Impacto de la crisis en el derecho a una alimentación sana y saludable. Informe SESPAS 2014

Unveiling Lived Experiences: Exploring the Health and Lifestyle Effects of COVID-19 on Healthcare Workers

The COVID-19 pandemic brought about significant life disruptions among healthcare workers (HCWs), including changes in weight, eating habits, and physical activity. This qualitative study sought to evaluate the initial and longitudinal effects of health habits among HCWs throughout the pandemic. Data were collected through Qualtrics surveys at three points over a 2-year period with questions asking participants (n = 234) to describe whether they experienced changes in weight, eating behaviors, and physical activity and why they believe these changes occurred. The open-ended responses were analyzed following the summative content analysis approach. Four key themes emerged: (1) problematic eating patterns and habits, (2) disruptions in physical activity, (3) alterations in work environment and schedule, and (4) declines in mental health. Respondent reflections highlight the immediate and long-term pandemic-related effects on weight status for some, attributed to alterations in routines and health habits. Other HCWs reported a "reset" or indicated their habits may have been initially disrupted but normalized or improved over the 2-year time span. Findings underscore the need for strategies that support the physical and mental health of healthcare workers.

[Do socioeconomic determinants influence school menus?]

Introduction

Introduction: the components of school menus is an important area in health strategies. Objectives: the aim of this study was to analyse differences in adherence to recommended food frequencies and other characteristics of school meals in educational centres according to the type of school and neighbourhood income. Method: schools in the city of Barcelona with a lunch service were offered a three-year review. In the three academic years, 341 schools participated: 175 were public and 165 were private. To identify any differences, the Pearson Chi-squared test or Fisher exact test were used, as appropriate. Statistical analyses were performed with the STATA SE/15 programme. Results: no statistically significant differences were found by the socioeconomic level of the school neighbourhood. Private and subsidised schools showed lower adherence to recommendations on pasta (11.1 %), red and processed meat (24.7 %), total meat (7.4 %) and fresh fruit (12.1 %), and lower use of the recommended cooking oil (13.1 %). In contrast, public schools showed lower adherence to the recommended type of frying oil (16.9 %). Conclusions: in private and subsidised schools, improvements should be recommended on the frequency of intake of certain foods. Future studies should examine the causes of lower adherence to certain recommendations in these centres.

Changes in French purchases of pulses during an FAO awareness campaign

Background

Pulses can play a key role in a well-balanced diet and are now recognized for their health and sustainability benefits. However, consumption remains quite low, motivating promotion efforts such as the "International Year of Pulses" declared by the Food and Agriculture Organization (FAO) in 2016. The present study aims to evaluate the changes in the purchase of pulses before and after the FAO's awareness campaign promoting the consumption of pulses in France and investigate the potential differences across sub-populations.

Methods

Purchase data come from Kantar Worldpanel 2014-2017. First, in order to understand demand for pulses, the influence of sociodemographic variables on the purchase of pulses in different forms (raw, processed, ultra-processed) is analyzed using a Box-Cox heteroskedastic double-hurdle model. Then, changes in purchasing before and after the FAO campaign were estimated using a two-way fixed-effects model, controlling for price and sociodemographic variables.

Results

On that period, the purchasing of pulses increased by 8.4% overall. The increase was greater for younger participants (+11.8%), people living in urban areas with over 200,000 inhabitants (+8.4%), and lower-income households (+7.1%). The 8.4% increase observed indicated that there were gradual preference change in favor of pulses and the impact of the awareness campaign was to boost expenditure on pulses by a further 2%.

Conclusion

The FAO campaign coincided with an increase in the purchasing of pulses and may have had an enhancing effect. However, consumption still remains below the level advised by dietary guidelines. There is a need for more public information and communication on the health and sustainability benefits of pulses, the consumption of which can be promoted through supply and education interventions.

JEL codes

D12; Q18; I18.

