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.

Combining employment and family in Europe: the role of family policies in health.

OBJECTIVES: The objectives of this study were: (i) to analyse the relationship between health status and paid working hours and household composition in the EU-27, and (ii) to examine whether patterns of association differ as a function of family policy typologies and gender. METHODS: Cross-sectional study based on data from the 5th European Working Conditions Survey of 2010. The sample included married or cohabiting employees aged 25-64 years from the EU-27 (10,482 men and 8,882 women). The dependent variables were self-perceived health status and psychological well-being. RESULTS: Irrespective of differences in family policy typologies between countries, working long hours was more common among men, and part-time work was more common among women. In Continental and Southern European countries, employment and family demands were associated with poor health status in both sexes, but more consistently among women. In Anglo-Saxon countries, the association was mainly limited to men. Finally, in Nordic and Eastern European countries, employment and family demands were largely unassociated with poor health outcomes in both sexes. CONCLUSIONS: The combination of employment and family demands is largely unassociated with health status in countries with dual-earner family policy models, but is associated with poorer health outcomes in countries with market-oriented models, mainly among men. This association is more consistent among women in countries with traditional models, where males are the breadwinners and females are responsible for domestic and care work.

Occupational epidemiology and work related inequalities in health: a gender perspective for two complementary approaches to work and health research.

OBJECTIVES: To provide a framework for epidemiological research on work and health that combines classic occupational epidemiology and the consideration of work in a structural perspective focused on gender inequalities in health. METHODS: Gaps and limitations in classic occupational epidemiology, when considered from a gender perspective, are described. Limitations in research on work related gender inequalities in health are identified. Finally, some recommendations for future research are proposed. RESULTS: Classic occupational epidemiology has paid less attention to women's problems than men's. Research into work related gender inequalities in health has rarely considered either social class or the impact of family demands on men's health. In addition, it has rarely taken into account the potential interactions between gender, social class, employment status and family roles and the differences in social determinants of health according to the health indicator analysed. CONCLUSIONS: Occupational epidemiology should consider the role of sex and gender in examining exposures and associated health problems. Variables should be used that capture the specific work environments and health conditions of both sexes. The analysis of work and health from a gender perspective should take into account the complex interactions between gender, family roles, employment status and social class.

Gender perspective in the analysis of the relationship between long workhours, health and health-related behavior.

OBJECTIVES: The objective of this study was to analyze gender differences in the impact of long workhours (>40 hours per week) on a variety of health outcomes and health-related behavior. METHODS: The sample included all salaried contract workers aged 16-64 years (1658 men and 1134 women) and interviewed in the 2002 Catalonian Health Survey. RESULTS: Whereas the men with a high job status were more likely to work >40 hours a week, long workhours were associated with situations of vulnerability (low job status and being separated or divorced) among the women. For both genders, working >40 hours was related to a shortage of sleep [adjusted odds ratio (aOR) 1.54, 95% confidence interval (95% CI) 1.21-1.98, for the men and aOR 1.63, 95% CI 1.11-2.38, for the women]. Among the women, long workhours were also associated with poor mental health status (aOR 1.58, 95% CI 1.04-2.40), hypertension (aOR 2.25, 95% CI 1.17-4.32), job dissatisfaction (aOR 1.77, 95% CI 1.08-2.90), and smoking (aOR 1.71, 95% CI 1.22-2.39). In addition, among the women working more hours at home, long workhours were related to sedentary leisure time activity (aOR 1.98, 95% CI 1.06-3.71). CONCLUSIONS: The relationship between long workhours and health and health-related behavior was found to be directly related to long worktime and indirectly related to long exposure to poor work conditions among the women and, to a less extent, to domestic work. The pathways that explain the relationship between long workhours and health and health-related behavior seems to depend on the outcome being analyzed.

[Gender inequalities related to labor flexibility]. / Desigualdades de género relacionadas con la flexibilidad laboral.

