Social determinants of self-perceived discrimination in Spain

Objectives: To analyse the association between self-perceived discrimination and social determinants (social class, gender, country of origin) in Spain, and further to describe contextual factors which contribute to self-perceived discrimination. Methods: Cross-sectional design using data from the Spanish National Health Survey (2006). The dependent variable was self-perceived discrimination, and independent and stratifying variables were sociodemographic characteristics (e.g. sex, social class, country of origin, educational level). Logistic regression was used. Results: The prevalence of self-perceived discrimination was 4.2% for men and 6.3% for women. The likelihood of self-perceived discrimination was higher in people who originated from low-income countries: men, odds ratio (OR) 5.59 [95% confidence interval (CI) 4.55–6.87]; women, OR 4.06 (95% CI 3.42–4.83). Women were more likely to report self-perceived discrimination by their partner at home than men [OR 8.35 (95% CI 4.70–14.84)]. The likelihood of self-perceived discrimination when seeking work was higher among people who originated from low-income countries than their Spanish counterparts: men, OR 13.65 (95% CI 9.62–19.35); women, OR 10.64 (95% CI 8.31–13.62). In comparison with Spaniards, male white-collar workers who originated from low-income countries [OR 11.93 (95% CI 8.26–17.23)] and female blue-collar workers who originated from low-income countries (OR 1.6 (95% CI 1.08–2.39)] reported higher levels of self-perceived discrimination. Conclusions: Self-perceived discrimination is distributed unevenly in Spain and interacts with social inequalities. This particularly affects women and immigrants.

La migración de retirados europeos al mercado de viviendas español: una evidencia sobre sus efectos

La migración internacional de retirados no es un fenómeno nuevo entre los países de la Unión Europea. Hay un buen número de sociólogos que han descrito el proceso y sus implicaciones en las formas de vida, especialmente en los casos de migración de los hogares de jóvenes retirados desde los países del norte de Europa hacia los soleados del sur. Muchos de estos movimientos afectan al mercado de viviendas desde el mismo momento de la llegada al país de destino y, en muchos casos, los flujos de población generados por esta migración contribuyen al cambio en las tendencias de edificación en los casos en que los destinos tienen bajos niveles de renta. Estos flujos tienen también implicaciones futuras como la necesidad de aumentar los servicios de atención a la tercera edad o en salud lo que, hoy por hoy, implican un elevado gasto público para el sistema español. Este artículo se interesa por las implicaciones en el corto plazo, así como en indagar en el fenómeno en sí. A través de la explotación de parte de los resultados de un proyecto de investigación denominado REVIcVAL (Retirados y vivienda en la Comunidad Valenciana), el artículo muestra algunas características de este flujo migratorio así como la racionalidad a la hora de tomar la decisión de comprar una vivienda. El ejercicio empírico utiliza información primaria recogida a través de un cuestionario recopilando información de retirados ingleses y alemanes en la costa de Alicante durante los años 2005 y 2006, con una base municipal, y estima la racionalidad en la toma de decisión de compra de viviendas.

From the boom to the crisis: changes in employment conditions of immigrants in Spain and their effects on mental health

Background: Migrant workers have been one of the groups most affected by the economic crisis. This study evaluates the influence of changes in employment conditions on the incidence of poor mental health of immigrant workers in Spain, after a period of 3 years, in context of economic crisis. Methods: Follow-up survey was conducted at two time points, 2008 and 2011, with a reference population of 318 workers from Colombia, Ecuador, Morocco and Romania residing in Spain. Individuals from this population who reported good mental health in the 2008 survey (n = 214) were interviewed again in 2011 to evaluate their mental health status and the effects of their different employment situations since 2008 by calculating crude and adjusted odds ratios (aORs) for sociodemographic and employment characteristics. Findings: There was an increased risk of poor mental health in workers who lost their jobs (aOR = 3.62, 95%CI: 1.64–7.96), whose number of working hours increased (aOR = 2.35, 95%CI: 1.02–5.44), whose monthly income decreased (aOR = 2.75, 95%CI: 1.08–7.00) or who remained within the low-income bracket. This was also the case for people whose legal status (permission for working and residing in Spain) was temporary or permanent compared with those with Spanish nationality (aOR = 3.32, 95%CI: 1.15–9.58) or illegal (aOR = 17.34, 95%CI: 1.96–153.23). In contrast, a decreased risk was observed among those who attained their registration under Spanish Social Security system (aOR = 0.10, 95%CI: 0.02–0.48). Conclusion: There was an increase in poor mental health among immigrant workers who experienced deterioration in their employment conditions, probably influenced by the economic crisis.