A Year in the Life of U.S. Frontline Health Care Workers: Impact of COVID-19 on Weight Change, Physical Activity, Lifestyle Habits, and Psychological Factors

Healthcare workers (HCWs) experienced significantly higher burdens and life demands due to the COVID-19 pandemic. This study sought to assess the longitudinal effects among HCWs throughout the pandemic. Qualtrics surveys collected self-reported data on weight changes, eating patterns, physical activity (PA), and psychological factors with data organized by timepoints prior to the pandemic (PP0—prior to March 2020), baseline (M0—January 2021), month 6 (M6—July 2021), and month 12 (M12—January 2022). Eating patterns were negatively impacted at the M0, with reported increases in snacking/grazing (69.7%), fast food/take-out consumption (57.8%), and alcohol (48.8%). However, by M6 and M12 there were no statistically significant differences in eating patterns, suggesting that eating patterns normalized over time. Mean weight increased from PP0 to M0 by 2.99 pounds (p < 0.001, n = 226) and from PP0 to M6 by 2.12 pounds (p < 0.027, n = 146), though the difference in mean weight from PP0 to M12 was not statistically significant (n = 122). PA counts decreased from 8.00 sessions per week PP0 to 6.80 by M0 (p = 0.005) before jumping to 12.00 at M6 (p < 0.001) and 10.67 at M12 (p < 0.001). Psychological factors comparing M0 to M12 found statistically significant differences for depression (p-value = 0.018) and anxiety (p-value = 0.001), meaning depression and anxiety were initially increased but improved by M12. Additionally, higher scores on depression and insomnia scales were associated with lower PA levels. These overall results imply that the COVID-19 pandemic had immediate effects on the eating patterns, weight changes, PA, and psychological factors of HCWs; however, routines and lifestyle habits appeared to have normalized one year later.

The precarisation of daily life in Spain: Austerity, social policy and food insecurity

This article examines the extent to which the 2008 economic crisis has led to a shift in ways of eating among people living in precarious conditions in Spain, and the kinds of strategies they have developed to obtain daily food. Building on a literature review on precarisation in Spain and an analysis of action plans to combat food insecurity, participant-observation ethnography was carried out in Catalonia. Fieldwork was conducted during 2017-2019 in public and private spaces focusing on the food practices of 51 first-time applicants for social assistance. Qualitative data obtained from interviews and direct observation were recorded, transcribed and coded using the ATLAS-ti program to facilitate thematic analysis. Study participants' oral narratives reveal substantial changes in food procurement and eating practices. Strategies include buying different foods, shopping less often and/or in different stores, seeking out cheaper brands, preparing simpler dishes, growing food and recycling leftovers. Their food itineraries reflect increasing reliance on charities, although a common alternative is meals prepared outside the home by family, neighbourhood, activist organisations or themselves. Eating patterns reveal not only experiences of food deprivation and social suffering, but also alternative ways of food procurement. Although food aid is based mainly on an assistance-oriented model, participatory initiatives have the potential to become political spaces that invite us to rethink the distribution of food resources and the limitations of social policies.

The impact of Corona pandemic on consumer's food consumption: Vulnerability of households with children and income losses and change in sustainable consumption behavior

The ongoing corona crisis affected many people worldwide by restrictions in their everyday lives. The question arises to what extent the pandemic has accelerated diet trends or general differences in food consumption between different population groups. For this purpose, an online-survey was carried out in order to determine the effects of the corona lockdown on food consumption, shopping behaviour and eating habits in Germany. The aspects of sustainability and health were given special consideration in this study, reflecting people choices of healthier and more environmentally conscious foods. This study demonstrates that the corona pandemic has a significant impact on consumers’ eating habits. More food was eaten, and more convenience products such as ready-made meals and canned food with a longer shelf life were purchased. The consumption of alcohol and sweets has also increased. In return, there was a reduced consumption of fresh fruits and vegetables. The findings reveal that families who are financially affected by the pandemic represent a vulnerable group. With the ongoing pandemic, possible lockdowns, corona-related closings of schools and kindergartens, severe health consequences are expected long term, especially for this population group.

