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.

Mapping the awareness of inequalities in health programs in Spanish communities: moving forward together

The aim of this study is to map the awareness of gender, socioeconomic, immigrant and ethnic health inequalities in health at schools, maternal health and traffic injury health prevention programs. The study was conducted in the 19 health descentralized areas in Spain, 17 autonomous community (ACs) and the 2 autonomous cities (ACities). The data were collected from May 2008 to January 2009. The unit of analysis was the collection of policy documents setting out the programs mentioned above and the related support material in each AC. A reading guide was used to analyze the awareness of inequalities. With regard to health at schools, 2 of 10 programs show a high awareness of inequalities and include many specific proposals to be implemented at the local level. Regarding maternal health, 13 ACs have prepared support material with high awareness of inequalities to be implemented. A traffic injury program has been created in two ACs. We map the whole situation in Spain regarding the health programs that we have used as examples and their awareness of inequalities. We can conclude that there are differences between the regions studied in Spain and in general, the awareness of inequalities is low.

Worldwide violence against women legislation: an equity approach

OBJECTIVES: To describe the recommendations and interventions addressing violence against women (VAW) in vulnerable women (disabled, pregnant, ethnic minority, immigrant and older women) in key documents and laws enacted in different countries. METHODS: Content analysis of key documents for the development of VAW policies and laws: The United Nations Handbook for Legislation on Violence Against Women Advance Version, the Model of Laws and Policies on Intrafamiliar Violence Against Women of the Pan-American Health Organization and Recommendation No. R(2002)5 of the Committee of Ministers of the European Council. The content of the 62 VAW laws was also analyzed. RESULTS: Key documents demonstrate the importance of eliminating any obstacle facing disabled, pregnant, immigrant, ethnic minority or older women when accessing VAW services. Only 12 laws mention one or more of these groups of vulnerable women. Pregnant, disabled and ethnic minority women are the groups most often mentioned. In these laws, references to punitive measures, action plans and specific strategies to guarantee access to VAW resources are the most common interventions. CONCLUSION: Decisive interventions addressing the specific needs of disabled, pregnant, immigrant, ethnic minority and older women are needed in order to achieve a broader equity approach in VAW legislation.

Violencia de género en mujeres inmigrantes y españolas: magnitud, respuestas ante el problema y políticas existentes

Objetivo: Comparar la prevalencia de la violencia de género entre mujeres inmigrantes y españolas. Describir sus respuestas ante esta situación y posibles diferencias entre ellas. Identificar intervenciones ya existentes en España sobre prevención y atención sociosanitaria de violencia de género dirigidas a inmigrantes. Métodos: Estudio transversal mediante encuesta autoadministrada en 10.202 mujeres que acudieron a centros de atención primaria en España (2006-2007). Análisis de contenido del informe de seguimiento de la ley 1/2004 de medidas de protección integral contra la violencia de género remitido por las comunidades autónomas (CC.AA.) (2005) y las leyes y planes autonómicos más recientes. Resultados: La prevalencia de violencia de género en las españolas es del 14,3% y en las inmigrantes del 27,3%. La probabilidad de violencia de género en las inmigrantes es mayor (odds ratio ajustada: 2,06; intervalo de confianza del 95%: 1,61–2,64). Las inmigrantes dijeron haber denunciado a su pareja con más frecuencia, así como que no sabían resolver su situación. Algunas CC.AA. ya han emprendido intervenciones para superar las barreras de acceso a los servicios sociosanitarios, pero sólo tres facilitan el número de mujeres inmigrantes beneficiarias de ayudas económicas y laborales hasta 2005. Conclusiones: Existe una desigual distribución en la prevalencia de la violencia de género según el país de origen, afectando en mayor medida a las mujeres inmigrantes. Éstas denuncian con más frecuencia que las españolas, pero tal actuación no supone una garantía de resultados efectivos. Aunque se han identificado otras intervenciones específicas en algunas CC.AA., sería necesario evaluarlas para asegurar que las mujeres inmigrantes se están beneficiando.

Social and immigration factors in intimate partner violence among Ecuadorians, Moroccans and Romanians living in Spain

Background: Intimate partner violence (IPV) against women occurs in all countries, all cultures and at every level of society; however, some populations may be at greater risk than others. The aim of this study was to explore IPV prevalence among Ecuadorian, Moroccan and Romanian immigrant women living in Spain and its possible association with their personal, family, social support and immigration status characteristics. Methods: Cross-sectional study of 1607 adult immigrant women residing in Barcelona, Madrid and Valencia (2011). Prevalence rates and adjusted odds ratios (AORs) were calculated, with current IPV being the outcome. Different women’s personal (demographic), family, social support and immigration status characteristics were considered as explicative and control variables. All analyses were separated by women’s country of origin. Results: Current IPV prevalence was 15.57% in Ecuadorians, 10.91% in Moroccans and 8.58% in Romanians. Some common IPV factors were found, such as being separated and/or divorced. In Romanians, IPV was also associated with lack of social support [AOR 5.96 (1.39–25.62)] and low religious involvement [AOR 2.17 (1.06–4.43)]. The likelihood of current IPV was lower among women without children or other dependants in this subgroup [AOR 0.29 (0.093–0.92)]. Conclusion: The IPV prevalence rates obtained for Moroccan, Romanian and Ecuadorian women residing in Spain were similar. Whereas the likelihood of IPV appeared to be relatively evenly distributed among Moroccan and Ecuadorian women, it was higher among Romanian women in socially vulnerable situations related to family responsibilities and the lack of support networks. The importance of intervention in the process of separation and divorce was common to all women.

Racism, Other Discriminations and Effects on Health

We study the probability of perceived racism/other forms of discrimination on immigrant and Spanish populations within different public spheres and show their effect on the health of immigrants using a cross-sectional design (ENS-06). Variables: perceived racism/other forms of discrimination (exposure), socio-demographic (explicative), health indicators (dependent). Frequencies, prevalences, and bivariate/multivariate analysis were conducted separately for men (M) and women (W). We estimated the health problems attributable to racism through the population attributable proportion (PAP). Immigrants perceived more racism than Spaniards in workplace (ORM = 48.1; 95 % CI 28.2–82.2), and receiving health care (ORW = 48.3; 95 % CI 24.7–94.4). Racism and other forms of discrimination were associated with poor mental health (ORM = 5.6; 95 % CI 3.9–8.2; ORW = 7.3; 95 % CI 4.1–13.0) and injury (ORW = 30.6; 95 % CI 13.6–68.7). It is attributed to perceived racism the 80.1 % of consumption of psychotropics (M), and to racism with other forms of discrimination the 52.3 % of cases of injury (W). Racism plays a role as a health determinant.