"The impact of social policies on gender inequalities in health" by Laia Palència and Davide Malmusi, in the framework of the final conference of the European research project SOPHIE. 29th September 2015, Brussels

1. The
impact
of
social
policies
on
gender
inequali5es
in
health
SOPHIE
project
findings
Laia
Palència,
Davide
Malmusi
“The
impact
on
health
and
equity
of
social
and
economic
policies”,
Brussels,
29.9.2015

2. The
impact
of
social
policies
on
gender
inequali5es
in
health
Cross-­‐na5onal
comparisons
Gender
inequaliNes
in
health
are
larger
in
countries
with
policies
less
oriented
towards
gender
equality
Country
case
studies
Public
services
for
disabled
people
can
improve
the
health
of
family
caregivers
(Spain’s
Dependence
Act)
Parental
leave
and
gendered
Nme
use
in
Sweden
and
Spain
Lone
mothers’
health
in
Spain
How
to
resist
austerity:
the
case
of
the
Gender
BudgeNng
strategy
in
Andalusia

3. 1.
Family
policy
models
and
gender
inequali5es
in
health:
cross-­‐na5onal
comparisons
Laia
Palència,
Deborah
De
Moortel,
Lucía
Artazcoz
et
al.
Agència
de
Salut
Pública
de
Barcelona

4. 1. Cross-­‐na5onal
comparisons
Background
(different
policies
that
can
affect
the
sexual
division
of
labour
and
the
conciliaNon
between
labour
and
family
life):
These
arrangements
can
influence
men
and
women’s
health.
European
countries
have
different
family
policy
models

5. 1. Cross-­‐na5onal
comparisons
What
we
did
A.
Compared
men
and
women’s
self-­‐perceived
health
and
mental
health
in
the
different
family
policy
models.
1.
Palència
L
et
al.
The
influence
of
gender
equality
policies
on
gender
inequaliNes
in
health
in
Europe.
Soc
Sci
Med.
2014;117:25-­‐33.
2.
De
Moortel
D
et
al.
Neo-­‐Marxian
social
class
inequaliNes
in
the
mental
well-­‐being
of
employed
men
and
women….
Soc
Sci
Med.
2015;128:188-­‐200.
3.
De
Moortel
D
et
al.
Contemporary
employment
arrangements
and
mental
well-­‐being
in
men
and
women
across
Europe:
a
cross-­‐secNonal
study.
Int
J
Equity
Health.
2014;13:1-­‐14.
B.
Analysed
whether
combining
employment
and
family
loads
affects
health
differently
in
the
different
family
policy
models.
4.
Artazcoz
L
et
al.
Combining
employment
and
family
in
Europe:
the
role
of
family
policies
in
health.
Eur
J
Public
Health.
2014;24:649-­‐55.

6. 1. Cross-­‐na5onal
comparisons
What
we
did.
InequaliNes.
A.
Compared
men
and
women’s
self-­‐perceived
health
and
mental
health
in
the
different
family
policy
models.
B.
Analysed
whether
combining
employment
and
family
loads
affects
health
differently
in
the
different
family
policy
models.
Data
from
the
European
Social
Survey
2010.
Analysed
age-­‐
standardised
prevalence
of
poor
self-­‐perceived
health
among
men
and
women
(1)
and
prevalence
of
poor
mental
well-­‐being
among
wage
earner
men
and
women,
overall
(2,3)
and
according
to
social
class
(3).

7. 1. Cross-­‐na5onal
comparisons
What
we
found.
InequaliNes.
Women’s
self-­‐
perceived
health
is
poorer
than
men’s
in
Tradi5onal
(Central
and
Southern)
and
contradictory
countries,
especially
in
Southern
Europe.
Palència
L
et
al.
Soc
Sci
Med.
2014;117:25-­‐33.

