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).
BACKGROUND
The objective of this study was to estimate changes over time in health status and selected health behaviours during the Great Recession, in the period 2011/12, in Spain, both overall, and according to socioeconomic position and gender.


METHODS
We applied a before-after estimation on data from four editions of the Spanish National Health Survey: 2001, 2003/04, 2006/07 and 2011/12. This involved applying linear probability regression models accounting for time-trends and with robust standard errors, using as outcomes self-reported health and health behaviours, and as the main explanatory variable a dummy "Great Recession" for the 2011/12 survey edition. All the computations were run separately by gender. The final sample consisted of 47,156 individuals aged between 25 and 64 years, economically active at the time of the interview. We also assessed the inequality of the effects across socio-economic groups.


RESULTS
The probability of good self-reported health increased for women (men) by 9.6 % (7.6 %) in 2011/12, compared to the long term trend. The changes are significant for all educational levels, except for the least educated. Some healthy behaviours also improved but results were rather variable. Adverse dietary changes did, however, occur among men (though not women) who were unemployed (e.g., the probability of declaring eating fruit daily changed by -12.1 %), and among both men (-21.8 %) and women with the lowest educational level (-15.1 %).


CONCLUSIONS
Socioeconomic inequalities in health and health behaviour have intensified, in the period 2011/12, in at least some respects, especially regarding diet. 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.
Agència de Salut Pública de Barcelona, Barcelona, Spain. xbartoll@aspb.cat.|Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain. xbartoll@aspb.cat.
Xavier
X
Bartoll
Health Economics Group, Norwich Medical School, University of East Anglia, Norwich, United Kingdom. V.Toffolutti@uea.ac.uk.
Veronica
V
Toffolutti
Agència de Salut Pública de Barcelona, Barcelona, Spain. dmalmusi@aspb.cat.|CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. dmalmusi@aspb.cat.|Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain. dmalmusi@aspb.cat.
Davide
D
Malmusi
Agència de Salut Pública de Barcelona, Barcelona, Spain. lpalenci@aspb.cat.|CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. lpalenci@aspb.cat.|Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain. lpalenci@aspb.cat.
Laia
L
Palència
Agència de Salut Pública de Barcelona, Barcelona, Spain. cborrell@aspb.cat.|CIBER Epidemiología y Salud Pública (CIBERESP), Barcelona, Spain. cborrell@aspb.cat.|Universitat Pompeu Fabra, Barcelona, Spain. cborrell@aspb.cat.|Institute of Biomedical Research (IIB-Sant Pau), Barcelona, Spain. cborrell@aspb.cat.
Carme
C
Borrell
Centre for Health Economics, University of York, York, United Kingdom. marc.suhrcke@york.ac.uk.|Centre for Diet and Activity Research (CEDAR), Institute of Public Health, Cambridge, United Kingdom. marc.suhrcke@york.ac.uk.
Marc
M
Suhrcke
D000328:Adult; D003430:Cross-Sectional Studies; D057172:Economic Recession; D005260:Female; D015438:Health Behavior; D006304:Health Status; D054624:Health Status Disparities; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D057566:Self Report; D012923:Social Class; D012959:Socioeconomic Factors; D013030:Spain / Q000453:epidemiology; D055815:Young Adult