trabajo. A partir de la historia médico y las condiciones de trabajo, se detectó una exposición crónica al benceno y una falta de medidas de prevención. Se estableció una asociación entre la exposición al benceno y la enfermedad mieloproliferativa, lo cual sugería una posible enfermedad profesional.

Crisis económico-financiera y salud en España. Evidencia y perspectivas. Informe SESPAS 2014 / The economic-financial crisis and health in Spain. Evidence and viewpoints. SESPAS report 2014

Los objetivos del Informe SESPAS 2014 son: a) analizar el impacto de la crisis en la salud y los comportamientos relacionados con la salud, en las desigualdades y en los determinantes de la salud en España; b) describir los cambios en el sistema sanitario español a raíz de las medidas adoptadas para afrontar la crisis y valorar su posible impacto en la salud; c) revisar la evidencia sobre el impacto de otras crisis y de la actual en otros países, así como las respuestas políticas; y d) proponer intervenciones y políticas alternativas a las llevadas a cabo hasta el momento con una perspectiva de salud poblacional y evidencia científica, que ayuden a mitigar el impacto en la salud y en las desigualdades en salud. El Informe se organiza en cinco bloques: 1) crisis económico-financiera y salud, causas, consecuencias y contextos; 2) impacto sobre los determinantes estructurales de la salud y las desigualdades en salud; 3) impacto en salud y en comportamientos relacionados con la salud, e indicadores para la monitorización; 4) impacto sobre los sistemas de salud; y 5) impacto en grupos específicos de población: infancia, personas mayores y población inmigrante. Hay evidencia de la relación de la crisis con la salud de la población española, con las desigualdades en salud, con los cambios en algunos estilos de vida y con el acceso a servicios sanitarios. La crisis ha impactado en muchos determinantes estructurales de la salud, y se identifican distintos grupos de población que son más vulnerables a los efectos de la crisis. Generalmente, las respuestas políticas sobre cómo gestionar las crisis no han tenido en cuenta la evidencia existente. La crisis puede facilitar la vulnerabilidad de las políticas públicas a la acción de las corporaciones, poniendo en riesgo la implantación de políticas saludables (AU)

The objectives of the SESPAS 2014 Report are as follows: a) to analyze the impact of the economic crisis on health and health-related behaviors, on health inequalities, and on the determinants of health in Spain; b) to describe the changes in the Spanish health system following measures to address the crisis and assess its potential impact on health; c) to review the evidence on the health impact of economic crises in other countries, as well as policy responses; and d) to suggest policy interventions alternative to those carried out to date with a population health perspective and scientific evidence in order to help mitigate the impact of the economic downturn on health and health inequalities. The report is organized in five sections: 1) the economic, financial and health crisis: causes, consequences, and contexts; 2) the impact on structural determinants of health and health inequalities; 3) the impact on health and health-related behaviors, and indicators for monitoring; 4) the impact on health systems; and 5) the impact on specific populations: children, seniors, and immigrants. There is some evidence on the relationship between the crisis and the health of the Spanish population, health inequalities, some changes in lifestyle, and variations in access to health services. The crisis has impacted many structural determinants of health, particularly among the most vulnerable population groups. Generally, policy responses on how to manage the crisis have not taken the evidence into account. The crisis may contribute to making public policy vulnerable to corporate action, thus jeopardizing the implementation of healthy policies (AU)

[The economic-financial crisis and health in Spain. Evidence and viewpoints. SESPAS report 2014]. / Crisis económico-financiera y salud en España. Evidencia y perspectivas. Informe SESPAS 2014.

The objectives of the SESPAS 2014 Report are as follows: a) to analyze the impact of the economic crisis on health and health-related behaviors, on health inequalities, and on the determinants of health in Spain; b) to describe the changes in the Spanish health system following measures to address the crisis and assess its potential impact on health; c) to review the evidence on the health impact of economic crises in other countries, as well as policy responses; and d) to suggest policy interventions alternative to those carried out to date with a population health perspective and scientific evidence in order to help mitigate the impact of the economic downturn on health and health inequalities. The report is organized in five sections: 1) the economic, financial and health crisis: causes, consequences, and contexts; 2) the impact on structural determinants of health and health inequalities; 3) the impact on health and health-related behaviors, and indicators for monitoring; 4) the impact on health systems; and 5) the impact on specific populations: children, seniors, and immigrants. There is some evidence on the relationship between the crisis and the health of the Spanish population, health inequalities, some changes in lifestyle, and variations in access to health services. The crisis has impacted many structural determinants of health, particularly among the most vulnerable population groups. Generally, policy responses on how to manage the crisis have not taken the evidence into account. The crisis may contribute to making public policy vulnerable to corporate action, thus jeopardizing the implementation of healthy policies.

La atención primaria de salud, un agente clave de la salud laboral / Primary health care, a key broker in occupational health

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