Desde mediados de la década de 1970 se han producido profundos cambios en las economías capitalistas occidentales relacionados con factores tecnológicos, políticos y económicos, entre los que destacan la globalización, la liberalización de las políticas laborales, el debilitamiento sindical y las nuevas tecnologías. Estos cambios han ido acompañados de un aumento progresivo de la flexibilidad laboral impulsada por necesidades de las empresas, incrementada en periodos de crisis económica como la de mediados de los años 1990 y la de 2008. Las estrategias de flexibilidad laboral son diversas. Pueden referirse a las jornadas laborales (tanto en el número de horas trabajadas como en la organización de la jornada), a los salarios, la subcontratación de personas o empresas, y una de las más importantes: la variación del número de personas empleadas mediante la contratación temporal, el despido, etc. En cualquier caso, el aumento de la flexibilidad ha dado lugar a un incremento de nuevas formas de ocupación caracterizadas por altos niveles de inestabilidad laboral y una erosión general de las condiciones de trabajo y ocupación de los trabajadores y trabajadoras. Son formas de ocupación que se acumulan en los grupos de personas en una situación de más vulnerabilidad en el mercado de trabajo debido a su falta de poder. En términos generales, y siguiendo los ejes de desigualdad social, son las personas jóvenes, las personas migradas, las mujeres y las personas con menos nivel de estudios….

Long working hours and health in Europe: Gender and welfare state differences in a context of economic crisis.

This article examines the relationship between moderately long working hours and health status in Europe. A cross-sectional study based on data from the 2010 European Working Conditions Survey (13,518 men and 9381 women) was performed. Working moderately long hours was consistently associated with poor health status and poor psychological wellbeing in countries with traditional family models, in both sexes in Liberal countries and primarily among women in Continental and Southern European countries. A combination of economic vulnerability, increasing labour market deregulation and work overload related to the combination of job and domestic work could explain these findings.

Social inequalities in the impact of flexible employment on different domains of psychosocial health.

STUDY OBJECTIVES: (1) To analyse the impact of flexible employment on mental health and job dissatisfaction; and (2) to examine the constraints imposed by flexible employment on men's and women's partnership formation and people's decision to become parents. For the two objectives the potentially different patterns by sex and social class are explored. DESIGN: Cross sectional health survey. Multiple logistic regression models separated for sex and social class (manual and non-manual workers) and controlling for age were fitted. Four types of contractual arrangements have been considered: permanent, fixed term temporary contract, non-fixed term temporary contract, and no contract. SETTING: Catalonia (a region in the north east of Spain). PARTICIPANTS: Salaried workers interviewed in the 2002 Catalonian health survey with no longstanding limiting illness, aged 16-64 (1474 men and 998 women). MAIN RESULTS: Fixed term temporary contracts were not associated with poor mental health status. The impact of other forms of flexible employment on mental health depended on the type of contractual arrangement, sex, and social class and it was restricted to less privileged workers, women, and manual male workers. The impact of flexible employment on living arrangements was higher in men. Among both manual and non-manual male workers, those with fixed term temporary contracts were less likely to have children when married or cohabiting and, additionally, among non-manual male workers they also were more likely to remain single (aOR = 2.35; 95%CI = 1.13 to 4.90). CONCLUSION: Some forms of temporary contracts are related to adverse health and psychosocial outcomes with different patterns depending on the outcome analysed and on sex and social class. Future research should incorporate variables to capture situations of precariousness associated with flexible employment.

Women, family demands and health: the importance of employment status and socio-economic position.

Although it is generally assumed that women engaged in paid work have better health than full-time homemakers, little is known about the situation in Southern European countries like Spain or about differences in the impact of family demands by employment status or the potential interaction with educational level. The objectives of this study are to analyse whether inequalities in health exist among housewives and employed women, and to assess whether the relationship between family demands and health differs by employment status. Additionally, for both objectives we examine the potential different patterns by educational level. The data have been taken from the 1994 Catalonian Health Survey (Spain). The sample was drawn from all women aged 25-64 years who were employed or full-time homemakers and married or cohabiting. Four health indicators (self-perceived health status, limiting long-standing illness, chronic conditions and mental health) and two health related behaviours (hours of sleeping and leisure-time physical activity) were analysed. Family demands were measured through household size, living with children under 15 and living with elderly. Overall, female workers had a better health status than housewives, although this pattern was more consistent for women of low educational level. Conversely, the health related behaviours analysed were less favourable for workers, mainly for those of low educational level. Among workers of low educational level, family demands showed a negative effect in most health indicators and health related behaviours, but had little or no negative association at all in workers of high educational level or in full-time homemakers. Moreover, among women of low educational level, both workers and housewives, living with elderly had showed a negative association with poor health status and health related behaviours. These results emphasise the need of considering the interaction between family demands, employment status and educational level in analysing the impact of family demands on women's health as well as in designing family policies and programmes of women's health promotion.

