title: Understanding the impact of the economic crisis on child health: the case of Spain.
abstract: BACKGROUND
  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.
authors.affiliation: Agència de Qualitat i Avaluació Sanitàries de Catalunya, Roc Boronat 81-95 2nd Floor, Barcelona, 08005, Spain. lrajmil@gencat.cat.|IMIM (Institut Hospital del Mar de Recerca Biomèdica) Barcelona, Barcelona, Spain. lrajmil@gencat.cat.|Centro de Investigación Epidemiológica en Red de Epidemiolgìa y Salud Pública CIBERESP, Madrid, Spain. lrajmil@gencat.cat.
authors.forename: Luis
authors.initials: L
authors.lastname: Rajmil
authors.affiliation: Divisions of Epidemiology and Social and Behavioral Sciences, Dalla Lana School of Public Health, University of Toronto, Ontario, Canada.|Department of Health Behavior, Gillings School of Global Public Health, University of North Carolina, Chapel Hill, USA.
authors.forename: Arjumand
authors.initials: A
authors.lastname: Siddiqi
authors.affiliation: Clinical Senior Lecturer Department of Public Health and Policy, Whelan Building, University of Liverpool, Liverpool, UK.
authors.forename: David
authors.initials: D
authors.lastname: Taylor-Robinson
authors.affiliation: Emeritus Professor of Child Health, Division of Mental Health and Wellbeing, Warwick Medical School, University of Warwick, Coventry, CV4 9JD, UK.|, 86, Leicester Street, Leamington Spa, CV32 4 TB, UK.
authors.forename: Nick
authors.initials: N
authors.lastname: Spencer
mesh_terms: D000293:Adolescent; D002648:Child; D000067576:Child Health / Q000191:economics*; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D057172:Economic Recession; D005260:Female; D006306:Health Surveys; D006801:Humans; D007223:Infant; D008297:Male; D013030:Spain