Journal Articles

The SOPHIE project

Introduction to the "Evaluating the Impact of Structural Policies on Health Inequalities and Their Social Determinants and Fostering Change" (SOPHIE) Project

Carme Borrell, Davide Malmusi, Carles Muntaner
International Journal of Health Services, 2017; 47(1): 10-17. doi: 10.1177/0020731416681891

The SOPHIE Project (acronym for Structural Policies for Health Inequalities Evaluation) has focused on evaluating the impact of structural policies on health equity, considering as such all those policies that exert a powerful influence on the structural determinants of health (e.g., patterns of social stratification, living and working conditions) and thus on health-related exposures through intermediary determinants. In these sections of the International Journal of Health Services, we present some of the main findings of the SOPHIE Project. We include both articles that summarize all the evidence already published in the project on a thematic area (such as labor market, gender, or housing) and articles that present new, unpublished evidence on a specific health inequality or policy.

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Macroeconomic policies

The Impact of Fiscal Policies on the Socioeconomic Determinants of Health. A Structured Review

Isabel Mosquera, Yolanda González-Rábago, Amaia Bacigalupe, Marc Suhrcke
International Journal of Health Services, 2016; 47(2): 189-206. doi: 10.1177/0020731416681230

The aim of this article is to review the recent evidence on the impact of discretionary fiscal policies on key SDH, i.e. income, poverty, education, and employment, in high income OECD countries. We find that there are no simple answers as to how fiscal policy affects those determinants of health. The effects of contractionary and expansionary fiscal policies on the analyzed SDH vary considerably across countries and will largely depend on the pre-crisis situation. Contractionary fiscal policies seem to have increased poverty, while their impact on income inequality will be influenced by the composition of the implemented measures.

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Why is There so Much Controversy Regarding the Population Health Impact of the Great Recession? Reflections on Three Case Studies

Amaia Bacigalupe, Faraz Vahid Shahidi, Carles Muntaner, Unai Martín, Carme Borrell
International Journal of Health Services, 2015; doi: 10.1177/0020731415611634

This article contributes to the debate on the health consequences of macroeconomic change through a review of recent evidence from three case studies: Iceland, Spain, and Greece. It shows that the economic crisis has negatively impacted some population health indicators (e.g., mental health) in all three countries, but especially in Greece.

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Health and health behaviours before and during the Great Recession, overall and by socioeconomic status, using data from four repeated cross-sectional health surveys in Spain (2001-2012)

Xavier Bartoll, Veronica Toffolutti, Davide Malmusi, Laia Palència, Carme Borrell and Marc Suhrcke
BMC Public Health, 2015; 15:865 doi:10.1186/s12889-015-2204-5

While average self-reported health status and some health behaviours improved during the economic recession, in 2011/12, this improvement was unequal across different socioeconomic groups.

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Socioeconomic inequalities in smoking in The Netherlands before and during the Global Financial Crisis: a repeated cross-sectional study.

Fiona E Benson, Mirte AG Kuipers, Vera Nierkens, Jan-Willem Bruggink, Karien Stronks and Anton E Kunst
BMC Public Health, 2015; 15:469.

This study examines socioeconomic inequalities in current smoking and smoking cessation in The Netherlands before and during the Global Financial Crisis.

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How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review

Moniek C.M. de Goeij, Marc Suhrcke, Veronica Toffolutti, Dike van de Mheen, Tim M. Schoenmakers, Anton E. Kunst
Social Science & Medicine, 2015; 131:131-146.

This realist systematic review aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms play a role among which individuals. Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption.

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The suffering of the population in the economic crisis of the Spanish State.

Carme Borrell, Maica Rodríguez-Sanz, Xavier Bartoll, Davide Malmusi, Ana M Novoa.
Salud Colectiva, 2014;10(1):95-98.

Despite mortality has continued to decline during the first years of economic crisis in Spain, several social determinants of health have been affected, and two studies in SOPHIE show the impact on mental health in the more socioeconomically deprived groups.

Open Access and Full debate (Spanish)

Assessing the short term health impact of the Great Recession in the European Union: A cross-country panel analysis.

Veronica Toffolutti, Marc Suhrcke.
Preventive Medicine, 2014;64:54-62.

In the first comprehensive assessment of short-term mortality effects of the Great Recession in EU, on average suicide rates have increased significantly as a result of the recession while all other cause-specific mortality rates have declined. Effects are smoothed in countries with higher social protection expenditures.

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The evolution of mental health in Spain during the economic crisis.

Xavier Bartoll, Laia Palència, Davide Malmusi, Marc Suhrcke, Carme Borrell.
European Journal of Public Health, 2013;24(3):415-8.