Sickness leave, administrative category and gender: results from the "Casa Gran" project.

OBJECTIVE: The aim of this study was to analyse the variations of sickness leave rates among the Barcelona city council civil servants by administrative category and gender. METHODS: The study was a retrospective cohort including all people who worked for more than six months for the City Council of Barcelona from 1 January 1984 to 31 December 1993. The cohort was composed of 11,647 men and 9,001 women who contribute to a total of 134,928.7 person/years of follow-up. The study population was classified into administrative categories. Sickness leaves were classified into short episodes (less than 11 days) and long episodes (more than 10 days). Age-specific rates of long and short episodes of sickness leave were computed in a gender-specific analysis. RESULTS: Among men, rate ratios of long spells increased constantly from the middle technician category to the unskilled worker category for the three oldest age groups. This social pattern was not as clear for younger workers. Among women, rate ratios of long spells showed far fewer differences than among men. The social gradient was evident for the three youngest age groups, with the exception of the unskilled workers. The oldest age group showed similar differences between all categories. Short spells followed a different pattern for men and women. CONCLUSIONS: Women had generally higher rates than men did, and manual categories had higher rates than non-manual ones, which was more evident for men and long episodes. The relationship between incidence rates and gender could be due to the different contents of the jobs performed by men and women, the influence of gender-based work segregation, and the unequal share of the reproductive workload between men and women, information which was not available for this study.

[Gender, paid work, domestic chores and health in Spain]. / Género, trabajos y salud en España.

The present study reviews gender-related differences and inequalities in paid work and domestic chores in Spain. The impact of both types of work on health are analyzed and the main policies of the European Union (EU) and Spain to achieve gender equality at work are described. In Spain, fewer women are in paid work than in other EU countries. The labor market displays horizontal segregation (men and women work in different sectors), as well as vertical segregation (men hold more senior positions), leading to gender-related differences in employment conditions and exposure to occupational hazards. The precariousness of work is significantly higher in women (19% unemployment in women versus 9% in men) and women are more likely than men to have temporary contracts. Men are more frequently exposed to physical risks and suffer a greater number of occupational accidents; women, especially manual workers, are more frequently exposed to psychosocial risks. Most domestic chores continue to be performed by women, even by working women, which negatively affects their health. The EU has made an increase in female employment a priority, which means that from 2000-2010 Spain should create 3 million jobs for women and implement work/family policies. Achieving gender equality at work requires employment policies that would guarantee equal opportunities for both sexes, as well as shared responsibility for domestic chores between men and women. In Spain, moreover, there is an urgent need to significantly increase public childcare facilities and resources for the care of other dependent individuals.

Full- and part-time work: gender and welfare-type differences in European working conditions, job satisfaction, health status, and psychosocial issues.

OBJECTIVES: The aim of this study was to analyze the differences between full- and part-time employment (FTE and PTE) in terms of working conditions, on the one hand, and job satisfaction, health status, and work-related psychosocial problems according to gender and welfare state regime, on the other hand, and to analyze the role of working conditions in the association between PTE and FTE. METHODS: This cross-sectional study was based on a sample of 7921 men and 8220 women from the European Working Conditions Survey aged 16-64 years, who were employed part-time (5-19 or 20-30 hours per week) or full-time (31-40 hours/week). Multiple logistic regression models were fitted separately for each gender and welfare state regime. RESULTS: PTE is associated with poorer working conditions than FTE for all national welfare types. Among women, only those in southern European countries experienced low job satisfaction [odds ratio after adjustment (OR adj) for sociodemographic variables, OR adj1.73, and 1.66, for those working 20-30 and 5-19 hours/week, respectively; reference group: FTE workers], but this association disappeared after further adjustment for working conditions. Low job satisfaction and poorer health status was more common among PTE men from continental (low job satisfaction, OR adj1.80 and 3.61, for 20-30 and 5-19 working hours/week, respectively), and southern European (OR adj, 2.98, for 5-19 working hours/week) countries. PTE tended to be associated with fewer psychosocial problems among women, but with more psychosocial problems among men in continental Europe and those those engaged in "mini-jobs" in southern European welfare regimes. CONCLUSIONS: The association between FTE and PTE and job satisfaction, health status, and psychosocial problems is partly driven by working conditions and differs between gender and welfare regime. This highlights the importance of promoting effective measures to ensure equal treatment between FTE and PTE workers and the role of the social norms that form part of these different welfare states regimes.

