Institucionalización de la evaluación del impacto en la salud en Andalucía.

Health impact assessment (HIA) aims to incorporate people's health and wellbeing as a key feature in policy-making. Many authors believe that HIA might be systematically integrated into all decision-making processes as a way to achieve that goal. To that end, there is need to overcome a number of challenges, including the fact that Andalusia (Spain) has made HIA compulsory by law, the need for awareness of all public sectors whose decisions might have substantial impacts on health and for a methodology that would enable a comprehensive approach to health determinants and inequalities, and the training of both the public health staff and professional sectors responsible for its application. In Andalusia, a law provides mandatory and binding health impact reports for most authorisation procedures in different areas: from sectoral plans to urban planning schemes, and especially projects subject to environmental assessment. Implementation of this law has required its integration into authorisation procedures, the training of interdisciplinary working groups in public health, the preparation of technical guidelines, and the organisation of dissemination and training seminars for developers.

The building blocks of international ecological footprint inequality: a regression-based decomposition

This paper performs an empirical Decomposition of International Inequality in Ecological Footprint in order to quantify to what extent explanatory variables such as a country’s affluence, economic structure, demographic characteristics, climate and technology contributed to international differences in terms of natural resource consumption during the period 1993-2007. We use a Regression-Based Inequality Decomposition approach. As a result, the methodology extends qualitatively the results obtained in standard environmental impact regressions as it comprehends further social dimensions of the Sustainable Development concept, i.e. equity within generations. The results obtained point to prioritizing policies that take into account both future and present generations.

Santé buccale: déterminants sociaux d'un terrain majeur des inégalités [Oral health: social determinants of a health inequality]

The oral health of disadvantaged social groups is worse at all the ages than that of the favored groups. If tooth decay prevalence decreases, this disease is still unequally distributed: 20% of the children, those with the weakest socio-economic statute (SES), concentrate 60% of the decays. Edentulism strikes significantly more people with weak SES. The inequalities of oral health reflect those of general health. Evidence of the inequalities in oral health is exposed even in the developed countries. Different models of intervention are presented: risk groups identification and targeting by specific programs; oral health community approach which includes socio-economic and public health measures aiming all the population; insurance approach to be combined with the preceding ones.

L’elecció del centre en famílies d’origen immigrat a la ciutat de Barcelona

El projecte ha assolit la majoria d’objectius, ajustats a la reducció d'una quarta part de l'import concedit: 1) caracteritzar la transformació del paisatge agro-forestal i urbà a dos municipis de la vall del Congost, La Garriga i Figaró-Montmany, reconstruint amb SIG els mapes d'ús del sòl de 1854, 1949, 1956 i 2005, obtenint per intersecció de cobertes les matrius dels canvis d'ús; i 2) avaluar amb l’índex de connectivitat ecològica l'impacte ambiental d'aquells canvis des del punt de vista de la biodiversitat i la resiliència del paisatges, amb un especial èmfasi en la reforestació induïda per l'abandonament rural i la pèrdua de paisatges en mosaic, en un àmbit més gran pel període 1956-1993-2005. Aquests resultats han permès preparar varis articles per publicar en co-autoría a revistes com Landscape History, Environment and History o Landscape and Urban Planning. Ja és a punt de poder-se lliurar el primer amb el títol de "Looking backwards into a Mediterranean edge environment: Landscape changes and ecological connectivity in El Congost Valley (province of Barcelona, Catalonia) 1850-2005", incloent dos objectius esmentats a la memòria: identificar les principals forces motores d'aquells canvis en el paisatge relacionant els usos del sòl amb les formes d'ordenació del territori, caracteritzar-ne les forces rectores econòmico-socials i el paper jugat per la protecció del Parc Natural del Montseny i els Cingles de Bertí. Els resultats també permetran abordar en el futur altres aspectes, com per exemple estimar el potencial energètic de la biomassa local tot cercant que el seu aprofitament generi sinèrgies territorials positives per a l'ecologia del paisatge amb la recuperació d’una ramaderia extensiva i una agricultura ecològica que facin possible la restauració dels paisatges en mosaic. L'estudi ha pogut incorporar un aspecte inicialment no previst, el cens d'orquídies mediterrànies a Figaró-Montmany elaborat pel naturalista Paul Wilcox.