This analysis of National Health Surveys shows a deterioration in mental health among men during the economic crisis in Spain, especially among those from low socioeconomic position, consistent with the increase in unemployment. A slight improvement is observed in younger and employed women.

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Welfare state

Austerity Resistant Social Policies to Protect Employment. The Italian Case of the Wage Supplementation Fund (Cassa Integrazione Guadagni) in 2009-2013

Elena Gelormino, Maurizio Marino, Roberto Leombruni, Giuseppe Costa
International Journal of Health Services, 2016; 47(2): 165-188; doi: 10.1177/0020731416681231.

During the worse phase of the economic downturn, few social policies resisted to the austerity measures imposed to Italy by the European Union. Among them, the most important is the Wage Supplementation Fund, to protect workers and entrepreneurs from bankruptcy and unemployment. Adopting a realist methodology we studied the social mechanisms which are the roots of some political and administrative choices in that period; the public policy decision making approach gave us a theoretical base. Some main mechanisms have been discovered: technical and economic mechanisms overcame politics, social attitudes pushed political choices, the fear of political and social instability drove all parties.

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Social welfare matters: A realist review of when, how, and why unemployment insurance impacts poverty and health

Patricia O'Campo, Agnes Molnar, Edwin Ng, Emilie Renahy, Christiane Mitchell, Ketan Shankardass, Alexander St. John, Clare Bambra, Carles Muntaner
Social Science & Medicine, 2015; 132:88-94.

This realist review aimed to produce a critical understanding of how and why unemployment insurance policies impact on poverty and health in different welfare state contexts. Generous unemployment insurance programs can moderate harmful health consequences of unemployment.

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Contemporary employment arrangements and mental well-being in men and women across Europe: a cross-sectional study

Deborah De Moortel, Hadewijch Vandenheede, Christophe Vanroelen
International Journal for Equity in Health, 2014, 13:90.

Analysis of cross-sectional data of salaried workers from 21 EU-member states shows that there are significant relations between indicators of low employment quality and poor mental well-being. Results point in the direction of a higher vulnerability of women to low employment quality, especially in the less gender equitable welfare regimes.

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Protocol: Realist synthesis of the impact of unemployment insurance policies on poverty and health

Agnes Molnar, Patricia O'Campo, Edwin Ng, Christiane Mitchell, Carles Muntaner, Emilie Renahy, Alexander St. John, Ketan Shankardass
Evaluation and Program Planning, 2015; 48:1-9.

First realist synthesis protocol to examine how, why, and under what circumstances unemployment insurance affects poverty and health. It conceptualizes unemployment insurance as a key social protection policy and seeks to unpack how contextual influences trigger relevant mechanisms to generate poverty and health outcomes.

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Labour market

The Quality of Work in the Belgian Service Voucher System

Sarah Mousaid, Kelly Huegaerts, Kim Bosmans, Mireia Julià, Joan Benach, Christophe Vanroelen
International Journal of Health Services, 2016; Nov 3 doi:10.1177/0020731416677478

Several European countries implemented initiatives to boost the growth of the domestic cleaning sector. Few studies investigated the quality of work in these initiatives, although effects on workers? health and on social health inequalities can be expected. This study contributes to the scant research on this subject, by investigating the quality of work in the Belgian service voucher system ? a subsidized system for domestic work.

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Employment and Labor Market Results of the SOPHIE Project: Concepts, Analyses, and Policies

Mireia Julià, Laia Ollé-Espluga, Christophe Vanroelen, Deborah De Moortel, Sarah Mousaid, Stig Vinberg, Vanessa Puig-Barrachina, Esther Sánchez, Carles Muntaner, Lucía Artazcoz, Joan Benach
International Journal of Health Services, 2016; Oct 28 doi: 10.1177/0020731416676233

This article reports evidence gained by the SOPHIE Project regarding employment and labor market-related policies. Our findings show that there is a need to standardize definitions and indicators of (the quality of) employment conditions and improve information systems. In order to protect the well-being of workers and reduce work-related health inequalities, policies leading to precarious working and employment conditions need to be suspended. Instead, efforts should be made to improve the security and quality of employment for all workers.

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How does employment quality relate to health and job satisfaction in Europe? A typological approach

Karen Van Aerden, Vanessa Puig-Barrachina, Kim Bosmans, Christophe Vanroelen
Social Science & Medicine, 2016; 158: 132-140. doi:10.1016/j.socscimed.2016.04.017

The findings presented in this study indicate that, among European wage workers, flexible and de-standardised employment tends to be related to lower job satisfaction, general health and mental health. The quality of employment is thus identified as an important social determinant of health (inequalities) in Europe.