Evaluating the Impact of the Diabetes Mellitus Strategy for the National Health System: An Interrupted Time Series Analysis

(1) Background: Diabetes mellitus is a significant public health problem. Macrovascular complications (stroke, acute myocardial infarction (AMI) and lower limb amputations (LLAs) represent the leading cause of morbi-mortality in DM. This work aims to evaluate the impact of the approval of the Diabetes Mellitus Strategy of the National Health System (SDM-NHS) on hospitalizations for those macrovascular complications related to DM; (2) Methods: Interrupted time series applying segmented regression models (Negative Binomial) adjusted for seasonality to data from hospital discharge records with a primary or secondary diagnosis of DM (code 250 ICD9MC); (3) Results: Between 2001 and 2015, there have been 7,302,750 hospital discharges with a primary or secondary diagnosis of DM. After the approval of the SDM-NHS, all the indicators showed a downward trend, modifying the previous trend in the indicators of AMI and LLA. The indicators of stroke and AMI also showed an immediate reduction in their rates; (4) Conclusions: After the approval of the SDM-NHS, an improvement has been observed in all the indicators of macrovascular complications of DM evaluated, although it is difficult to establish a causal relationship between the strategy and the effects observed. Interrupted time series is applicable for evaluating the impact of interventions in public health when experimental designs are not possible.

Household Food Metabolism: Losses, Waste and Environmental Pressures of Food Consumption at the Regional Level in Spain

Dealing with an increasing population is challenging the global food system not only in productive terms, but also through the associated environmental pressures. A growing diagnostic effort is being made by global and national agencies. Innovative approaches are needed to support effective policy efforts. This study aims to illustrate the potentialities of the household metabolism approach in the diagnosis of the environmental pressures derived from household food consumption, using the Spanish regions and the effects of the 2008 crisis as case studies. The direct information concerning food consumption in physical terms provided by the Spanish household budget survey is used to estimate some relevant environmental pressures (food losses and waste along the food chain, as well as water and carbon footprint) for the Spanish food system at a sub-national level. These data are directly translated into differences in environmental pressures and compared with other dietary profiles. Furthermore, the physical information of environmental pressures is related to household socio-economic status, showing the potentialities of the association with household socio-economic information. Finally, our data illustrate with some examples how the economic crisis has acted as a driver of change in food consumption, promoting a better environmental performance at the cost of poorer diets.

Social and Economic Factors and Malnutrition or the Risk of Malnutrition in the Elderly: A Systematic Review and Meta-Analysis of Observational Studies

Malnutrition in the elderly could be tackled by addressing socioeconomic factors. This study aimed to determine the magnitude of the relationship between socioeconomic factors and the malnutrition or malnutrition risk (MR) in the elderly. The PubMed and SCOPUS databases were searched for observational studies that included assessment of malnutrition or/and MR and socioeconomic variables (educational level, living alone, marital status, income and occupational level, feeling of loneliness, place of residence, and food expenditure) in ≥60-year-old subjects, published in English among 2000–2018 (PROSPERO: CRD42019137097). The systematic review included 40 observational studies (34 cross-sectional and 4 cohort studies) and 16 cross-sectional studies in the meta-analysis (34,703 individuals) of malnutrition and MR in relation to low educational level (Odds Ratio (OR): 1.48; 95% Confidence Interval (CI): 1.33–1.64; p < 0.001), living alone (OR: 1.92; 95% CI: 1.73–2.14; p < 0.001), being single, widowed, or divorced (OR: 1.73; 95% CI: 1.57–1.90; p < 0.001), and low income level (OR: 2.69; 95% CI: 2.35–3.08; p < 0.001), and considering these four socioeconomic factors, malnutrition and MR is associated with them (OR: 1.83; 95% CI: 1.73–1.93; p < 0.001). Malnutrition and MR could be reduced by increasing economic level, supporting people living alone or being single, widowed, and divorced, and improving lifelong learning.

