[Social inequities of health in Spain. Report of the Scientific Commission for the Study of Social Inequities in Health in Spain].
In 1993 the Ministry of Health of the Spanish Government appointed a Scientific Commission to analyze social inequalities in health in Spain, as well as to make recommendations for improving Spanish health, through the practical implementation of public policies to reduce existing inequalities. The present report is the result of the work carried out by the said Commission. It has the following aims: first, to present a general introduction to the topic of social inequalities in health; second, to offer a global vision of the topic in Spain based upon the editing of available information: finally, to encourage the need for an in-depth analysis of the study and the reduction in social inequalities in health in the scientific and social fields, offering illustrative examples. The first chapter points out the importance of the topic, and Spain is located in the international historical and geographical context. The second chapter presents the most important concepts regarding the definition and measurement of health and inequality. The third and fourth chapters review various international and national studies of particular importance, and the Spanish case includes the current limitations to research. The fifth chapter presents two original investigations on the four perspectives of social inequalities in health in Spain: death rate, noticeable health, conducts related to health and the use and access to health services. Chapter six comments on some examples of policies aimed at reducing inequalities in health. Finally, the seventh chapter summarises the main conclusions of the report and makes some recommendations both for the improvement of current information systems as well as for obtaining the main conclusions for the health policies. Amongst the report's main conclusions the following may be pointed out: 1) an ecological study on the social inequalities in the death rate of small areas between 1990-1992 has revealed the existence of inequalities at a small area level. Autonomous Communities and regions. Inequality is confirmed between North-Northwestern Spain (with a high level) and South-Southwestern Spain (with a low level). Likewise, a positive relationship may be observed between various social indicators and the death rate; 2) the analysis of health surveys for 1987 and 1993 according to social class has revealed the existence of inequalities in health. Thus, in most of the health variables studied regarding the state of health-the conducts related to health or health services-the most disadvantaged social classes present greater health problems; 3) the political social and health experiences carried out in the Basque Country and Barcelona respectively, aimed at improving living standards, social welfare and the health of the most vulnerable sectors of the population have been positive and should be expanded and studied in depth; 4) the study and decrease of social inequalities in health by putting into practice social and health public policies should be a main objective of all political and social forces.
Navarro López
V
V
Escuela Nacional de Sanidad, Ministerio de Sanidad y Consumo, España.
Benach de Rovira
J
J
D006304:Health Status; D006306:Health Surveys; D006801:Humans; D012924:Social Conditions; D013030:Spain