Desigualdades sociales en la mortalidad cardiovascular en España desde una perspectiva interseccional

Introduction and objectivesThere is an interaction between age, sex, and educational level, among other factors, that influences mortality. To date, no studies in Spain have comprehensively analyzed social inequalities in cardiovascular mortality by considering the joint influence of age, sex, and education (intersectional perspective).MethodsStudy of all deaths due to all-cause cardiovascular disease, ischemic heart disease, heart failure, and cerebrovascular disease among people aged ≥ 30 years in Spain in 2015. Data were obtained from the Spanish Office of Statistics. The relative index of inequality (RII) and the slope index of inequality (SII) were calculated by using Poisson regression models with age-adjusted mortality. The RII is interpreted as the relative risk of mortality between the lowest and the highest educational level, and the SII as the absolute difference in mortality.ResultsThe RII for all-cause cardiovascular mortality was 1.88 (95%CI, 1.80-1.96) in women and 1.44 (95%CI, 1.39-1.49) in men. The SII was 178.46 and 149.43 deaths per 100 000, respectively. The greatest inequalities were observed in ischemic heart disease and heart failure in younger women, with a RII higher than 4. There were no differences between sexes in inequalities due to cerebrovascular disease.ConclusionsCardiovascular mortality is inversely associated with educational level. This inequality mostly affects premature mortality due to cardiac causes, especially among women. Monitoring this problem could guide the future Cardiovascular Health Strategy in the National Health System, to reduce inequality in the first cause of death.     

The global reproductive health market: U.S. media framings and public discourses about transnational surrogacy

During the first decade of the 21st century a new “dramatic story” about the growing global surrogacy industry brought renewed attention to surrogacy as a social problem and a health policy issue. This paper asks: What cultural assumptions about gender, family and the global reproductive health market are revealed in current U.S. media coverage of and public discourses about surrogacy? From a qualitative analysis of prominent news accounts of surrogacy that were published in 2008, New York Times articles and blogs published on the topic between 2006 and 2010, and over 1000 online reader comments to these articles, I identify key frames used to discursively construct and debate the international surrogacy market. This study reveals the distinct contrast between the occasions when reproductive labor is rhetorically distanced from commodification processes and when it is linked to those processes. The findings contribute to intersectional analyses of assisted reproductive practices and women’s health/bodies/gametes. In particular, this study’s analysis of recent media framings of and public discourses about surrogacy across the globe serves as another illustration that national/classed/racialized bodies continue to be reproductively stratified via differently gendered discourses about women, motherhood and family.     

Mississippi front-line recovery work after Hurricane Katrina: an analysis of the intersections of gender, race, and class in advocacy, power relations, and health

By disrupting the routine practices and social structures that support social hierarchy, disasters provide a unique opportunity to observe how gender, race, and class power relations are enacted and reconstituted to shape health inequities. Using a feminist intersectional framework, we examine the dynamic relationships among a government/corporate alliance, front-line disaster recovery workers, and disadvantaged residents in Mississippi Gulf Coast communities in the aftermath of Hurricane Katrina, which struck in August, 2005. Data were collected between January 2007 and October 2008 through field observations, public document analysis, and in-depth interviews with 32 front-line workers representing 27 non-governmental, nonprofit community-based organizations. Our analysis reveals how power relationships among these groups operated at the macro-level of the political economy as well as in individual lives, increasing health risks among both the disadvantaged and the front-line workers serving and advocating on their behalf. Socially situated as outsiders-within, front-line recovery workers operated in the middle ground between the disadvantaged populations they served and the powerful alliance that controlled access to essential resources. From this location, they both observed and were subject to the processes guiding the allocation of resources and their unequal outcomes. Following a brief period of hope for progressive change, recovery workers became increasingly stressed and fatigued, particularly from lack of communication and coordination, limited resources, insufficient capacity to meet overwhelming demands, and gendered and racialized mechanisms of marginalization and exclusion. The personal and collective health burdens borne by these front-line recovery workers--predominantly women and people of color - exemplify the ways in which the social relations of power and control contribute to health and social inequities.     

Neighborhood social cohesion is associated with lower levels of interleukin-6 in African American women

IntroductionSocial cohesion is a positive neighborhood characteristic defined by feelings of connectedness and solidarity within a community. Studies have found significant associations between social cohesion and cardiovascular disease (CVD) risk factors and outcomes. Inflammation is one potential physiological pathway linking social cohesion to CVD development, but few studies have evaluated the relationship between social cohesion and inflammatory biomarkers. Prior research has also established that race and gender can modify the effects of neighborhood features, including social cohesion, on CVD risk factors and outcomes. This study aimed to examine the association between social cohesion and the inflammatory biomarkers interleukin-6 (IL-6) and C-reactive protein (CRP) in a cohort of African American and White women and men.Materials and methodsData from the Morehouse and Emory Team Up to Eliminate Health Disparities (META-Health) Study were used to assess the association between social cohesion and inflammation among African American (n = 203) and White (n = 176) adults from the Atlanta metropolitan area. Social cohesion was measured using the social cohesion subscale from the Neighborhood Health Questionnaire. Inflammatory biomarkers were measured from plasma frozen at −70 °C. Multivariable linear regression analyses were conducted, controlling for demographic, clinical, behavioral, and psychosocial factors sequentially. Interaction by race and gender was also examined.ResultsIn models adjusted for age, race, gender, and education, social cohesion was significantly associated with lower levels of IL-6 (β = −0.06, p = 0.03). There was a significant race × social cohesion interaction (p = 0.04), and a marginally significant gender × race × social cohesion interaction (p = 0.09). In race-stratified models controlling for age, gender, and education, social cohesion was associated with lower IL-6 levels in African Americans (β = −0.11, p = 0.01), but not Whites (β = 0.01, p = 0.91). In fully adjusted race- and gender-stratified models, social cohesion was associated with lower levels of IL-6 in African American women only (β = −0.15, p = 0.003). CRP was not associated with social cohesion in fully adjusted models.ConclusionThe association between social cohesion and lower levels of IL-6 is modified by gender and race, with the strongest association emerging for African American women. Although the pathways through which social cohesion impacts inflammation remain unclear, it is possible that for African American women social cohesion manifests through neighborhood networks.     

