In the face of austerity, a series of disconnected “reforms” could, without corrective measures, lead to the effective dismantling of large parts of the Spanish healthcare system, with potentially detrimental effects on health. Helena Legido-Quigley and colleagues explain The financial crisis has hit Spain hard. Initially, given its low government debt, Spain seemed safe, but it was forced to bail out its banks when the housing boom they had been fuelling finally collapsed.1 In the first quarter of 2013, 27% of the labour force were unemployed,2 including over 57% of the under 25s. Poverty has increased. Twenty one per cent of the Spanish population lived below the poverty line in 2012, on less than €7354 (£5980; $9599) annually.3 In June 2012 the Spanish government negotiated a €100bn intervention with the European Stability Mechanism (ESM) to support the banks. In 2012, the general government deficit reached 8.1% of GDP,4 against a target of 5.3%, and its debt rose from 26.7% of GDP in 2007 to 93.8% in 2012.5 Public expenditure on healthcare is low. Although, in 2010, Spain spent 9.6% of GDP on healthcare, 26% of this was from private sources (6% private insurance and the remaining 20% paid by individuals) and 74% was public, with the latter equivalent to 7.0% of GDP, compared to an average of 7.6% in the European Union.6 Yet the Spanish health system is viewed positively by the public. In a 2011 national survey 73.1% of 7800 individuals said that the Spanish system was working fairly well or well.7 Professional dissatisfaction (attributed to low salaries), procurement problems, and limited access to some specialties were issues before the crisis. However, the Spanish system performed better than neighbouring countries.8 The national health ministry is responsible for the equitable functioning of …

Hegemonic masculinity has been recognized as contributing to the perpetration of different forms of gender-based violence (GBV). Abandoning hegemonic masculinities and promoting positive masculinities are both strategies used by interventions that foreground a “gender-transformative approach.” Preventing GBV among young people could be strengthened by engaging young men. In this article, we aim to systematically review the primary characteristics, methodological quality, and results of published evaluation studies of educational interventions that aim to prevent different forms of GBV through addressing hegemonic masculinities among young people. We conducted a systematic review of available literature (2008–2019) using Medline (PubMed), Scopus, Web of Science, PsycInfo, the CINAHL Complete Database, and ERIC as well as Google scholar. The Template for Intervention Description and Replication was used for data extraction, and the quality of the selected studies was analyzed using the Mixed Method Appraisal Tool. More than half of the studies were conducted in Africa (n = 10/15) and many were randomized controlled trials (n = 8/15). Most of the studies with quantitative and qualitative methodologies (n = 12/15) reported a decrease in physical GBV and/or sexual violence perpetration/victimization (n = 6/15). Longitudinal studies reported consistent results over time. Our results highlight the importance of using a gender-transformative approach in educational interventions to engage young people in critical thinking about hegemonic masculinity and to prevent GBV.

Aims: To analyze the temporal and geographical distribution of different indicators for the evolution of intimate partner violence against women (IPV) before, during and after the COVID-19 induced lockdown between March and June 2020 in Spain. Methods: Descriptive ecological study based on numbers of 016-calls, policy reports, women killed, and protection orders (PO) issued due to IPV across Spain as a whole and by province (2015–2020). We calculated quarterly rates for each indicator. A cluster analysis was performed using 016-call rates and protection orders by province in the second quarters of 2019 and 2020. ANOVAs were calculated for clustering by province, unemployment rates by province, and the current IPV prevalence. Results: During the second quarter of 2020, the highest 016-call rate was recorded (12.19 per 10,000 women aged 15 or over). Policy report rates (16.62), POs (2.81), and fatalities (0.19 per 1,000,000 women aged 15 or over) decreased in the second quarter of 2020. In the third quarter, 016-calls decreased, and policy reports and POs increased. Four clusters were identified, and significant differences in unemployment rates between clusters were observed (F = 3.05, p < 0.05). Conclusions: The COVID-19 lockdown fostered a change in IPV-affected women’s help-seeking behavior. Differences between the volume of contacts made via 016-call and the policy reports generated provide evidence for the existence of barriers to IPV-service access during the lockdown and the period of remote working. More efforts are needed to reorganize services to cope with IPV in non-presential situations. The provinces with the highest 016-call and PO rates were also those with the highest rates of unemployment, a worrying result given the current socioeconomic crisis.

Objective. To determine the social class gradient in health in general Spain population and the health status of the Spanish Roma. Design. The National Health Survey of Spanish Roma 2006 (sample size = 993 people; average age: 33.6 years; 53.1% women) and the National Health Surveys for Spain 2003 (sample size: 21,650 people; average age: 45.5 years; 51.2% women) and 2006 (sample size: 29,478 people; average age: 46 years; 50.7% women) are compared. Several indicators were chosen: self-perceived health, activity limitation, chronic diseases, hearing and sight problems, caries, and obesity. Analysis was based on age-standardised rates and logistic regression models. Results. According to most indicators, Roma's health is worse than that of social class IV–V (manual workers). Some indicators show a remarkable difference between Roma and social class IV–V: experiencing three or more health problems, sight problems, and caries, in both sexes, and hearing problems and obesity, in women. Conclusion. Roma people are placed on an extreme position on the social gradient in health, a situation of extreme health inequality.

El pueblo romaní o gitano constituye la principal minoría étnica en España. Presente en el país desde hace más de 500 años, las estimaciones disponibles señalan que su población oscila entre 700.000 y 970.000 personas, lo cual supone entre el 1,5% y el 2,1% de la población total. Según diferentes informes publicados sobre sus condiciones de vida, el pueblo gitano sufre mayores niveles de exclusión social que el resto de la población

Socioeconomic crisis and humanitarian disasters can cause increased stress for women who experience inter-partner violence (IPV). This study analyzed the impact of the COVID-19 lockdown on this important issue, their related health and social services and working conditions from the perspectives of professionals in different sectors. Forty-three semi-structured interviews were carried out with 47 professionals (44 women and 3 men) from 40 different entities (September 2020—April 2021). This content analysis suggests that the pandemic and its associated prevention measures have had a negative impact on women exposed to IPV and their children, which affected their social wellbeing. Professionals described burnout, difficult and slow administrative processes, and problems with coordination and access to information. These negative impacts were mitigated, in part, by the work of professionals, but this suggests that a series of key strategies are needed to improve the response capacity of the service sector to IPV in situations of crisis. These improvements are related to the availability of human and material resources; an efficient coordination network between the professionals from different sectors; existence of informal support networks in the community; protocols/procedures and prior training for better implementation; and greater flexibility and accessibility of basic services that benefit women who experience IPV.