Economic crisis and obesity in the Canary Islands: an exploratory study through the relationship between body mass index and educational level

Background

The Canary Islands is one of the Spanish Regions with the highest obesity prevalence, and one of the Autonomous Communities that was hit hard by the economic crisis that arrived to Spain in 2008. This research studies the education-related inequalities in adult obesity in the Canary Islands and their evolution in recent years, considering the possible impact of the economic recession.

Methods

A repeated cross-sectional analysis is carried out with data obtained from the Canary Islands Health Surveys of 2004, 2009 and 2015. Obesity is measured through the body mass index (BMI). The analysis is performed using linear regression models for the general population and by gender, adjusting by age, educational attainment and island of residence. Likewise, the models also include dummy variables for each year and the corresponding interactions between the years and the education variable.

Results

The results show a decrease in the obesity prevalence in 2015 compared to 2009 (from 19.54 to 18.64%). An increase in the BMI of the population and that of women (+ 0.33 and + 0.59 units, respectively) in 2009, as well as a decline in the BMI of women with medium education (− 0.21 units) are also observed. Besides, there is an inverse correlation between education and BMI, and statistically significant differences among some islands.

Conclusions

Obesity figures in the Canary Islands have decreased and women have been more greatly affected by the changes in BMI during the economic crisis. Due to the fact that educational attainment is a protective factor in general (and for women with medium education levels in times of crisis, in particular), regional authorities should implement actions that promote access to education and healthy lifestyles, paying attention to territorial disparities.

[Biopsychosocial consequences in Spanish population affected by an eviction process]

The biopsychosocial consequences in Spanish population affected by an eviction process were described in this paper. A scoping review was conducted, consulting the following databases: PubMed, Scopus, PsycINFO, CINAHL, LILACS, CSIC, MEDES, Scielo, Dialnet, Cuiden Plus and Cochrane. The search strategy was (Eviction OR "Home eviction" OR "Housing eviction" OR "Households at risk of eviction" OR Foreclosure) AND ("Health" OR "Mental Health" OR "Psychosocial impact" OR "Impacts on health" OR "Social impact indicators" OR "Social Determinants of Health" OR "Social Indicators").Eleven articles published between 2008 and September 2018 were selected. They followed a quantitative or qualitative methodology. The research quality was measured, and the results were organized according to the biopsychosocial model. From the physical perspective, results described a poor self-perception of health, as well as an increase of chronic diseases, pain, drug consumptions. From the psychological perspective, it was found negative thoughts, recurrent emotions and increased anxiety, depression, mental disorder and post-traumatic stress. From the social perspective, it was found that family, the offspring and the guarantor were affected, as well as the health system with greater medical visits and emergencies. This review showed worse health indicators among women, such as a headache, smoking habits, worse self-perception of health and more mental health disorders (depression, anxiety and other types of psychological distress). Daughters revealed worse self-perception of health than sons. It is necessary an approach from public health, epidemiological surveillance, action protocols and health programs, to advise, diagnose, prevent, protect and promote the health of the Spanish population affected.

Child health and the possibilities for childcare in a context of poverty and food insecurity: The narratives of parents attending a self-managed foodbank in Spain

Food insecurity would influence children's health and development through its effects on nutrition and household stress in the context of broader poverty-related problems. This study contributes to research regarding the characterisation of food-insecure households with children under the age of 18. In particular, it highlights the social and institutional aspects which influence and interact with parents' attempts to protect their children from hunger and destitution. In this study, we document some aspects of the harsh realities faced by mothers and fathers with children under the age of 18 living in poverty who attended a self-organised foodbank in the city of Madrid in 2015. We used a qualitative methodology consisting of 7 months of participant observation and the conduction of 15 in-depth interviews. This study shows how the possibilities for the meaningful protection of children in food-insecure households can be influenced by parental coping strategies, community resources and availability and accessibility to public help. Foodbanks can help reduce both household hunger (although not meeting all nutritional requirements) and parental psychosocial distress, which might support parents to better protect their children. In particular, self-managed foodbanks appear to help parents cope with emotional distress by reducing feelings of powerlessness and self-blame through their active involvement, and thanks to the collective caring that occurs between members. Public services are of special relevance, since their absence or an active institutional discrimination has been shown to further damage impoverished households with children. We suggest that public policies in Spain are revised and reinforced to enable a more genuine protection of children and their families living under severe deprivation, and to prevent life-long damage. Public institutions could assume that people attending a foodbank are living in severe poverty and need access to adequate and supportive public resources to address it.