Health behaviours, socioeconomic status, and mortality: further analyses of the British Whitehall II and the French GAZEL prospective cohorts

BACKGROUND: Differences in morbidity and mortality between socioeconomic groups constitute one of the most consistent findings of epidemiologic research. However, research on social inequalities in health has yet to provide a comprehensive understanding of the mechanisms underlying this association. In recent analysis, we showed health behaviours, assessed longitudinally over the follow-up, to explain a major proportion of the association of socioeconomic status (SES) with mortality in the British Whitehall II study. However, whether health behaviours are equally important mediators of the SES-mortality association in different cultural settings remains unknown. In the present paper, we examine this issue in Whitehall II and another prospective European cohort, the French GAZEL study. METHODS AND FINDINGS: We included 9,771 participants from the Whitehall II study and 17,760 from the GAZEL study. Over the follow-up (mean 19.5 y in Whitehall II and 16.5 y in GAZEL), health behaviours (smoking, alcohol consumption, diet, and physical activity), were assessed longitudinally. Occupation (in the main analysis), education, and income (supplementary analysis) were the markers of SES. The socioeconomic gradient in smoking was greater (p<0.001) in Whitehall II (odds ratio [OR] = 3.68, 95% confidence interval [CI] 3.11-4.36) than in GAZEL (OR = 1.33, 95% CI 1.18-1.49); this was also true for unhealthy diet (OR = 7.42, 95% CI 5.19-10.60 in Whitehall II and OR = 1.31, 95% CI 1.15-1.49 in GAZEL, p<0.001). Socioeconomic differences in mortality were similar in the two cohorts, a hazard ratio of 1.62 (95% CI 1.28-2.05) in Whitehall II and 1.94 in GAZEL (95% CI 1.58-2.39) for lowest versus highest occupational position. Health behaviours attenuated the association of SES with mortality by 75% (95% CI 44%-149%) in Whitehall II but only by 19% (95% CI 13%-29%) in GAZEL. Analysis using education and income yielded similar results. CONCLUSIONS: Health behaviours were strong predictors of mortality in both cohorts but their association with SES was remarkably different. Thus, health behaviours are likely to be major contributors of socioeconomic differences in health only in contexts with a marked social characterisation of health behaviours. Please see later in the article for the Editors' Summary.

Gender inequality in health among elderly people in a combined framework of socioeconomic position, family characteristics and social support

This study analyses gender inequalities in health among elderly people in Catalonia (Spain) by adopting a conceptual framework that globally considers three dimensions of health determinants : socio-economic position, family characteristics and social support. Data came from the 2006 Catalonian Health Survey. For the purposes of this study a sub-sample of people aged 65–85 years with no paid job was selected (1,113 men and 1,484 women). The health outcomes analysed were self-perceived health status, poor mental health status and long-standing limiting illness. Multiple logistic regression models separated by sex were fitted and a hierarchical model was fitted in three steps. Health status among elderly women was poorer than among the men for the three outcomes analysed. Whereas living with disabled people was positively related to the three health outcomes and confidant social support was negatively associated with all of them in both sexes, there were gender differences in other social determinants of health. Our results emphasise the importance of using an integrated approach for the analysis of health inequalities among elderly people, simultaneously considering socio-economic position, family characteristics and social support, as well as different health indicators, in order fully to understand the social determinants of the health status of older men and women.

A qualitative study about immigrant workers’ perceptions of their working conditions in Spain

Background: Spain has recently become an inward migration country. Little is known about the occupational health of immigrant workers. This study aimed to explore the perceptions that immigrant workers in Spain had of their working conditions.Methods: Qualitative, exploratory, descriptive study. Criterion sampling. Data collected between September 2006 and May 2007 through semi-structured focus groups and individual interviews, with a topic guide. One hundred and fifty-eight immigrant workers (90 men/68 women) from Colombia (n = 21), Morocco (n = 39), sub-Saharan Africa (n = 29), Romania (n = 44) and Ecuador (n = 25), who were authorised (documented) or unauthorised (undocumented) residents in five medium to large cities in Spain.Results: Participants described poor working conditions, low pay and health hazards. Perception of hazards appeared to be related to gender and job sector. Informants were highly segregated into jobs by sex, however, so this issue will need further exploration. Undocumented workers described poorer conditions than documented workers, which they attributed to their documentation status. Documented participants also felt vulnerable because of their immigrant status. Informants believed that deficient language skills, non-transferability of their education and training and, most of all, their immigrant status and economic need left them with little choice but to work under poor conditions.Conclusions: The occupational health needs of immigrant workers must be addressed at the job level, while improving the enforcement of existing health and safety regulations. The roles that documentation status and economic need played in these informants' work experiences should be considered and how these may influence health outcomes.

