[Response to the COVID-19 Health Crisis from a Gender Perspective: Lessons Learned]. / Respuesta a la crisis sanitaria de la COVID-19 desde la perspectiva de género: lecciones aprendidas.

OBJECTIVE: To delve deeper from a gender perspective into the lessons learned during the COVID-19 pandemic to address future health crises. METHOD: Study with key informants with experience in public health and gender from the Ministerio de Sanidad, ministries of the autonomous communities, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública and Universidad País Vasco. SOURCE OF INFORMATION: individual open-ended questionnaire on health and health inequalities/gender inequalities related to COVID-19. After presenting the findings, the key informants group discussed them in a meeting until reaching a consensus on the lessons learned. RESULTS: The lack of clinical statistics by sex could compromise epidemiological surveillance, losing the opportunity to characterize the disease. The performance of essential services fell more on women, exhausting them with double and triple shifts; with the differences according to sex in the clinical presentation of COVID-19, and the criteria for hospitalization/admission to the intensive care unit, their access to health care decreased. Increased: gender violence and mental health problems; delaying recognition of the second effects of vaccines in women; partially due to information biases in clinical trials. The gender perspective was lacking in academic, healthcare, and health management areas. CONCLUSIONS: Women's gender dimensions determined their higher frequency of COVID-19 and played a fundamental role in its control. Broadly considering the lessons learned will strengthen prevention systems and be able to provide effective responses to future health crises.

Respuesta a la crisis sanitaria de la COVID-19 desde la perspectiva de género: lecciones aprendidas / Response to the COVID-19 Health Crisis from a Gender Perspective: Lessons Learned

Objetivo: Profundizar desde la perspectiva de género en las lecciones aprendidas durante la pandemia de COVID-19 para hacer frente a futuras crisis de salud. Método: Estudio con informantes clave con experiencia en salud pública y género del Ministerio de Sanidad, Consejerías de las comunidades autónomas, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública y Universidad del País Vasco. Fuente de información: cuestionario individual de respuestas abiertas sobre inequidades o desigualdades de género sanitarias y en salud relacionadas con la COVID-19. Tras presentar los hallazgos, el grupo de informantes clave se reunió y debatió hasta llegar a un consenso sobre las lecciones aprendidas. Resultados: La falta de estadísticas clínicas por sexo pudo comprometer la vigilancia epidemiológica, perdiendo una oportunidad para caracterizar la enfermedad. El desempeño de los servicios esenciales recayó más en las mujeres, extenuándolas con dobles y triples jornadas, lo cual, junto con las diferencias según sexo en la presentación clínica de la COVID-19 y los criterios de hospitalización y de ingreso en la unidad de cuidados intensivos, disminuyó su acceso a la atención sanitaria. Aumentaron la violencia de género y los problemas de salud mental, retrasando el reconocer los efectos secundarios de las vacunas en las mujeres parcialmente por sesgos de información en los ensayos clínicos. La perspectiva de género faltó en los ámbitos académicos, asistenciales y de gestión sanitaria. Conclusiones: Las dimensiones de género de las mujeres determinaron su mayor frecuencia de COVID-19 y desempeñaron un papel fundamental en su control. Considerar las lecciones aprendidas fortalecerá los sistemas de prevención y permitirá poder dar respuestas eficaces a futuras crisis de salud.(AU)

Objective: To delve deeper from a gender perspective into the lessons learned during the COVID-19 pandemic to address future health crises. Method: Study with key informants with experience in public health and gender from the Ministerio de Sanidad, ministries of the autonomous communities, Institut Català de la Salut, Hospital de La Princesa, Escuela Andaluza de Salud Pública and Universidad País Vasco. Source of information: individual open-ended questionnaire on health and health inequalities/gender inequalities related to COVID-19. After presenting the findings, the key informants group discussed them in a meeting until reaching a consensus on the lessons learned. Results: The lack of clinical statistics by sex could compromise epidemiological surveillance, losing the opportunity to characterize the disease. The performance of essential services fell more on women, exhausting them with double and triple shifts; with the differences according to sex in the clinical presentation of COVID-19, and the criteria for hospitalization/admission to the intensive care unit, their access to health care decreased. Increased: gender violence and mental health problems; delaying recognition of the second effects of vaccines in women; partially due to information biases in clinical trials. The gender perspective was lacking in academic, healthcare, and health management areas. Conclusions: Women's gender dimensions determined their higher frequency of COVID-19 and played a fundamental role in its control. Broadly considering the lessons learned will strengthen prevention systems and be able to provide effective responses to future health crises.(AU)

Caregiving and Caregiver Health 1 Year into the COVID-19 Pandemic (CUIDAR-SE Study): A Gender Analysis.