Social Norms Influencing the Local Food Environment as Perceived by Residents and Food Traders: The Heart Healthy Hoods Project

Exploring subjective elements of the food environment remains key to understand why and how residents purchase food. Our aim was to explore and describe the social norms relating to the local food environment and food purchasing behaviors, as perceived by residents and food traders in Madrid, Spain. This qualitative study took place in a middle socioeconomic status neighborhood of Madrid between January 2015 and May 2016. We conducted 35 semi-structured interviews. We used stratified purposive sampling to recruit residents, neighborhood workers (N = 20) and food traders (N = 15) representing different levels of involvement with food purchasing behaviors. We analyzed these data using an interpretative phenomenological analysis approach. Participants highlighted social aspects of the food environment in relation to food purchasing behaviors. First, interpersonal and relational food environment elements were emphasized, including trust and tradition. Participants also identified generational demographic trends in relation to changes in the way residents purchased food: the new pace of life and the lack of time to buy fresh food and to cook at home. All these elements were influenced by the economic crisis. Food environment interventions aiming to improve food purchasing behaviors and residents' diets should consider intermediate social aspects of the food environment like trust and tradition and the fast pace of life of younger generations.

Food Reference Budgets as a Potential Policy Tool to Address Food Insecurity: Lessons Learned from a Pilot Study in 26 European Countries

The aim of this article is to present the development of cross-country comparable food reference budgets in 26 European countries, and to discuss their usefulness as an addition to food-based dietary guidelines (FBDG) for tackling food insecurity in low-income groups. Reference budgets are illustrative priced baskets containing the minimum goods and services necessary for well-described types of families to have an adequate social participation. This study was conducted starting from national FBDG, which were translated into monthly food baskets. Next, these baskets were validated in terms of their acceptability and feasibility through focus group discussions, and finally they were priced. Along the paper, we show how that food reference budgets hold interesting contributions to the promotion of healthy eating and prevention of food insecurity in low-income contexts in at least four ways: (1) they show how a healthy diet can be achieved with limited economic resources, (2) they bring closer to the citizen a detailed example of how to put FBDG recommendations into practice, (3) they ensure that food security is achieved in an integral way, by comprising the biological but also psychological and social functions of food, and (4) providing routes for further (comparative) research into food insecurity.

Socioeconomic differences in body mass index in Spain: An intersectional multilevel analysis of individual heterogeneity and discriminatory accuracy

Many studies have demonstrated the existence of simple, unidimensional socioeconomic gradients in body mass index (BMI). However, in the present paper we move beyond such traditional analyses by simultaneously considering multiple demographic and socioeconomic dimensions. Using the Spanish National Health Survey 2011–2012, we apply intersectionality theory and multilevel analysis of individual heterogeneity and discriminatory accuracy (MAIHDA) to analyze 14,190 adults nested within 108 intersectional strata defined by combining categories of gender, age, income, educational achievement and living situation. We develop two multilevel models to obtain information on stratum-specific BMI averages and the degree of clustering of BMI within strata expressed by the intra-class correlation coefficient (ICC). The first model is a simple variance components analysis that provides a detailed mapping of the BMI disparities in the population and measures the accuracy of stratum membership to predict individual BMI. The second model includes the variables used to define the intersectional strata as a way to identify stratum-specific interactions. The first model suggests moderate but meaningful clustering of individual BMI within the intersectional strata (ICC = 12.4%). Compared with the population average (BMI = 26.07 Kg/m2), the stratum of cohabiting 18-35-year-old females with medium income and high education presents the lowest BMI (-3.7 Kg/m2), while cohabiting 36-64-year-old females with low income and low education show the highest BMI (+2.6 Kg/m2). In the second model, the ICC falls to 1.9%, suggesting the existence of only very small stratum specific interaction effects. We confirm the existence of a socioeconomic gradient in BMI. Compared with traditional analyses, the intersectional MAIHDA approach provides a better mapping of socioeconomic and demographic inequalities in BMI. Because of the moderate clustering, public health policies aiming to reduce BMI in Spain should not solely focus on the intersectional strata with the highest BMI, but should also consider whole population polices.