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Time strain among employed and self-employed women and men in Sweden

Emma Hagqvist, Susanna Toivanen, Stig Vinberg
Society, Health & Vulnerability, 2015; doi:10.3402/shv.v6.29183

This study uses time-use data to examine potential gender differences among men and women who are self-employed and those who are employees with regard to time strain effects related to time spent on paid and unpaid work in Sweden. The results provide evidence that gender differences in time strain are greater among self-employed individuals than among employees.

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Dirty work, dirty worker? Stigmatisation and coping strategies among domestic workers

Kim Bosmans, Sarah Mousaid, Nele De Cuyper, Stefan Hardonk, Fred Louckx, Christophe Vanroelen
Journal of Vocational Behavior, 2016; 92: 54-67 doi:10.1016/j.jvb.2015.11.008

In this article, the authors explored the coping strategies that moderate the relation between the stigma of dirty work and domestic workers' sense of self, based on the analyses of 43 interviews with domestic workers in Belgium. By using a social stress approach in which stigma is considered a stressor, our results reveal a range of maladaptive and adaptive coping strategies that contribute to a negative or a more positive sense of self.

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Informal employment in high-income countries for a health inequalities research: A scoping review

Mireia Julià, Gemma Tarafa, Patricia O'Campo, Carles Muntaner, Pere Jòdar, Joan Benach
Work, 2015; doi:10.3233/WOR-152176

The aim of this review is to identify literature on informal employment in order to improve its definition and methods of measurement, with special attention given to high-income countries, to be able to study the possible impact on health inequalities within and between countries.

Open Access to postprint

Multidimensional measurement of precarious employment: social distribution and its association with health in Catalonia (Spain)

Joan Benach, Mireia Julià, Gemma Tarafa, Jordi Mir, Emilia Molinero, Alejandra Vives
Gaceta Sanitaria, 2015; doi:10.1016/j.gaceta.2015.04.002

This study shows for the first time in Catalonia the prevalence of precarious employment, measured with a multidimensional scale. Precariousness is higher in women, youth, immigrants, and manual workers, and associated with poorer mental and self-rated health.

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Neo-Marxian social class inequalities in the mental well-being of employed men and women: The role of European welfare regimes

Deborah De Moortel, Laia Palència, Lucía Artazcoz, Carme Borrell, Christophe Vanroelen
Social Science & Medicine, 2015; 128:188-200.

This study confirms the importance of "neo-Marxian" social class and welfare regimes to explain gender and social class inequalities in mental well-being among employees.

Open Access to postprint

Can informal employment be compared in South America? Analysis of its definition, measurement and classification

Marisol E. Ruiz, Gemma Tarafa Orpinell, Pere Jódar Martínez, Joan Benach
Gaceta Sanitaria, 2015; 29(1):65-71.

This review characterizes the situation of informal employment with regard to its definition, measurement and classification in South American countries.

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What is the impact on occupational health and safety when workers know they have safety representatives?

Laia Ollé-Espluga, Montse Vergara-Duarte, Francesc Belvis, María Menéndez-Fuster, Pere Jódar, Joan Benach
Safety Science, 2015; 74:55-58.

This paper explores differences in the intensity of self-reported preventive action among workers reporting to have safety representatives (SRs) at their workplaces, workers reporting not having them, and workers unaware of SRs' existence. It was found that workers reporting SRs' existence were protected by greater preventive action.

Open Access to postprint

Self-employed persons in Sweden - mortality differentials by industrial sector and enterprise legal form: A five-year follow-up study

Susanna Toivanen, Christin Mellner, Stig Vinberg
American Journal of Industrial Medicine 2015; 58(1):21-32.

This study investigated mortality differentials between self-employed persons in Sweden, considering industrial sector, enterprise characteristics and socio-demographic factors.

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Structural and intermediary determinants of social inequalities in the mental well-being of European workers: a relational approach

Deborah De Moortel, Hadewijch Vandenheede, Carles Muntaner, Christophe Vanroelen
BMC Public Health 2014; 14:938.

This study found social class inequalities in mental well-being in the European working population for both men and women. The authors conclude that, from a policy perspective, better employee mental well-being and less social class inequality could be achieved through initiatives addressing the unequal social relations generated by structural positions in the labour process.

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Safety representatives' views on their interaction with workers in a context of unequal power relations: An exploratory qualitative study in Barcelona (Spain).

Laia Ollé-Espluga, María Menéndez-Fuster, Joan Benach, Carles Muntaner, Montse Vergara-Duarte, María Luisa Vázquez.
American Journal of Industrial Medicine, 2014;57:338-50.

This paper deals with worker representatives' participation in occupational health and safety and shows that safety representatives' interaction with workers is influenced by a more prevalent technical-legal view of their role and by unequal power relations between workers and management. Poor interaction with workers might lead to decreasing safety representatives' effectiveness.