8. Women’s
mental
health
is
poorer
than
men’s,
especially
in
Southern
and
market
oriented
countries.
Gender
inequaliNes
in
mental
well-­‐being
are
concentrated
among
unskilled
workers
in
Southern
countries
but
are
marked
and
widespread
in
market
oriented
countries.
1. Cross-­‐na5onal
comparisons
What
we
found.
InequaliNes
De
Moortel
D
et
al.
Soc
Sci
Med.
2015;128:188-­‐200.

9. 1. Cross-­‐na5onal
comparisons
What
we
did.
Employment
and
family.
A.
Compared
men
and
women’s
self-­‐perceived
health
and
mental
health
in
the
different
family
policy
models.
B.
Analysed
whether
combining
employment
and
family
loads
affects
health
differently
in
the
different
family
policy
models.
Data
from
the
European
Working
CondiNons
Survey
of
2010.
Married
or
cohabi5ng
employees
aged
25-­‐64.
Analysed
risk
of
poor
self-­‐perceived
health
and
poor
mental
well-­‐being
according
to
working
hours
and
family
loads
(number
of
children,
elderly).

10. 1. Cross-­‐na5onal
comparisons
What
we
found.
Employment
and
family.
In
the
Nordic
countries
and
Eastern
Europe,
which
have
beier
public
services
to
outsource
the
care
of
children
and
dependents,
men
and
women
with
long
working
hours
or
family
responsibiliNes
generally
don’t
see
their
health
affected.
Among
married
or
cohabiNng
employees
in
Central
and
Southern
Europe,
long
working
hours
and
family
responsibiliNes
are
bad
for
the
health
of
men
and
women,
more
consistently
on
women.
Artazcoz
L
et
al.
Eur
J
Public
Health.
2014;24:649.55.

11. 1. Cross-­‐na5onal
comparisons
What
we
did
and
found.
Video.
https://youtu.be/L98_NaNIzGc
Video
on
how
more
equity-­‐oriented
family
policy
models
are
related
with
lower
gender
inequaliNes
in
health
in
Europe.

12. 2.
Mixed-­‐method
evalua5on
of
the
impact
of
the
Dependence
Act
on
the
health
of
family
caregivers
in
Spain
María
Salvador
Piedrafita,
Davide
Malmusi,
Carme
Borrell
et
al.
Agència
de
Salut
Pública
de
Barcelona

13. 2.
Evalua5on
of
the
Dependence
Act
Background
In
Spain,
over
80%
of
the
care
to
dependent
people
is
provided
by
relaNves
-­‐
mostly
women,
and
in
low
socio-­‐economic
posiNon.
The
physical
and
mental
health
impacts
of
this
informal
caregiving
are
well
documented.
The
2006
“Ley
de
Dependencia”
established
the
universal
right
to
social
services
(at
home
or
in
care
centres)
and
benefits
(economic
contribuNon
for
family
caregivers)
for
people
in
need
of
long-­‐term
care.
ImplementaNon
of
the
Act
has
been
delayed
by
budgetary
constraints,
more
so
aler
2012
austerity
cuts.

14. 2.
Evalua5on
of
the
Dependence
Act
What
we
did
Did
the
Dependence
Act
improve
the
quality
of
life
and
health
of
family/informal
caregivers?
Mixed
method
evalua5on:
A. Qualita5ve
data
collec5on
with
Concept
Mapping
hip://bit.ly/salvador14
B. Quasi-­‐experimental
pre-­‐post
survey
analysis
hip://bit.ly/salvador15iberoepi
(in
Spanish)

15. 2.
Evalua5on
of
the
Dependence
Act
What
we
did.
Concept
Mapping
Mixed
method
evalua5on:
A. Qualita5ve
data
collec5on
with
Concept
Mapping
Groups
of
caregivers
of
dependent
people
receiving
benefits
from
the
Act
(total
16)
and
of
Primary
Health
Care
professionals
(21).
Focus
quesNon:
“A
way
in
which
the
Dependence
Act
has
affected
my
quality
of
life
(caregivers’
quality
of
life)
is…”
1. Brainstorming
session
>
list
of
statements
2. ParNcipants
individually
rate
statements
and
sort
them
in
piles
3. Analysis
>
representaNon
in
maps
and
group
interpretaNon
B. Quasi-­‐experimental
pre-­‐post
survey
analysis