Políticas de austeridade fiscal: tentativa de desmantelamento do Sistema Nacional de Salud da Espanha e resistência cidadã

Resumo Este ensaio de natureza teórica analisa os ajustes fiscais colocados em marcha na Espanha como resposta à crise financeira de 2008, suas implicações para o Sistema Nacional de Salud (SNS) e a consequente resistência cidadã. Elaboramos um estudo de caso tendo como fonte primária a narrativa de um ator social que participou da reforma espanhola. Utilizamos também fontes secundárias para coleta de dados socioeconômicos e a análise de 20 artigos publicados pelo Relatório Sespas 2014. O SNS formou-se por aumento progressivo da cobertura populacional, financiamento total por impostos e organização da rede por meio da Atenção Primária em Saúde (APS). As medidas de austeridade fiscal impuseram limitações de ordem orçamentária, reduziram a provisão de serviços, introduziram copagamentos e retrocederam o direito à saúde à meritocracia. A corrente crítica da economia política sinaliza que o propósito dos ajustes econômicos é a transferência regressiva de renda e riqueza. As Mareas Ciudadanas constituíram-se numa resposta cidadã com êxito em muitas lutas sociais contra a austeridade fiscal. A alternativa de resistência e superação pela via política se fez presente com vigor na Espanha e tem resistido ao desmantelamento do SNS.

Influence of economic crisis on dietary quality and obesity rates

The objective was to investigate how socio-economic changes have modified body mass index values and dietary patterns in the Spanish population. A comparative cross-sectional analysis of the last two iterations of the Spanish National Health Survey (SNSH) was done. The independent variables were sex, age, education level, employment situation, and social class. Outcome variables were: poor diet quality and obesity. Economic crisis increases the probability to become obese and to have a poor diet and employment situation is the variable that showed the greatest differences between years. While in 2006 to be unemployed did not represent a risk to have a poor diet [odds ratio (OR): 0.74; p<.005], in 2012 it did (OR: 1.27; p<.005). Economic changes can modify diet quality and nutritional status, increasing the risk to have a poor diet or to be obese.

The Influence of Place of Residence, Gender and Age Influence on Food Group Choices in the Spanish Population: Findings from the ANIBES Study

Socioeconomic factors (SEF) can exert a great impact on food choices. However, limited data are available from the Spanish population. Our aim was to describe the influence of place of residence and habitat size on food group intakes. Data were obtained from the ANIBES study. A 3-day dietary record provided information on food and beverage consumption. Data analysis compared gender, age, Nielsen geographic areas, and habitat population size (urban, semi-urban, and rural). Place of residence did not appear to be a determinant for specific food group consumption during childhood and adolescence, as only higher intakes of non-alcoholic beverages were observed among children aged 9 to 12 years living in the East, when compared to those from the Northwest of Spain (p < 0.05). Food choices within adults (18 to 64 years) and seniors (65 to 75 years) were conditioned: sugar and sweets intake was significantly higher (p < 0.05) for adult men living in the Northwest than those from the South, and senior males from North Central areas had significantly higher consumption of eggs (p < 0.05) compared to the Northeast. Basic food group consumption was only affected during childhood and aging. Adults who inhabited rural areas consumed greater quantities of fats and oils than those from higher population densities (p < 0.01). Our results indicate that place of residence and habitat size have a limited influence on food choices, regardless of age and gender in the ANIBES study population. It is fundamental to acknowledge that other SEF variables are important and further studies are needed to monitor and assess these influences are warranted.