Open Access to postprint

Precarious Employment: Understanding an Emerging Social Determinant of Health.

Joan Benach, Alejandra Vives, Marcelo Amable, Christophe Vanroelen, Gemma Tarafa, Carles Muntaner.
Annual Review of Public Health, 2014;35:229-253.

The article identifies the historical, economic, and political factors that link precarious employment to health and health equity; reviews concepts, models, instruments, and findings on precarious employment and health inequalities; summarizes the strengths and weaknesses of this literature; and highlights substantive and methodological challenges that need to be addressed.

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

Lucía Artazcoz, Imma Cortès, Vanessa Puig-Barrachina, Fernando G. Benavides, Vicenta Escribà-Agüir, Carme Borrell.
European Journal of Public Health, 2014; 24 (4): 649-655.

Long working hours and high family demands are associated with poorer health outcomes among both women and men in countries with traditional family policy models, where males are the breadwinners and females are responsible for domestic and care work; among men in countries with market-oriented models; but among neither in countries with dual-earner family policy models.

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Measuring employment precariousness in the European working conditions survey: The social distribution in Europe.

Vanessa Puig-Barrachina, Christophe Vanroelen, Alejandra Vives, José Miguel Martínez, Carles Muntaner, Katia Levecque, Joan Benach, Fred Louckx.
Work, 2014;49(1):143-161.

This article offers the first validation for an innovative multidimensional conceptualisation of employment precariousness applied to the analysis of existing survey data, showing the unequal distribution of precarious employment across the European labour force.

Open Access to postprint

Job control and demands, work-life balance and wellbeing among selfemployed men and women in Europe.

Mikael Nordenmark, Stig Vinberg, Mattias Strandh.
Vulnerable Groups & Inclusion, 2012. doi:10.3402/vgi.v3i0.18896

Results from a dataset of 26 European countries in 2004 show that men and women who are self-employed experience a lower level of work-life balance than those employed. However, once controlled for job control, the relationship between self-employment and wellbeing is significantly negative among men but not among women.

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The challenge of monitoring employment-related health inequalities.

Joan Benach, Vanessa Puig-Barrachina, Alejandra Vives, Gemma Tarafa, Carles Muntaner.
Journal of Epidemiology and Community Health, 2012;66:1085-7.

The creation of surveillance systems for social determinants of health is essential to identify entry points for intervention and evaluate the impact of policies on health inequalities. Gaps and challenges are described with examples from information on employment conditions.

Open Access to postprint


Built environment

The Effects of the Urban Built Environment on Mental Health: A Cohort Study in a Large Northern Italian City

Giulia Melis, Elena Gelormino, Giulia Marra, Elisa Ferracin, Giuseppe Costa
Int. J. Environ. Res. Public Health 2015, 12(11), 14898-14915

Results from this study, in agreement with previous literature, suggest that built environment has a stronger effect on mental health for people who spend more time in the neighborhood. Therefore, this research suggests that good accessibility to public transport, as well as a dense urban structure (versus sprawl), could contribute to reduced risk of depression, especially for women and elderly, by increasing opportunities to move around and have an active social life.

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From built environment to health inequalities: An explanatory framework based on evidence

Elena Gelormino, Giulia Melis, Cristina Marietta, Giuseppe Costa
Prev Med Reports. 2015 Sep;2:737-45 doi:10.1016/j.pmedr.2015.08.019

The built environment represents an important policy domain and, apart from its housing component, its impact on health inequalities is seldom assessed. A scoping review of evidence on the built environment and its health equity impact was carried out. The proposed explanatory framework assumes that key features of built environment identified as density, functional mix and public spaces and services), may influence individual health through their impact on both natural environment and social context, as well as behaviours, and that these effects may be unequally distributed according to the social position of individuals.

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Are social mix policies effective to reduce residential segregation and social inequalities?

Giulia Marra, Giulia Melis, Elena Gelormino
Environ Risque Sante 2015; 14: 342-9. DOI: 10.1684/ers.2015.0798

This article summarizes the results of a review of scientific literature on Housing and social mix focused on the potential effects of urban policies on social inequalities. Mix policies are usually based on a corpus of beliefs about the benefits generated by the mixed communities, with little supporting evidence and a growing database that contradicts those beliefs. Some authors seem to suggest that it would be more effective to try to improve social equity directly on individuals, rather than the transformation of housing units. The article presents the current debate on the relevance of social diversity as a goal, by questioning the principles that are the basis of diversity policies and showing how the results are controversial and with insufficient evidence.

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Are area-based initiatives able to improve area safety in deprived areas? A quasi-experimental evaluation of the Dutch District Approach.