16. 2.
Evalua5on
of
the
Dependence
Act
What
we
found.
Concept
Mapping
1
2
3
4
5
6
7
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
1. Caregivers’ employment
conditions2.Economic
4.Inconveniences with
the law and its
implementation
3.Technical, insitutional and
service support
6.Emotional health,
relationships and
personal growth
7. Sharing of care
5.Physical health
Cluster
map,
primary
healthcare
professionals
“A
way
in
which
the
Act
has
affected
caregivers’
quality
of
life
is…”

17. Caregivers’
raNng
of
importance
and
saNsfacNon
by
cluster
2.
Evalua5on
of
the
Dependence
Act
What
we
found.
Concept
Mapping
r = -.65
4.5
2.5
4.5
2.5
Condiciones de concesión de las ayudasRecursos económicos
Tiempo y cuidado personalResponsabilidad cuidado y otras dedicaciones
Compartir cuidadoTiempo y cuidado personal
Recursos económicosCompartir cuidado
Responsabilidad cuidado y otras dedicacionesCondiciones de concesión de las ayudas
Condi5ons
related
to
gran5ng
of
benefits
Sharing
the
burden
of
care
Time
and
personal
care
Caring
responsabili5es
and
dedica5ons
to
other
ac5vi5es
Economic
resources
Caring
responsabili5es
and
dedica5ons
to
other
ac5vi5es
Economic
resources
Sharing
the
burden
of
care
Time
and
personal
care
Condi5ons
related
to
gran5ng
of
benefits
r=-­‐0.65
2.5
4.5
2.5
4.5

18. 2.
Evalua5on
of
the
Dependence
Act
What
we
did.
Health
Surveys
analysis
Mixed
method
evalua5on:
A. Qualita5ve
data
collec5on
with
Concept
Mapping
B. Quasi-­‐experimental
pre-­‐post
survey
analysis
Data
from
the
Spanish
NaNonal
Health
Survey
2006
(pre-­‐Act)
and
2012
(post-­‐Act).
EvoluNon
of
health
indicators
in
3
different
groups:
cohabitants
of
a
disabled
person
who
were
their
lone
carers
(“alone
caregiving”),
who
shared
the
care
with
other
persons
(“shared
caregiving”),
and
who
were
not
responsible
of
care
or
non-­‐cohabitants
(“non
caregiving”)
Age-­‐standardized
%
of
poor
self-­‐rated
health,
poor
mental
health,
chronic
back
pain,
psychotropic
drug
use.

19. 2.
Evalua5on
of
the
Dependence
Act
What
we
found.
Health
Surveys
analysis
Women
Men
Health
indicators
improved
more
in
caregivers
–
above
all
those
sharing
the
care
–
than
in
non-­‐
caregivers.
In
2012,
women
caring
alone
had
diminished
but
were
sNll
the
largest
group
and
the
one
with
poorest
health.

20. The
impact
of
social
policies
on
gender
inequali5es
in
health.
Conclusions
Policies
that
support
women’s
parNcipaNon
in
the
labour
force
and
decrease
their
burden
of
care,
such
as
increasing
public
services
and
support
for
families
and
enNtlements
for
fathers,
are
related
to
lower
levels
of
gender
inequality
in
terms
of
health.
Public
services
and
benefits
for
disabled
and
dependent
people
can
reduce
the
burden
placed
on
their
family
caregivers
and
hence
improve
their
health.

21.
sophie-­‐project.eu
@sophieproject
info@sophie-­‐project.eu