Regional differences in the prevalence of underweight, overweight and obesity among 13-year-old adolescents in Greece

Background and objectives

To assess regional differences in the weight status and abdominal obesity among 13-year-old Greek adolescents.

Design and setting

Cross-sectional, nationwide study in Greece.

Patients and methods

A representative sample of 4833 13-year-old adolescents (50.7% boys) was recruited throughout the nine regional districts of Greece from 2010 to 2012. Basic anthropometry measurements (weight, height, and waist circumference) were obtained. Abdominal obesity and weight status were assessed according to the International Obesity Task Force criteria.

Results

The majority of the sample had a healthy body weight (60.3%), 4.1% were underweight, 27.2% were overweight, and 8.5% were obese. For boys, the highest prevalence of underweight was recorded in Epirus, normal body weight on the Ionian Islands, overweight in Central Greece and Macedonia, and obesity on the Ionian Islands. Among girls, the highest underweight prevalence was on the Ionian Islands, normal body weight in Macedonia, overweight in Central Greece and Macedonia, and obesity in Crete. Abdominal obesity affected 12.9% of the sample, with the greatest prevalence among Cretan boys and Thracian girls. Additionally, residing on the Greek islands was associated with a higher prevalence of central adiposity.

Conclusion

Greek 13-year-old adolescents who are subjected to geographical changes exhibit high obesity and abdominal obesity rates. This study provides evidence to design regionally tailored interventions that aim to tackle and prevent the disease among the nine regional districts in Greece.

Development of the Spanish Healthy Food Reference Budget for an adequate social participation at the minimum

OBJECTIVE

It has been observed that diet quality and food choices vary depending on socio-economic status (SES), especially when measured through income and educational level. Although the reasons behind these differences are multiple, diet cost is a critical determinant in those groups that spend a higher proportion of their budget on food. Reference budgets are priced baskets containing the minimum goods and services necessary for well-described types of families to have an adequate social participation. In the current paper we describe the development and content of the Spanish Healthy Food Basket (SHFB).

DESIGN

National dietary guidelines were translated into monthly food baskets. Next, these baskets were validated in terms of acceptability and feasibility through focus group discussions, and finally they were priced.

SETTING

The focus group discussions and the pricing were performed in Barcelona, Spain.

SUBJECTS

Twenty adults aged 30-50 years from different SES backgrounds and their children aged 2-22 years participated in three discussion groups.

RESULTS

The SHFB complies with the dietary recommendations for the Spanish population. The monthly cost of this basket ranges from 131·63 € to 573·80 € depending on the type of family.

CONCLUSIONS

The SHFB does not have the purpose of prescribing what people should eat, but of estimating a minimum budget threshold below which healthy eating is not possible for well-described types of families. Thus, the SHFB is an educative guide on how to plan a healthy food budget and orient policies designed to guarantee food access and reduce SES inequalities.

Food consumption frequency and excess body weight in adolescents in the context of financial crisis in Barcelona (Spain)

OBJECTIVES

To describe food consumption frequency in adolescents in the context of the financial crisis in 2012, and to analyse potential fluctuations in excess body weight between 2008 and 2012.

METHOD

A cross-sectional study of eating habits and excess body weight was conducted in adolescents aged 13 to 19 years old from public, subsidised and private secondary schools in Barcelona, Spain. The FRESC lifestyle risk factors survey was used, and food frequency consumption, food recommendations and body mass index were analysed according to gender, year of education and socioeconomic status.

RESULTS

Girls ate vegetables and fruits more frequently than boys, while the prevalence of junk food consumption was higher in boys. The prevalence of compliance with food recommendations was lower than 50% for all foods, and gender and socioeconomic differences were found for eggs, red meat and soft drinks. Regarding excess body weight, boys had a higher prevalence than girls in the 2 years analysed. Furthermore, a reduction in excess body weight was observed among girls in secondary education in the highest socioeconomic groups (28.7% [95% CI: 24.8-32.6%] in 2008 to 20.5% [95% CI: 17.1-23.8%] in 2012).