Daniëlle Kramer, Birthe Jongeneel-Grimen, Karien Stronks, Mariël Droomers, Anton E. Kunst
BMC Public Health, July 2015, 15:711; doi: 10.1186/s12889-015-2027-4

This study aims to assess the impact of a Dutch area-based initiative called the District Approach on trends in perceived area safety and underlying problems in deprived target districts. Results suggest that the District Approach has been unable to improve perceptions of area safety and disorder in deprived areas, but that it did result in declining victimization rates.

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Exploring complex causal pathways between urban renewal, health and health inequality using a theory-driven realist approach

Roshanak Mehdipanah, Ana Manzano, Carme Borrell, Davide Malmusi, Maica Rodriguez-Sanz, Joanne Greenhalgh, Carles Muntaner, Ray Pawson
Social Science & Medicine, 2015; 124:266-274.

Urban populations are growing and to accommodate these numbers, cities are becoming more involved in urban renewal programs to improve the physical, social and economic conditions in different areas. This paper explores some of the complexities surrounding the link between urban renewal, health and health inequalities using a theory-driven approach.

Open Access to postprint

Perception of neighborhood environment and health risk behaviors in Prague's teenagers: a pilot study in a post-communist city

Jana Spilkova, Dagmar Dzúrova, Michal Pitonak
International Journal of Health Geographics, 2014; 13:41.

Results of this on-line survey among Prague students aged between 14-15 years show that perceptions of problems in both residential and school environment are associated with health risk behaviors. The school surroundings need special attention by the local authorities responsible for the public space.

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The effects of an urban renewal project on health and health inequalities: A quasi-experimental study in Barcelona.

Roshanak Mehdipanah, Maica Rodríguez-Sanz, Davide Malmusi, Carles Muntaner, Elia Diez, Xavier Bartoll, Carme Borrell.
Journal of Epidemiology and Community Health, 2014;68:811-817

The Neighbourhoods Law has shown potential beneficial changes for residents' wellbeing. This paper shows positive effects on the self-rated and mental health status amongst residents of both sexes and especially manual social classes in areas intervened. Moreover, the Neighbourhoods Law appears to mitigate the increase in poor mental health observed in men in the comparison group.

Open Access to postprint , Presentation and Video

An evaluation of an urban renewal program and its effects on neighborhood resident's overall wellbeing using concept mapping.

Roshanak Mehdipanah, Davide Malmusi, Carles Muntaner, Carme Borrell.
Health & Place, 2013;23:9-17.

As part of the evaluation of the health impacts of the urban renewal program Llei de Barris, we applied concept mapping, a method that combines qualitative and quantitative techniques, to collect the perceptions of three groups of neighbors in two intervened areas.

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Housing Policies and Health Inequalities

Marc Marí-Dell'Olmo, Ana M. Novoa, Lluís Camprubí, Andrés Peralta, Hugo Vásquez-Vera, Jordi Bosch, Jordi Amat, Fernando Díaz, Laia Palència, Roshanak Mehdipanah, Maica Rodríguez-Sanz, Davide Malmusi, Carme Borrell
International Journal of Health Services, 2017; 47(2):207-232; doi: 10.1177/0020731416684292

The aim of this paper is to summarize the research on the impact of local housing policies on health inequalities, focusing on the issues of access to housing and fuel poverty as studied in the SOPHIE project. Our case studies in Spain showed that people facing housing insecurity, experienced intense levels of mental distress. We found that access to secure and adequate housing can improve the health of these populations, therefore, public policies that address housing instability and their consequences are urgently needed.

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Changes in Health Following Housing Improvement in a Vulnerable Population in Spain. A Follow-up Study

Ana M. Novoa, Jordi Amat, Davide Malmusi, Fernando Díaz, Mercè Darnell, Carme Trilla, Jordi Bosch, Carme Borrell
International Journal of Health Services, 2016; Oct 31 doi:10.1177/0020731416676228

The objective of this study is to compare changes in health among a sample of families living in substandard dwellings or with housing affordability problems assisted by Caritas Diocesana de Barcelona, according to the improvement of their socioeconomic and housing situation during the study period.

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Evictions and health, a response from the public health in Spain is needed

Antonio Daponte Codina, Inmaculada Mateo Rodrìguez, Hugo Vásquez-Vera
Gaceta Sanitaria, 2016; Editorial.

Evictions can be use as subject of reflection and analysis on the role of public health and their social determinants. Strategies and actions regarding public health policies that deserve citizens of a European country in the 21st century should be adopted.