Diversity policies and practices - a new perspective for health care

Background Globalization and migration intensify relations of interdependence between individuals all over the world and lead to complex forms of social and cultural diversity both within and across societies. The changing structure of family patterns and processes of individualization also contribute to growing diversity. Organizations and actors in health care will therefore also be challenged to achieve social inclusion of care seekers with different social and cultural backgrounds. Disparities in the health status of people from socially and culturally diverse backgrounds have been examined broadly, but the question is how diversity as an innovative concept will influence any agenda of research on human health and health care provision. Objective The purpose of this article is to theorize what a diversity framework could imply for health research and care system alike. Our thesis is that diversity as a reference point for research and practices will gain significance in Germany and Europe. We will present methodologies to understand diversity and “intersectionality” as paradigms to investigate the complexity and interdependence of health modifiers. Methodologies Diversity does not construct hierarchies of health modifiers and avoids focusing on groups without further differentiation. Health care programs will not only be challenged by the rising diversity among both patients and staff in the health care sector but also by supporting the integration of more disabled and chronically ill persons into the labor markets of ageing societies which cannot afford leaving groups behind as an unrecognized potential. Antidiscrimination legislation in Europe will possibly drive implementation of diversity policies in health care functions. Last but not least diversity management may become attractive as a strategy for improving the effectiveness of any structured health care program for prevention, rehabilitation and treatment alike through the implementation of a more consistent, multidimensional target group orientation. Conclusion Diversity as a conceptual framework applied to the health care field has yet to prove whether it may be a new tool possibly worthwhile to be developed to improve quality of care - but it has the potential to meat the challenges of health equity, defined in terms of resource allocations and access to health care determined by needs of multiple groups of patients.     

Intersectionality and gender mainstreaming in international health: using a feminist participatory action research process to analyse voices and debates from the global south and north

Critiques of gender mainstreaming (GM) as the officially agreed strategy to promote gender equity in health internationally have reached a critical mass. There has been a notable lack of dialogue between gender advocates in the global north and south, from policy and practice, governments and non-governmental organisations (NGOs). This paper contributes to the debate on the shape of future action for gender equity in health, by uniquely bringing together the voices of disparate actors, first heard in a series of four seminars held during 2008 and 2009, involving almost 200 participants from 15 different country contexts. The series used (Feminist) Participatory Action Research (FPAR) methodology to create a productive dialogue on the developing theory around GM and the at times disconnected empirical experience of policy and practice. We analyse the debates and experiences shared at the seminar series using concrete, context specific examples from research, advocacy, policy and programme development perspectives, as presented by participants from southern and northern settings, including Kenya, Mozambique, India, the Democratic Republic of Congo, Canada and Australia. Focussing on key discussions around sexualities and (dis)ability and their interactions with gender, we explore issues around intersectionality across the five key themes for research and action identified by participants: (1) Addressing the disconnect between gender mainstreaming praxis and contemporary feminist theory; (2) Developing appropriate analysis methodologies; (3) Developing a coherent theory of change; (4) Seeking resolution to the dilemmas and uncertainties around the 'place' of men and boys in GM as a feminist project; and (5) Developing a politics of intersectionality. We conclude that there needs to be a coherent and inclusive strategic direction to improve policy and practice for promoting gender equity in health which requires the full and equal participation of practitioners and policy makers working alongside their academic partners.     

Who gains, who loses and how: leveraging gender and class intersections to secure health entitlements

This paper argues that a focus on the middle groups in a multi-dimensional socioeconomic ordering can provide valuable insights into how different axes of advantage and disadvantage intersect with each other. It develops the elements of a framework to analyse the middle groups through an intersectional analysis, and uses it to explore how such groups leverage economic class or gender advantages to secure entitlements to treatment for long-term illness. The study draws upon household survey data on health-seeking for long-term ailments from 60 villages of Koppal district, Karnataka (India). The survey was designed to capture gender, economic class, caste, age and life stage-based inequalities in access to health care during pregnancy and for short and long-term illnesses. There were striking similarities between two important middle groups--non-poor women and poor men--in some key outcomes: their rates of non-treatment when ill, treatment discontinuation and treatment continuation, and the amounts they spent for treatment. These two groups are the obverse of each other in terms of gender and economic class advantage and disadvantage. Non-poor women have an economic advantage and a gender disadvantage, while poor men have the exact opposite. However, despite the similarities in outcomes, the processes by which gender and class advantage were leveraged by each of the groups varied sharply. Similar patterns held for the poorest men except that the class disadvantage they had to overcome was greater, and the results are modified by this.