The COVID-19 pandemic has highlighted the importance of informal care and shown that women continue to shoulder the brunt of responsibilities in this area. In this study, we analyzed differences in caregiving and self-perceived health in a group of informal male and female caregivers 1 year into the COVID-19 pandemic. We performed a cross-sectional survey of 261 informal caregivers (165 women and 96 men) in two regions of Spain using computer-assisted telephone interviewing between February and April 2021. We performed descriptive, bivariate, and multivariate analyses to calculate the odds of poor self-perceived health according to different caregiver, care recipient, and caregiving characteristics. We also analyzed the perceived effects of the pandemic on caregiving, caregiver health, and other aspects of life. Compared with male caregivers, female caregivers were more likely to experience increases in caregiving intensity and burden and a decline in self-perceived health as a result of the pandemic. Men providing high-intensity care, however, also reported deteriorated health. Men experienced fewer reductions in informal support, a factor that exerted a protective health effect. Women, by contrast, experienced a reduction in all support systems and in this case, a third-level education exerted a protective effect. Our results provide key insights that should be taken into account to design gender-based interventions aimed at supporting already stretched and burdened caregivers. A greater sharing of responsibilities and more resources are needed.

Embedded gender and social changes underpinning inequalities in health: an ethnographic insight into a local Spanish context.

Despite growing interest in the social determinants of health and contributions from studies focussing on the analysis of explanations to enhance our understanding of the interactions between gender identities, embodied experiences and structural inequalities between men and women, few research papers have devoted attention to this perspective in the Spanish context. This study is an empirical exploration of lay knowledge, for an enhanced understanding of health inequalities in this context, from an ethnographic standpoint based on a phenomenological approach. Specifically, our aim is to study the lay perceptions of men and women regarding their gender identity and living conditions as health determinants within different "contexts" of their everyday lives, namely: the personal context; the home context; and the neighbourhood context. Fifty eight in-depth interviews and three focus groups were held between January 2005 and January 2007, and analysed using a hermeneutic method. Our findings show how disease-coping strategies or the perceived loss of social cohesion are linked to the gender system. They also point to how the dynamics of social change have developed around a strong division between the productive and reproductive arenas. Approaching these issues from different "contexts" provides insights into the explanations for the gendered patterning of mortality and morbidity, as well as furthering our understanding of the basis for social embodiment of gender differences and health inequalities in the context studied. In the discussion of our findings, we place emphasis on the implications that informal caring has for these processes and also take into account contributions of the "lay approach" to study and understand social determinants and health inequalities.

Desigualdades de género en el deterioro de la salud como consecuencia del cuidado informal en España / Gender inequalities in health deterioration as a result of informal care in Spain

Objetivos: Analizar las diferencias en las características del cuidado que prestan mujeres y hombres a personas dependientes, y su asociación con la percepción del deterioro de la salud como consecuencia de cuidar. Métodos: Estudio epidemiológico transversal de ámbito nacional sobre la muestra de 7.512 personas cuidadoras principales de la Encuesta de Discapacidad, Autonomía Personal y Dependencia 2008. Se realizó un análisis descriptivo de características del cuidado (tareas realizadas, intensidad, frecuencia y duración) según sexo. Mediante regresión logística multivariada se analizó la asociación entre la percepción de deterioro de la salud y las variables de cuidado, ajustando por características sociodemográficas. Resultados: El 74% de las personas cuidadoras son mujeres y perciben con mayor frecuencia que los varones un deterioro de su salud como consecuencia de cuidar (37% y 21%, respectivamente). Ellas prestan un cuidado de mayor intensidad y asumen con mayor frecuencia tareas de ayuda para el aseo personal, comer y vestirse, asociadas a un mayor riesgo de percepción de deterioro de la salud. Los hombres realizan más tareas de cuidado fuera del hogar (ir al médico, hacer compras y gestiones), que resultan protectoras para la percepción de deterioro de la salud. La intensidad del cuidado es un factor de riesgo para la percepción de deterioro de la salud en ambos sexos, y en las mujeres se añaden la frecuencia y duración. Conclusiones: El mayor deterioro de la salud derivado del cuidado que perciben las mujeres está relacionado con desigualdades de género en las características del cuidado. Las intervenciones orientadas a personas cuidadoras deberían ser sensibles a las desigualdades de género existentes en el cuidado informal (AU)