Long working hours and health status among employees in Europe: between-country differences.

OBJECTIVES: This study aimed to (i) identify family responsibilities associated with moderately long working hours (41-60 hours a week); (ii) examine the relationship between moderately long working hours and three health outcomes; and (iii) analyze whether patterns differ by welfare state regimes. METHODS: The sample was composed of all employees aged 16-64 years working 30-60 hours a week interviewed in the 2005 European Working Conditions Survey (9288 men and 6295 women). We fitted multiple logistic regression models separated by sex and welfare state regime typologies. RESULTS: Married males were more likely to work long hours in countries with male breadwinner models whereas family responsibilities were related to long working hours among both sexes in countries with dual breadwinner models. The association between long working hours and health was (i) stronger among men in countries with male breadwinner models, primarily in Anglo-Saxon countries [adjusted odds ratio (OR adj) associated with working 51-60 hours of 6.43, 6.04 and 9.60 for work-related poor health status, stress and psychological distress, respectively); (ii) similar among both sexes in Nordic countries; and (iii) stronger among women in Eastern European countries. CONCLUSIONS: In the European Union of 25 members (EU-25), working moderately long hours is associated with poor health outcomes with different patterns depending on welfare state regimes. The findings from this study suggest that the family responsibilities and breadwinner models can help explain the relationship between long working hours and health status.

Social inequalities in the association between partner/marital status and health among workers in Spain.

The objectives of this study are to examine the association between partner/marital status and several health outcomes among workers and to assess whether it depends on gender and occupational social class. The sample was composed of all workers aged 21-64 years interviewed in the 2006 Spanish National Health Survey (8563 men and 5881 women). Partner/marital status had seven categories: married and living with the spouse (reference category), married and not living with the spouse, cohabiting, single and living with parents, single and not living with parents, separated/divorced and widowed. Four health outcomes were analysed: self-perceived health status, mental health, psychiatric drugs consumption and hypertension. Multiple logistic regression models stratified by sex and social class were fitted. Female manual workers who were cohabiting were more likely to report poor self-perceived health status, poor mental health status, psychiatric medication consumption and hypertension than their married and living with the spouse counterparts. In that group the prevalence of poor health outcomes was even higher when compared with single people. Among male non-manual workers, being married and not living with the spouse was associated with poor self-perceived health status, poor mental health status and hypertension. There were almost no differences in health between being married and the rest of partner/marital status categories for different combinations of gender and social class and, even, some groups of single people reported better health outcomes than people who were married. Our results show no evidence that being married and living with the spouse is unequivocally linked to better health status among Spanish workers. They emphasize the importance of not only considering marital status, but also partner status, as well as the role of gender, social class and the sociocultural context in the analysis of the association between family characteristics and health.

Gender and social class differences in the association between early retirement and health in Spain.

OBJECTIVES: We sought to examine the association between reasons for early retirement and health status and to assess whether this association differs by gender and social class. METHODS: The sample was all people currently working or retired between 50 and 64 years of age (2,497 men and 1,420 women) who were interviewed in the 2006 Spanish National Health Survey. The health outcomes analyzed were self-perceived health status and mental health. Multiple logistic regression models stratified by gender and occupational social class were fitted. RESULTS: Female manual workers who were forced into early retirement due to organizational reasons were more likely to report poor self-perceived health status (adjusted odds ration [aOR], 4.04; 95% confidence interval [CI], 1.44-11.32) and poor mental health (aOR, 2.70; 95% CI, 1.15-6.33), whereas no such association was observed among male workers or among female nonmanual workers. Early retirement on health grounds was associated with both health outcomes in all groups, but retirement because of age, voluntary retirement, and retirement for other reasons were not related to poor health outcomes in any group analyzed. DISCUSSION: Forced early retirement owing to organizational reasons is related to poor health indicators only among female manual workers. Results highlight the importance of paying more attention to the potential vulnerability of female manual workers in downsizing processes as well as in early retirement policies.

[Stress in a changing society]. / El estrés en una sociedad instalada en el cambio.