CONCLUSIONS

The prevalence of adolescents following food recommendations is low, and gender differences were found in terms of food consumption frequency, even in the context of financial crisis. There is a need to promote programmes and policies to reduce inequalities related to eating habits and excess body weight in adolescents.

[Families of the economic crisis in paediatric Primary Care clinics: descriptive observational study]

OBJECTIVE

To study the impact of the economic crisis on the families of the children who attend Primary Health Care and its relationship with their socioeconomic status.

PATIENTS AND METHODS

Observational descriptive study was conducted by analysing the results of 453 questionnaires, given to the parents of children between 1 and 7 years old who attended 4 paediatric clinics in Madrid. The raw data was analysed, and comparisons between groups and multivariate analysis were performed.

RESULTS

In the multivariate analysis, the variables related to the non-acquisition of prescribed medication are: lower income level OR=0.118, p<.0001 and lower educational level OR=0.464, p<.001; the variables related to the reduction of food expenditure are: lower income level OR=0.100, p<.0001 and a higher number of family members OR=1.308, p=.045; the variables related to anti-pneumococcal vaccination without public funding are: higher income level OR=2.170, p=.0001, higher educational level OR=1.835, p=.013, and not being an immigrant OR=0.532, p=.037. The presence of health problems from the beginning of the economic crisis is related to unemployment OR=4.079, p=.032, lower educational level R=0.678, p=.042, and income level OR=0.342, p<.0001. In all cases, the models achieved a statistical significance of p<.0001.

CONCLUSIONS

The economic crisis has greater impact on the group with the lowest income level in all analysed variables. The lower educational level and higher number of family members has an impact on the reduction in food expenditure. The fact of being an immigrant has an impact on not receiving the anti-pneumococcal and rotavirus vaccination. Unemployment leads to an increase in health problems in the family. To sum up, the economic crisis has increased inequalities according to socioeconomic status.

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

In the aftermath of the Great Recession, public health scholars have grown increasingly interested in studying the health consequences of macroeconomic change. Reflecting existing debates on the nature of this relationship, research on the effects of the recent economic crisis has sparked considerable controversy. On the one hand there is evidence to support the notion that macroeconomic downturns are associated with positive health outcomes. On the other hand, a growing number of studies warn that the current economic crisis can be expected to pose serious problems for the public’s health. This article contributes to this debate 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. Available evidence defies deterministic conclusions, including increasingly “conventional” claims about economic downturns improving life expectancy and reducing mortality. While our results echo previous research in finding that the relationship between economic crises and population health is complex, they also indicate that this complexity is not arbitrary. On the contrary, changing social and political contexts provide meaningful, if partial, explanations for the perplexing nature of recent empirical findings.

Understanding the impact of the economic crisis on child health: the case of Spain

INTRODUCTION

The objectives of the study were to explore the effect of the economic crisis on child health using Spain as a case study, and to document and assess the policies implemented in response to the crisis in this context.

METHODS

Serial cross-sectional data from Eurostat, the Spanish Health Interview Survey, and the database of childhood hospitalisation were analysed to explore impacts on child health, and key determinants of child health. A content analysis of National data sources/government legislation, and Spanish literature was used to describe policies implemented following the crisis.

RESULTS

Unemployment rates in the general population (8.7% in 2005 and 25.6% in 2013), and children living in unemployed families (5.6% and 13.8%) increased in the study period. The percentage of children living under the poverty line, and income inequalities increased 15-20% from 2005 to 2012. Severe material deprivation rate has worsened in families with Primary Education, while the number of families attending Non-Governmental Organisations has increased. An impact on children's health at the general population level has not currently been detected; however an impact on general health, mental health and use of healthcare services was found in vulnerable groups. Investment in social protection and public policy for children showed a reduction as part of austerity measures taken by the Spanish governments.

CONCLUSIONS

Despite the impact on social determinants, a short-term impact on child health has been detected only in specific vulnerable groups. The findings suggest the need to urgently protect vulnerable groups of children from the impact of austerity.