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

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

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

Time trends in health inequalities due to care in the context of the Spanish Dependency Law / Evolución de las desigualdades en salud debidas al cuidado en el contexto de la Ley de Dependencia española

Objective: In Spain, responsibility for care of old people and those in situations of dependency is assumed by families, and has an unequal social distribution according to gender and socioeconomic level. This responsibility has negative health effects on the carer. In 2006, the Dependency Law recognised the obligation of the State to provide support. This study analyses time trends in health inequalities attributable to caregiving under this new law. Methods: Study of trends using two cross-sectional samples from the 2006 and 2012 editions of the Spanish National Health Survey (27,922 and 19,995 people, respectively). We compared fair/poor self-rated health, poor mental health (GHQ-12 >2), back pain, and the use of psychotropic drugs between non-carers, carers sharing care with other persons, and those providing care alone. We obtain prevalence ratios by fitting robust Poisson regression models. Results: We observed no change in the social profile of carers according to gender or social class. Among women, the difference in all health indicators between carers and non-carers tended to decrease among those sharing care but not among lone carers. Inequalities tend to decrease slightly in both groups of men carers. Conclusions: Between 2006 and 2012, trends in health inequalities attributable to informal care show different trends according to gender and share of responsibility. It is necessary to redesign and implement policies to reduce inequalities that take into account the most affected groups, such as women lone carers. Policies that strengthen the fair social distribution of care should also be adopted (AU)

Objetivo: En España, el cuidado de las personas mayores o en situación de dependencia es desempeñado por las familias, con desigual distribución social según género y nivel socioeconómico. Esta responsabilidad afecta negativamente a la salud de quienes cuidan. En 2006, la Ley de Dependencia reconoció la obligación del Estado de atender esta situación. Este estudio analiza la evolución de las desigualdades en salud atribuibles al cuidado en el contexto de la ley. Método: Estudio de tendencias basado en las ediciones de 2006 y 2012 de la Encuesta Nacional de Salud de España (27.922 y 19.995 personas, respectivamente). Se obtuvieron razones de prevalencia robusta mediante modelos de Poisson para comparar mala salud autopercibida, mala salud mental (GHQ-12 >2), lumbalgia crónica y uso de psicotrópicos entre quienes no cuidaban, quienes compartían con alguien el cuidado y quienes cuidaban en solitario. Resultados: El perfil de las personas cuidadoras permaneció invariable según género y nivel socioeconómico. Entre las mujeres, las desigualdades en salud, respecto a las que no cuidaban, se redujeron para aquellas que compartían el cuidado, manteniéndose para las que cuidaban en solitario. En los hombres, las desigualdades disminuyeron para ambos grupos de cuidadores respecto a no cuidadores. Conclusiones: Entre 2006 y 2012, la evolución de las desigualdades en salud atribuibles al cuidado informal muestra diferentes tendencias según género y reparto de responsabilidad. Son necesarias políticas dirigidas a reducir estas desigualdades valorando los grupos más afectados, como las mujeres que cuidan solas. Además, deben adoptarse políticas que fortalezcan una distribución social más equitativa del cuidado (AU)

Views on the Effects of the Spanish Dependency Law on Caregivers' Quality of Life Using Concept Mapping.

In 2006 the Spanish Dependency Law established new rights for people in situation of dependency. The impact of the Law could have also affected the quality of life of their carers. This study aims to understand how the Law may have influenced caregivers' quality of life through their own perceptions and those of Primary Health Care professionals, and to compare both perspectives. The study used Concept Mapping, a mixed methods technique. In total, 16 caregivers and 21 professionals participated. Both groups identified a mix of positive and negative effects. Uncertainties and delays in granting benefits were reported. However, several advantages were identified, such as the possibility of sharing the burden of care, thus reducing its physical, mental and social consequences, while at the same time being able to maintain responsibility. Most of the mechanisms identified were common to both caregivers and professionals; the most notable differences were that the latter attached more importance to economic support and less to the negative effects of implementation of the Law. This study reveals positive effects of the Law on caregivers' quality of life and the potential for improvement of some negative aspects in its implementation related with the context of austerity.

Gender Policies and Gender Inequalities in Health in Europe: Results of the SOPHIE Project.

The aim of this article is to explain the results of the SOPHIE project regarding the effect of gender policies on gender inequalities in health in Europe. We start with the results of a systematic review on how gender regimes and gender equality policies at the country level impact women's health and gender inequalities in health. Then, we report on three empirical analyses on the relationship between different family policy models existing in Europe and gender inequalities in health. Finally we present four case studies on specific examples of gender policies or determinants of gender inequalities in health. The results show that policies that support women's participation in the labor force and decrease their burden of care, such as public services and support for families and entitlements for fathers, are related to lower levels of gender inequality in terms of health. In addition, public services and benefits for disabled and dependent people can reduce the burden placed on family caregivers and hence improve their health. In the context of the current economic crisis, gender equality policies should be maintained or improved.

Time trends in health inequalities due to care in the context of the Spanish Dependency Law.

OBJECTIVE: In Spain, responsibility for care of old people and those in situations of dependency is assumed by families, and has an unequal social distribution according to gender and socioeconomic level. This responsibility has negative health effects on the carer. In 2006, the Dependency Law recognised the obligation of the State to provide support. This study analyses time trends in health inequalities attributable to caregiving under this new law. METHODS: Study of trends using two cross-sectional samples from the 2006 and 2012 editions of the Spanish National Health Survey (27,922 and 19,995 people, respectively). We compared fair/poor self-rated health, poor mental health (GHQ-12 >2), back pain, and the use of psychotropic drugs between non-carers, carers sharing care with other persons, and those providing care alone. We obtain prevalence ratios by fitting robust Poisson regression models. RESULTS: We observed no change in the social profile of carers according to gender or social class. Among women, the difference in all health indicators between carers and non-carers tended to decrease among those sharing care but not among lone carers. Inequalities tend to decrease slightly in both groups of men carers. CONCLUSIONS: Between 2006 and 2012, trends in health inequalities attributable to informal care show different trends according to gender and share of responsibility. It is necessary to redesign and implement policies to reduce inequalities that take into account the most affected groups, such as women lone carers. Policies that strengthen the fair social distribution of care should also be adopted.