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Foreclosure and Health in Southern Europe: Results from the Platform for People Affected by Mortgages

Hugo Vásquez-Vera, Maica Rodríguez-Sanz, Laia Palència, Carme Borrell
Journal of Urban Health, 2016; March; doi:10.1007/s11524-016-0030-4

The aims of this study were to describe and compare the health status of The Platform for People Affected by Mortgages (PAH) members from Catalonia to a sample of the general population and to analyze the association between health status and mortgage status, foreclosure stage, and other socioeconomic variables, among members of the PAH. We observed a considerably higher prevalence of poor mental and self-reported health among male and female PAH members than in the general population.

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Façade insulation retrofitting policy implementation process and its effects on health equity determinants: A realist review

Lluís Camprubí, Davide Malmusi, Roshanak Mehdipanah, Laia Palència, Agnes Molnar, Carles Muntaner, Carme Borrell
Energy Policy, 2016; Apr; 91:304 doi:10.1016/j.enpol.2016.01.016

Despite evidence of the health benefits of insulation, little is known about the political and social contexts that contribute to social inequalities in receiving and experiencing health benefits from these interventions. We used a realist review methodology to better understand the mechanisms that explain how and why variations across different social groups appear in receiving energy efficiency façade retrofitting interventions and in their impact on health determinants. We found strong evidence that certain social groups (low-income, renters, elderly) suffering most from fuel poverty, experience more barriers for undertaking a building retrofitting (due to factors such as upfront costs, "presentism" thinking, split incentives, disruption and lack of control), and that some public policies on housing energy efficiency may exacerbate these inequalities.

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How substandard dwellings and housing affordability problems are associated with poor health in a vulnerable population during the economic recession of the late 2000s

Ana M. Novoa, Julia Ward, Davide Malmusi, Fernando Díaz, Mercè Darnell, Carme Trilla, Jordi Bosch, Carme Borrell
International Journal for Equity in Health, 2015; Nov 4;14(1):120. doi: 10.1186/s12939-015-0238-z.

This study aims to describe the housing conditions and health status of a sample of people assisted by Caritas Barcelona (Spain) and living in inadequate housing and/or struggling to pay their rent or mortgage, to compare the health outcomes of this population with those of the overall population of Barcelona, and to analyze the association between housing dimensions and mental health.

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Impact of the crisis on the relationship between housing and health. Policies for good practice to reduce inequalities in health related to housing conditions

Ana M. Novoa, Jordi Bosch, Fernando Díaz, Davide Malmusi, Mercè Darnell, Carme Trilla
Gaceta Sanitaria, 2014;28 Supl 1:44-50.

Housing conditions can impact on physical and mental health. In Spain, poorly developed housing policies and the current economic crisis have dramatically increased the number of people struggling to cover their housing costs or being evicted. This article, included in the SESPAS report 2014 "Crisis and health", reports some preliminary health impacts of this situation, and issues short and long-term policy recommendations.

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

María Salvador-Piedrafita, Davide Malmusi, Roshanak Mehdipanah, Maica Rodríguez-Sanz, Albert Espelt, Cristina Pérez, Elisabeth Solf, María Abajo del Rincón, Carme Borrell
International Journal of Health Services, 2017; 47(2): 233-257; doi:10.1177/0020731416685494

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. This study have revealed 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.

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Gender and socio-economic inequalities in health and living conditions among co-resident informal caregivers: a nationwide survey in Spain.

María Abajo, Maica Rodríguez-Sanz, Davide Malmusi, María Salvador-Piedrafita, Carme Borrell
Journal of Advanced Nursing, 2016; 73(3): 700-715. doi: 10.1111/jan.13172

The aim of this article is to explore the associations between social determinants, caregiver's network support, burden of care and their consequences in health and living conditions of informal caregivers. The study highlights gender and socio-economic inequalities in informal caregiving and its negative consequences. These findings may be useful in the design of policies and support programmes targeting the most affected groups of informal caregivers.

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Gender Policies and Gender Inequalities in Health in Europe.

Laia Palència, Deborah De Moortel, Lucía Artazcoz, Maria Salvador, Vanessa Puig-Barrachina, Emma Hagqvist, Glòria Pèrez, Marisol E Ruiz, Sara Trujillo-Alemán, Christophe Vanroelen, Davide Malmusi, Carme Borrell
International Journal of Health Services, 2016; doi:10.1177/0020731416662611

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.

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

Maria Salvador, Davide Malmusi, Carme Borrell
Gaceta Sanitaria, 2016

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.

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Gender differences in hazardous drinking among middle-aged in Europe: the role of social context and women's empowerment

Marina Bosque-Prous, Albert Espelt, Carme Borrell, Montse Bartroli, Anna M. Guitart, Joan R. Villalbí, M. Teresa Brugal
European Journal of Public Health, 2015; 25:698-705.