The objective of this study is to describe the job stress models and non-work stressors, their influence on health and magnitude in Spain. Data come from scientific publications, reports and official statistics, primarily of the last decade. Moreover, original data are provided from the analysis of the 5th Spanish Working Conditions Survey. Job stress analysis is based on two complementary models, that based on psychological demands, control and social support (Karaseks model) and another based on the effort-reward unbalance (Siegrists model). In Spain 15% of men and 22% of women have had an excessive workload that have made them feel tired in the last three months. A quarter of workers have low autonomy and 48% of men and 32% of women work in occupations that do not require special abilities, just experience. Moreover, Spain has the highest unemployment and temporary contracts rates in the 15-European Union. The entrance of women into the labour market implies difficulties in reconciling job and family life. Moreover, paid work provides women with power and economic autonomy, therefore making possible the divorce that has significantly increased in Spain as well as the lonely parents families, these being difficult and stressing situations. Additionally the higher economic autonomy and power among women is considered as one of the causes of the gender violence as well. Response to stress-related problems derived from the globalisation, the increasing importance of the tertiary sector and other social changes is insufficient either because health professionals ignore the causes of the problem and treat pharmacologically the consequences or because health consequences of these new social and economic tendencies are not taken into account in other sectors.

Combining job and family demands and being healthy: what are the differences between men and women?

BACKGROUND: The objective of this study is to analyse gender inequalities in the combination of job and family life and their effect on health status and use of health care services. METHODS: The data come from the Navarra Survey of Working Conditions (Spain, 1997) carried out on a sample of 2185 workers. The analysis was restricted to 881 men and 400 women, aged 25-64 years, who were married or cohabiting. Dependent variables were self-perceived health status, psychosomatic symptoms, and medical visits, all of them dichotomized. Independent variables were family demands and number of hours of paid work a week. The analysis was adjusted for age and occupational social class. Multivariate logistic regression models, separated by sex, were fitted in order to calculate adjusted odds ratios (aOR) and 95% confidence intervals (CI). RESULTS: Family demands were not associated with men's health whereas married women who lived in family units of more than three members had a higher risk of poor self-perceived health status (aOR=4.16; 95% CI: 1.37-12.65) and of psychosomatic symptoms (aOR=2.05; 95% CI: 1.12-3.75). Among women, working more than 40 hours a week was also associated with both health indicators and, additionally, with a higher probability of medical visits. CONCLUSION: In order to fully understand social determinants of workers' health, besides social class, gender inequalities in the distribution of family responsibilities should be considered.

Género, trabajos y salud en España / Gender, paid work, domestic chores and health in Spain

En este trabajo se revisan las diferencias y desigualdades de género existentes en España en el trabajo remunerado y en el doméstico, se analizan el impacto de ambos tipos de trabajo en la salud y se describen las principales estrategias políticas de la Unión Europea (UE) y España para alcanzar la igualdad de género en el trabajo. En España la tasa de actividad femenina es significativamente más baja que en otros países de la UE. En el mercado laboral existe una segregación horizontal -hombres y mujeres trabajan en distintos sectores- y vertical -ellos ocupan los puestos de categoría superior-, causa de las diferencias de género en las condiciones de empleo y en la exposición a riesgos laborales. La precariedad laboral es significativamente más alta en las mujeres (un 19% de paro en las mujeres frente a un 9% en los hombres), así como la contratación temporal. Ellos están más expuestos a riesgos físicos y padecen más accidentes laborales; ellas lo están más a riesgos psicosociales, sobre todo las trabajadoras manuales. Las mujeres continúan asumiendo la mayor parte del trabajo del hogar, aun estando ocupadas, lo que es causa de efectos negativos en su salud. La UE ha establecido entre sus prioridades aumentar el empleo femenino, lo que significa que en el período 2000-2010 España debe crear 3 millones de puestos para las mujeres y facilitar la conciliación de la vida laboral y familiar. Avanzar hacia la igualdad de género en el trabajo requiere políticas de empleo decididas que garanticen la igualdad de oportunidades para ambos sexos en el empleo, así como la corresponsabilidad de los hombres en las tareas del hogar. En España, además, es urgente incrementar significativamente los recursos públicos para el cuidado de los niños y otras personas dependientes del hogar (AU)