Itinéraires de formation et lignes biographiques

This paper proposes an analysis of training courses and their connection to other biographical lines, by highlighting their evolution according to social origin and gender. The variable of having received a diploma does not fully explain the longitudinal characteristics of the courses: the social inequalities prove to be also inequalities from the point of view of the followed itinerary. The range of available trajectories as well as the possibility of deviating in order to fulfil a custom trajectory depends on the social characteristics. The training course is connected to other biographical lines, in particular the family and the profession.

Do women in female-dominated occupations exit the labour market more? Evidence from Italy, Spain, Denmark and the UK

Literature on sex occupational segregation has typically focused on the micro and macro determinants of it, on mobility patterns over the life course, on implications of segregation and mobility for gender inequalities. Rarely the link between sex-type occupations and women’s risk of labour market interruptions over family formation has been explored. In this piece of work we shall analyse whether women who are working in the female-dominated, male-dominated or integrated occupations have more or less chances to remain attached to the labour market, controlling for qualifications, class, sector and contract positions. By drawing from ECHP, and comparing Italy, Spain, Denmark and the UK, we shall in particular see whether such connection varies across countries with different institutional and cultural configurations.We find that, ceteris paribus, only in the UK the sex-composition of an occupation matters: women in female occupations are more likely to move to inactivity than women in mixed or male occupations. In the other countries considered the main cleavages lie elsewhere. In Italy what matters most is the sector of employment (public vs. private). In Spain the sector is relevant too, but also social class and the type of contract held (permanent vs. temporary). In Denmark women’s transitions to inactivity are largely independent of human capital and job characteristics.

Who benefits from parental leave in Spain? : a life course analysis

This paper analyses the extent to which individual and workplacecharacteristics and regional policies influence the use and duration ofparental leave in Spain. The research is based on a sample of 125,165people, and 6,959 parental leaves stemming from the ‘Sample ofWorking Life Histories’ (SWLH), 2006. The SWLH consists of administrative register data which include information from threedifferent sources: Social Security, Municipality and Income TaxRegisters. We adopt a simultaneous equations approach to analyse theuse (logistic regression) and duration (event history analysis) ofparental leave, which allows us to control for endogeneity and censoredobservations. We argue that the Spanish parental leave scheme increases gender and social inequalities insofar as reinforces genderrole specialization, and only encourages the reconciling of work andfamily life among workers with a good position in the labour market(educated employees with high and stable working status).

Deferred effects of nursery school on adolescents' school performance in Spain

This research analysis the long-term effects of nursery school attendance before the age of three in Spain. The effects are measured when the individuals are adolescents and attend secondary school. The article deals with the controversy over the long-term effects of nursery school attendance and its potential effect on reducing inequalities and social exclusion. The results estimate a significant long-term effect of nursery school attendance on improving educational performance, although the beneficial effects are lower among adolescents residing in the lower status households.

Parental investments in children: how bargaining and educational homogamy affect time allocation

This study examines parental time investment in their children, distinguishing between developmental and non-developmental care. Our analyses centre on three influential determinants: educational background, marital homogamy, and spouses' relative bargaining power. We find that the emphasis on quality care time is correlated with parents' education, and that marital homogamy reduces couple specialization, but only among the highly educated. In line with earlier research, we identify gendered parental behaviour. The presence of boys is an important condition for fathers' time dedication, but primarly among lower educated fathers. To the extent that parental stimulation is decisive for child outcomes, our findings suggest the persistence of important inequalities. This emerges through our special attention to behavioural differences across the educational distribution among households.