Countries with the greatest gender differences in hazardous drinking were those with the most restrictions on women's behaviour, and the greatest gender inequalities in daily life. Lower gender differences in hazardous drinking seem to be related to higher consumption among women.

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The influence of gender equality policies on gender inequalities in health in Europe

Laia Palència, Davide Malmusi, Deborah De Moortel, Lucía Artazcoz, Mona Backhans, Christophe Vanroelen, Carme Borrell
Social Science & Medicine, 2014; 117:25-33.

This multilevel cross-sectional study (based on data from the European Social Survey 2010) shows that gender inequalities in self-perceived health were higher in countries with family policies that were less oriented to gender equality, especially those in Southern Europe.

Open Access to postprint and Infographics

Gender inequalities in health: exploring the contribution of living conditions in the intersection of social class.

Davide Malmusi, Alejandra Vives, Joan Benach, Carme Borrell.
Global Health Action, 2014;7:23189.

Determinants of gender inequalities in health differ across social classes. Individual income accounts for women's poorer health. Policies to facilitate women's labour market participation and to close the gender pay gap may be helpful to improve women's health.

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Influence of macro-social policies on women's health and gender inequalities in health.

Carme Borrell, Laia Palència, Carles Muntaner, Marcelo Urquia, Davide Malmusi, Patricia O'Campo.
Epidemiologic Reviews, 2014;36(1):31-48.

A systematic review of papers that assessed the effect of gender equality policies on gender inequalities in health or on women's health using cross-territorial comparisons. The hypothesis that Nordic social democratic welfare regimes and dual-earner family models best promote women's health was partially supported. Enforcement of reproductive policies is associated with better mental health outcomes.

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Inequalities by immigrant status in unmet needs for healthcare in Europe: the role of origin, nationality and economic resources

Caterina Francesca Guidi, Laia Palència, Silvia Ferrini, Davide Malmusi
EUI RSCAS; 2016/55; Global Governance Programme-237

This study contributes to the discussion of adequate access to healthcare systems and adaptation of services for migrants. While inequalities cannot be detected for naturalised immigrants, the higher risk of unmet need affecting foreigners, even within the EU, deserves further attention.

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Perceived Discrimination and Health among Immigrants in Europe According to National Integration Policies

Carme Borrell, Laia Palència , Xavier Bartoll, Umar Ikram and Davide Malmusi
Int. J. Environ. Res. Public Health 2015, 12(9), 10687-10699; doi:10.3390/ijerph120910687

The objective of this study was to analyze the association between perceived discrimination and health outcomes among first and second generation immigrants from low-income countries living in Europe, while accounting for sex and the national policy on immigration. Main conclusion is that perceived group discrimination is associated with poor health outcomes in first generation immigrants from low-income countries who live in European countries, but not among their descendants. These associations are more important in assimilationist countries.

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New perspectives on occupational health and safety in immigrant populations: studying the intersection between immigrant background and gender.

Sarah Mousaid, Deborah De Moortel, Davide Malmusi & Christophe Vanroelen
Ethnicity & Health, 2015; doi:10.1080/13557858.2015.1061103

This article looks at the relation between perceptions of work-related health and safety risk and (1) immigrant background and (2) gender in the EU-15. Female immigrant workers have higher work-related health and safety risk than native women, and similar to that of immigrant and native men. Our findings highlight the importance of an intersectional approach in the study of work-related health inequalities.

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

Mercè Gotsens, Davide Malmusi , Nazmy Villarroel, Carmen Vives-Cases, Irene Garcia-Subirats, Cristina Hernando, Carme Borrell
European Journal of Public Health, 2015; doi:10.1093/eurpub/ckv126

We compare the health status of natives and immigrants in Spain in 2006 (when most immigrants had arrived relatively recently) and 2012 (when they were facing high unemployment rates and financial strain). The health status of immigrants arrived before 2006 shows a less favourable evolution than that of natives.

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Association between Integration Policies and Immigrants' Mortality: An Explorative Study across Three European Countries.

Umar Z. Ikram, Davide Malmusi , Knud Juel, Grégoire Rey, Anton E. Kunst
PLoS ONE, 2015; 10(6): e0129916.

This study examines mortality differences of immigrants from the same country of origin living in countries with distinct integration policy contexts (The Netherlands, France and Denmark). Results suggests that different macro-level policy contexts may influence immigrants' mortality.

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Immigrants' health and health inequality by type of integration policies in European countries

Davide Malmusi
European Journal of Public Health 2015; 25:293-299.

The debate on policies on immigration control and integration has been high on the agenda for many years. This study shows that in European countries with a "differential exclusionist" model in integration policies, immigrants of both sexes report worse health than the native population and than immigrants in other countries.