Health inequality between immigrants and natives in Spain: the loss of the healthy immigrant effect in times of economic crisis

Background: The immigrant population living in Spain grew exponentially in the early 2000s but has been particularly affected by the economic crisis. This study aims to analyse health inequalities between immigrants born in middle- or low-income countries and natives in Spain, in 2006 and 2012, taking into account gender, year of arrival and socioeconomic exposures. Methods: Study of trends using two cross-sections, the 2006 and 2012 editions of the Spanish National Health Survey, including residents in Spain aged 15–64 years (20 810 natives and 2950 immigrants in 2006, 14 291 natives and 2448 immigrants in 2012). Fair/poor self-rated health, poor mental health (GHQ-12 > 2), chronic activity limitation and use of psychotropic drugs were compared between natives and immigrants who arrived in Spain before 2006, adjusting robust Poisson regression models for age and socioeconomic variables to obtain prevalence ratios (PR) and 95% confidence interval (CI). Results: Inequalities in poor self-rated health between immigrants and natives tend to increase among women (age-adjusted PR2006 = 1.39; 95% CI: 1.24–1.56, PR2012 = 1.56; 95% CI: 1.33–1.82). Among men, there is a new onset of inequalities in poor mental health (PR2006 = 1.10; 95% CI: 0.86–1.40, PR2012 = 1.34; 95% CI: 1.06–1.69) and an equalization of the previously lower use of psychotropic drugs (PR2006 = 0.22; 95% CI: 0.11–0.43, PR2012 = 1.20; 95% CI: 0.73–2.01). Conclusions: Between 2006 and 2012, immigrants who arrived in Spain before 2006 appeared to worsen their health status when compared with natives. The loss of the healthy immigrant effect in the context of a worse impact of the economic crisis on immigrants appears as potential explanation. Employment, social protection and re-universalization of healthcare would prevent further deterioration of immigrants’ health status.

Self-rated health and hospital services use in the Spanish National Health System: a longitudinal study

Background: Self-rated health is a subjective measure that has been related to indicators such as mortality, morbidity, functional capacity, and the use of health services. In Spain, there are few longitudinal studies associating self-rated health with hospital services use. The purpose of this study is to analyze the association between self-rated health and socioeconomic, demographic, and health variables, and the use of hospital services among the general population in the Region of Valencia, Spain. Methods: Longitudinal study of 5,275 adults who were included in the 2005 Region of Valencia Health Survey and linked to the Minimum Hospital Data Set between 2006 and 2009. Logistic regression models were used to calculate the odds ratios between use of hospital services and self-rated health, sex, age, educational level, employment status, income, country of birth, chronic conditions, disability and previous use of hospital services. Results: By the end of a 4-year follow-up period, 1,184 participants (22.4 %) had used hospital services. Use of hospital services was associated with poor self-rated health among both men and women. In men, it was also associated with unemployment, low income, and the presence of a chronic disease. In women, it was associated with low educational level, the presence of a disability, previous hospital services use, and the presence of chronic disease. Interactions were detected between self-rated health and chronic disease in men and between self-rated health and educational level in women. Conclusions: Self-rated health acts as a predictor of hospital services use. Various health and socioeconomic variables provide additional predictive capacity. Interactions were detected between self-rated health and other variables that may reflect different complex predictive models, by gender.

Gender and health inequalities: intersections with other relevant axes of oppression

The risk of disease, disability, and mortality as well as access to health services are unfairly distributed among the population, with certain groups bearing an unequally larger burden of ill health and poorer access to care due to gender, sexual identity/orientation, ethnic background, or class. According to the WHO Commission on Social Determinants of Health (CSDH), these health inequalities emanate from socioeconomic and political factors (governance, cultural values, macroeconomic policies), which generate a set of socioeconomic positions in society according to which populations are stratified based on gender, ethnicity, education, income, or other factors. These societal inequalities influence people’s material and psychosocial circumstances as well as behavioral and biological factors, which in turn impact on health inequalities. Tackling gender, race/ethnic, and socioeconomic inequalities in society is thus recognized as the most powerful action to cope with unequal health risks distribution, and social innovations focusing on these ‘root causes’ are needed in order to prevent and stop endemic social inequalities and social exclusion in health within low-income as well as high-income countries. Increasing existing knowledge and making visible the health status of the most vulnerable and invisible groups are critical in order to contribute to this imperative challenge.

Requalificação urbana e meio ambiente: a inserção da temática ambiental nas propostas de intervenção sobre centros antigos

O crescimento espraiado e periférico das cidades nos países dependentes, tal qual o Brasil, tem reproduzido um movimento de segregação socioespacial das classes de baixos rendimentos, as quais são relegadas a condições ambientais insalubres. Nos países centrais do capitalismo, sob formas distintas, se observa também desde os anos 1960 discussões com respeito à expansão urbana para áreas cada vez maiores, seja por fenômenos como o urban sprawl anglo-saxão, ou a urbanização difusa, dos países da Europa latina. Diante desse quadro, com a publicação do Livro Verde sobre o Ambiente Urbano, documento elaborado em 1990 pela Comissão das Comunidades Européias para fornecer subsídios à elaboração das políticas urbano-ambientais, tem se propagado a ideia de que a promoção de “cidades compactas” seria uma solução adequada para reverter o atual estágio de expansão urbana para novas áreas, aumentando as densidades demográficas em áreas infraestruturadas, sobretudo por meio da reabilitação de edificações e terrenos ociosos localizados nos centros tradicionais, os quais tem passado por processos de abandono, perda de população e deterioração física do patrimônio edificado. Tendo isso em vista, na presente comunicação temos por objetivo analisar como a temática ambiental tem se inserido no contexto das discussões sobre a requalificação de centros antigos com foco na promoção de habitações para as classes populares. Para tal realizamos revisão da literatura sobre o tema proposto bem como procuramos identificar os princípios que tem regido tais políticas com relação ao tema ambiental. A relevância do tema encontra-se na necessidade de buscar caminhos alternativos a política habitacional e urbana brasileira, a qual tem reproduzido um modelo predatório de reprodução do espaço urbano.