Home visitors and child health in England: advances and challenges

There is increasing interest in the early years as a focus for reducing health inequalities as well as one that is important for the children themselves. This paper describes the introduction in England of Sure Start Local Programmes, which included home visiting within a community development approach, and an intensive home visiting programme, the Nurse-Family partnership, for disadvantaged teenage mothers. It reflects on changes and challenges in service provision to mothers and their pre-school children in England, explaining that a long tradition of home visiting was, paradoxically, reduced as attention focused on the newer initiatives. This is now being addressed, with attention to a range of evidence based programmes and a specific focus on heath visitor provision.

Causal explanations and scientific realism in particle physics

Particle physics studies highly complex processes which cannot be directly observed. Scientific realism claims that we are nevertheless warranted in believing that these processes really occur and that the objects involved in them really exist. This dissertation defends a version of scientific realism, called causal realism, in the context of particle physics. I start by introducing the central theses and arguments in the recent philosophical debate on scientific realism (chapter 1), with a special focus on an important presupposition of the debate, namely common sense realism. Chapter 2 then discusses entity realism, which introduces a crucial element into the debate by emphasizing the importance of experiments in defending scientific realism. Most of the chapter is concerned with Ian Hacking's position, but I also argue that Nancy Cartwright's version of entity realism is ultimately preferable as a basis for further development. In chapter 3,1 take a step back and consider the question whether the realism debate is worth pursuing at all. Arthur Fine has given a negative answer to that question, proposing his natural ontologica! attitude as an alternative to both realism and antirealism. I argue that the debate (in particular the realist side of it) is in fact less vicious than Fine presents it. The second part of my work (chapters 4-6) develops, illustrates and defends causal realism. The key idea is that inference to the best explanation is reliable in some cases, but not in others. Chapter 4 characterizes the difference between these two kinds of cases in terms of three criteria which distinguish causal from theoretical warrant. In order to flesh out this distinction, chapter 5 then applies it to a concrete case from the history of particle physics, the discovery of the neutrino. This case study shows that the distinction between causal and theoretical warrant is crucial for understanding what it means to "directly detect" a new particle. But the distinction is also an effective tool against what I take to be the presently most powerful objection to scientific realism: Kyle Stanford's argument from unconceived alternatives. I respond to this argument in chapter 6, and I illustrate my response with a discussion of Jean Perrin's experimental work concerning the atomic hypothesis. In the final part of the dissertation, I turn to the specific challenges posed to realism by quantum theories. One of these challenges comes from the experimental violations of Bell's inequalities, which indicate a failure of locality in the quantum domain. I show in chapter 7 how causal realism can further our understanding of quantum non-locality by taking account of some recent experimental results. Another challenge to realism in quantum mechanics comes from delayed-choice experiments, which seem to imply that certain aspects of what happens in an experiment can be influenced by later choices of the experimenter. Chapter 8 analyzes these experiments and argues that they do not warrant the antirealist conclusions which some commentators draw from them. It pays particular attention to the case of delayed-choice entanglement swapping and the corresponding question whether entanglement is a real physical relation. In chapter 9,1 finally address relativistic quantum theories. It is often claimed that these theories are incompatible with a particle ontology, and this calls into question causal realism's commitment to localizable and countable entities. I defend the commitments of causal realism against these objections, and I conclude with some remarks connecting the interpretation of quantum field theory to more general metaphysical issues confronting causal realism.

The Evolution of Inequity in the Access to Health Care in Spain: 1987-2001

This paper reports an analysis of the evolution of income related health inequalities in Spain over the period 1987-2001. We use recently developed methods in order to cardinalise and model self assessed health within a regression framework, decompose the sources of inequality and explain the observed differences between 1987 (one year after the 1986 General Health Act was approved) and 2001 (the latest available representative data on health for the Spanish population). The results show that the period has witnessed a reduction in income related health inequality. The driver of such reduction has been the weakening of the income health gradient, which lends support to the hypothesis that the important health policy reforms implemented over the period have been successful in the objective of reducing socio-economic inequalities in health. Our results also suggest that actions aimed at improving the health of those with low levels of education and of those who are not actively participating in the labor market would lead to further reductions in income related health inequality.