The present study reviews gender-related differences and inequalities in paid work and domestic chores in Spain. The impact of both types of work on health are analyzed and the main policies of the European Union (EU) and Spain to achieve gender equality at work are described. In Spain, fewer women are in paid work than in other EU countries. The labor market displays horizontal segregation (men and women work in different sectors), as well as vertical segregation (men hold more senior positions), leading to gender-related differences in employment conditions and exposure to occupational hazards. The precariousness of work is significantly higher in women (19% unemployment in women versus 9% in men) and women are more likely than men to have temporary contracts. Men are more frequently exposed to physical risks and suffer a greater number of occupational accidents; women, especially manual workers, are more frequently exposed to psychosocial risks. Most domestic chores continue to be performed by women, even by working women, which negatively affects their health. The EU has made an increase in female employment a priority, which means that from 2000-2010 Spain should create 3 million jobs for women and implement work/family policies. Achieving gender equality at work requires employment policies that would guarantee equal opportunities for both sexes, as well as shared responsibility for domestic chores between men and women. In Spain, moreover, there is an urgent need to significantly increase public childcare facilities and resources for the care of other dependent individuals (AU)

El estrés en una sociedad instalada en el cambio / Stress in a changing society

El objetivo de este estudio es describir los modelos explicativos del estrés laboral y algunos estresores del ámbito extralaboral, su influencia en la salud y su magnitud en España. Las fuentes de información utilizadas son publicaciones científicas, informes y estadísticas oficiales, fundamentalmente de la última década. Además se aportan datos originales procedentes del análisis de la V Encuesta Nacional de Condiciones del Trabajo (ENCT). En el ámbito laboral el análisis del estrés se basa en dos modelos complementarios, el basado en las exigencias psicológicas, el control y el apoyo social (modelo de Karasek) y el centrado en el equilibrio entre el esfuerzo y la recompensa (modelo de Siegrist). En España, el 15% de los varones y el 22% de las mujeres han tenido en los últimos 3 meses una cantidad de trabajo excesiva que les ha hecho sentirse agobiados. La cuarta parte de la población ocupada tiene poca autonomía y el 48% de los varones y el 32% de las mujeres trabajan en ocupaciones que no requieren ningún tipo de conocimiento especial, sólo práctica en el puesto. Además, España es el país de la Unión Europea de los 15 con más paro e inestabilidad laboral. La incorporación de la mujer al mercado de trabajo se traduce en dificultades para la conciliación de la vida laboral y familiar. Además el trabajo remunerado proporciona poder y autonomía económica y hace viable para la mujer la separación y el divorcio, que han aumentado de forma significativa en los últimos años, y se incrementa así la proporción de hogares monoparentales (el 89% de los responsables son mujeres), situación a menudo difícil y generadora de estrés. La respuesta a los problemas relacionados con el estrés derivados de la globalización, la terciarización de la economía y otros cambios sociales es insuficiente, bien porque los profesionales sanitarios ignoran las causas del estrés y medican las consecuencias o bien porque desde otros sectores no se tienen en cuenta las consecuencias en salud de las nuevas tendencias sociales y económicas (AU)

The objective of this study is to describe the job stress models and non-work stressors, their influence on health and magnitude in Spain. Data come from scientific publications, reports and official statistics, primarily of the last decade. Moreover, original data are provided from the analysis of the 5th Spanish Working Conditions Survey. Job stress analysis is based on two complementary models, that based on psychological demands, control and social support (Karasek's model) and another based on the effort-reward unbalance (Siegrist's model). In Spain 15% of men and 22% of women have had an excessive workload that have made them feel tired in the last three months. A quarter of workers have low autonomy and 48% of men and 32% of women work in occupations that do not require special abilities, just experience. Moreover, Spain has the highest unemployment and temporary contracts rates in the 15-European Union. The entrance of women into the labour market implies difficulties in reconciling job and family life. Moreover, paid work provides women with power and economic autonomy, therefore making possible the divorce that has significantly increased in Spain as well as the lonely parents families, these being difficult and stressing situations. Additionally the higher economic autonomy and power among women is considered as one of the causes of the gender violence as well. Response to stress-related problems derived from the globalisation, the increasing importance of the tertiary sector and other social changes is insufficient either because health professionals ignore the causes of the problem and treat pharmacologically the consequences or because health consequences of these new social and economic tendencies are not taken into account in other sectors (AU)