Objectives: To analyze differences in the characteristics of care provided by women and men to dependent persons, and their association with the perception of health deterioration in both sexes. Methods: We performed a nationwide cross-sectional study with data obtained from the 2008 Spanish Survey on Disability, Personal Autonomy and Dependence, based on a sample size of 7,512 principal caregivers. A descriptive analysis was performed of the characteristics of the care provided (tasks performed, intensity, frequency and duration) by sex. A multivariate logistic regression analysis was carried out to explore the association between the caregivers’ perceptions of deteriorated health and the variables related to care, adjusted by sociodemographic characteristics. Results: Most (74%) of the caregivers in the sample were women. Women more frequently perceived a deterioration in their health as a result of providing care than did men (37% and 21%, respectively). Women provided care with greater intensity and more frequently performed the tasks most associated with deteriorated health (personal hygiene, assistance in feeding, etc.). Men more frequently carried out tasks related to care outside the home (going to the doctor, shopping, etc.), all of which acted as a protective factor against health deterioration. The intensity of care was a risk factor for the perception of health deterioration in both sexes, while frequency and duration were also risk factors in women. Conclusions: The greater health deterioration perceived by women is related to gender inequalities in the characteristics of the care provided. Interventions in informal caregivers should be sensitive to these gender inequalities (AU)

[Gender inequalities in health deterioration as a result of informal care in Spain]. / Desigualdades de género en el deterioro de la salud como consecuencia del cuidado informal en España.

OBJECTIVES: To analyze differences in the characteristics of care provided by women and men to dependent persons, and their association with the perception of health deterioration in both sexes. METHODS: We performed a nationwide cross-sectional study with data obtained from the 2008 Spanish Survey on Disability, Personal Autonomy and Dependence, based on a sample size of 7,512 principal caregivers. A descriptive analysis was performed of the characteristics of the care provided (tasks performed, intensity, frequency and duration) by sex. A multivariate logistic regression analysis was carried out to explore the association between the caregivers' perceptions of deteriorated health and the variables related to care, adjusted by sociodemographic characteristics. RESULTS: Most (74%) of the caregivers in the sample were women. Women more frequently perceived a deterioration in their health as a result of providing care than did men (37% and 21%, respectively). Women provided care with greater intensity and more frequently performed the tasks most associated with deteriorated health (personal hygiene, assistance in feeding, etc.). Men more frequently carried out tasks related to care outside the home (going to the doctor, shopping, etc.), all of which acted as a protective factor against health deterioration. The intensity of care was a risk factor for the perception of health deterioration in both sexes, while frequency and duration were also risk factors in women. CONCLUSIONS: The greater health deterioration perceived by women is related to gender inequalities in the characteristics of the care provided. Interventions in informal caregivers should be sensitive to these gender inequalities.

Perceived discrimination and health by gender, social class, and country of birth in a Southern European country.

OBJECTIVES.: This study aimed to examine the association between perceived discrimination and five health outcomes in Spain as well as to analyze whether these relationships are modified by sex, country of birth, or social class. METHODS.: We used a cross-sectional design. Data were collected as part of the 2006 Spanish Health Interview Survey. The present analysis was restricted to the population aged 16-64 years (n=23,760). Five dependent variables on health obtained through the questionnaire were examined. Perceived discrimination was the main independent variable. We obtained the prevalence of perceived discrimination. Logistic regression models were fitted. RESULTS.: Perceived discrimination was higher among populations originating from low income countries and among women and showed positive and consistent associations with all poor health outcomes among men and with 3 poor health outcomes among women. Poor mental health showed the largest difference between people who felt and those who did not feel discriminated (prevalence for these 2 groups among men was 42.0% and 13.3%, and among women, was 44.7% and 22.8%). The patterns found were modified by gender, country of birth, and social class. CONCLUSION.: This study has found a consistent relationship of discrimination with five health indicators in Spain, a high-income Southern European country. Public policies are needed that aim to reduce discrimination.