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Inequalities in healthcare access by type of visa in a context of restrictive health insurance policy: the case of Ukrainians in Czechia

Davide Malmusi, Dušan Drbohlav, Dagmar Dzúrová, Laia Palència, Carme Borrell
International Journal of Public Health 2014; 59(5),7144-7153.

In Czechia, immigrants without permanent residence are not entitled to public health insurance. We show that Ukrainians with a long-term visa have a lower access than compatriots with a permanent visa to primary care, hospitalization and emergency room. The exclusion of long-term immigrants from the public healthcare system should be revised on grounds of equity and public health protection.

Open Access to postprint

Immigrants' Access to Health Insurance: No Equality without Awareness

Dagmar Dzúrová, Petr Winkler, Dušan Drbohlav
International Journal of Environmental Research and Public Health 2014; 11(7), 7144-7153.

This study examines migrants' access to the public health insurance system in Czechia. It shows that migrants with a poor knowledge of the Czech language are more likely to remain excluded from the system of public health insurance, and concludes that this lack of awareness keeps eligible immigrants from entering the system.

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Gender Inequalities in the Health of Immigrants and Workplace Discrimination in Czechia

Dagmar Dzúrová, Dušan Drbohlav
BioMed Research International, 2014; 2014:480425.

Using data from two surveys of Ukrainian immigrants in Czechia and a countrywide health interview survey for Czechs, we found that only Ukrainian women were heavily exposed to workplace discrimination, thereby modifying and worsening the quality of their self-rated health. Determinants of self-rated health differ between Ukrainian immigrants and Czechs.

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Methods for policy evaluation

Impact of a Dutch urban regeneration programme on mental health trends: a quasi-experimental study

Birthe Jongeneel-Grimen, Mariël Droomers, Daniëlle Kramer, Jan-Willem Bruggink, Hans van Oers, Anton E Kunst, Karien Stronks
Journal of Epidemiology & Community Health doi:10.1136/jech-2015-207016.

This paper aims to assess the mental health impact of an urban regeneration programme implemented from 2008 onwards in the 40 most deprived districts in the Netherlands. Interventions varied from improvements in the built environment to activities promoting social cohesion.

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How economic crises affect alcohol consumption and alcohol-related health problems: a realist systematic review

Moniek C.M. de Goeij, Marc Suhrcke, Veronica Toffolutti, Dike van de Mheen, Tim M. Schoenmakers, Anton E. Kunst
Social Science & Medicine, 2015; 131:131-146.

This realist systematic review aimed to investigate evidence from studies of previous or ongoing crises on which mechanisms play a role among which individuals. Such evidence would help understand and predict the potential impact of economic crises on alcohol consumption.

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The impact of area-based initiatives on physical activity trends in deprived areas; a quasi-experimental evaluation of the Dutch District Approach.

Daniëlle Kramer, Mariël Droomers, Birthe Jongeneel-Grimen, Marleen Wingen, Karien Stronks, Anton E Kunst
International Journal of Behavioral Nutrition and Physical Activity, 2014, 11:36.

This study aimed to assess the impact of a Dutch area-based initiatives (ABI) called the District Approach on trends in leisure-time physical activity (PA) in deprived districts. Some evidence was found to suggest that ABIs like the District Approach have a positive impact on leisure-time walking in deprived districts.

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A Critical Approach to Macrosocial Determinants of Population Health: Engaging Scientific Realism and Incorporating Social Conflict.

Edwin Ng, Carles Muntaner.
Current Epidemiology Reports, 2014;1:27-37.

Engaging scientific realism fosters a deeper understanding on how and why macrosocial factors, processes, and institutions are causally linked to population health. Thinking in terms of social conflict allows us to view social structures as inequality-generating mechanisms, and re-orients our public health efforts toward social change.

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Invited Commentary: On the Future of Social Epidemiology—A Case for Scientific Realism.

Carles Muntaner.
American Journal of Epidemiology, 2013;178:852-7.

To advance in social epidemiology research, this commentary makes the case for some of the aspects that we are trying to develop in SOPHIE: the study of macrosocial factors; a realist perspective and more attention on theory to understand social mechanisms; a focus on evaluating interventions; community partnerships in research.

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Participation and knowledge transfer

The Role of Dissemination as a Fundamental Part of a Research Project. Lessons Learned From SOPHIE

Esther Marín González, Davide Malmusi, Lluís Camprubí, Carme Borrell
International Journal of Health Services, 2016; Oct 31 doi:10.1177/0020731416676227.

Dissemination and communication of research should be considered as an integral part of any research project. Both help in increasing the visibility of research outputs, public engagement in science and innovation, and confidence of society in research. Here we provide our experience and make some recommendations based on our learning.

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