Social determinants of health are major factors responsible for a population's health and health inequalities.1 Public health surveillance was originally developed for the control of infectious diseases, but today its principles have also been applied to other public health problems such as chronic diseases and occupational and traffic injuries.2 Many countries already collect data on social determinants of health, dispersed across different information systems typically designed for other purposes. However, most social determinants of health remain outside surveillance systems and this area of public health remains limited or marginal within mainstream policy practice. Surveillance of social determinants of health is therefore a neglected but essential and challenging public health issue. The WHO Commission on Social Determinants of Health strongly recommended the creation of National Health Equity Surveillance Systems, with routine data collection on the social determinants of health and health equity, and investment in training of policy-makers and health practitioners in equity monitoring and health equity impact assessment.1 Such investment was given further priority by international organisations and member states through the adoption of a World Health Assembly Resolution on social determinants of health in May 2009, and further reaffirmed in the Rio Political Declaration on Social Determinants of Health in October 2011.3 Likewise, the former Spanish Minister of Health and Social Policy launched ‘Innovation in Public Health: Monitoring Social Determinants of Health and Reduction of Health Inequalities’ as a top priority for the Spanish presidency of the European Union in the first semester of 2010.4 In spite of these initiatives, however, today there is no comprehensive surveillance system capable of globally or nationally monitoring social determinants and their relationship with health inequalities. …

The growth of poor jobs related to economic crisis adds to its increase since the mid-1970s as a result of new forms of flexible employment. In Europe, there is no clear evidence on whether working in a poor-quality job is better for mental wellbeing than being unemployed. The objectives of this study were to compare mental wellbeing between the unemployed and those working in jobs with different quality levels and to examine gender and welfare state differences in Europe. We selected 8324 men and 7496 women from the European Social Survey, 2010. Hierarchical multiple logistic regression models were fitted, separated by sex and country group. No significant differences in mental wellbeing were shown between unemployed-non-active, unemployed-active, and those working in low-quality jobs in either sex. Only men from Conservative countries in low-quality jobs had better mental wellbeing than unemployed (non-active) men. Only having a good-quality job reduced the likelihood of poor mental wellbeing compared with being unemployed (non-active) among men in all countries (except Social-Democratic) and among women in Eastern and Southern European countries. No differences were observed among men or women in Social-Democratic countries, while strong gender differences were found in Conservative and Liberal countries. Our study indicates the need to take job quality into account, in addition to creating jobs during economic crises. The main mechanisms to explain the strong gender and welfare state differences identified could be social protection for unemployed, labor market regulations, and family models.

Background: Municipalities are important actors in the implementation of policies to tackle health inequalities, which requires political will, the availability of financial support, and technical and human resources. With the aim of aligning with local government political priorities, in 2017 the Barcelona Public Health Agency (Agència de Salut Pública de Barcelona, henceforth ASPB), which is responsible for the public health functions of the city, launched a strategy to improve the approach to tackling health inequalities in all its services. The objectives of this study were to show how social health inequalities were addressed in the ASPB from 2017 to 19 and to describe which actions were proposed after a participatory process aiming to create a plan to systematically incorporate health inequalities in ASPB actions.Methods: The ASPB has 304 workers, 8 directors and 20 services or departments. Participatory methodologies were carried out: 1) semi-structured interviews with department heads (N = 12, 60%); 2) world cafe workshops open to a group of workers (N = 63, 37%); 3) aQuick and Colorfulvoting session open to a group of workers (N = 108, 63%); and 4) Hanlon matrix with 19 actions to be prioritized (N = 12 services, 60%).Results: Semi-structured interviews and world cafe workshops provided 40 potential actions. After a step by step process of participatory prioritization, seven lines of action emerged: 1) to make progress in collaborative networking; 2) to promote policy evaluation; 3) to increase the ability of the ASPB to evaluate policies to reduce health inequalities; 4) to incorporate the axes of inequalities in all ASPB products; 5) to improve information on vulnerable groups; 6) to incorporate the gender perspective; and 7) to participate in an internal training plan to address health inequalities.Conclusions: The participation of ASPB public health professionals and staff allowed the organization to design a shared plan of actions to address health inequalities. This experience could be useful for other municipalities whose political agendas include tackling inequalities in health.

Lone mothers report worse health and adopt more risky health behaviours than couple mothers, as largely documented in several European countries, but not deeply in Spain. The primary aim of this study was to identify the possible existence of inequalities in health and health behaviours between couple and lone mothers in Spain by occupational social class and employment status. A second aim was to explore whether any inequalities were influenced by the economic crisis beginning in 2008, analysing changes in inequalities between 2003-2004 and 2011-2012. Two waves of the cross-sectional Spanish National Health Survey data were used. Analyses were restricted to mothers aged 16-64 years, with at least one child aged 18 years or younger. The sample consisted of 2982 mothers in 2003-2004 and 3070 in 2011-2012, representing more than 80% of couple mothers. Two health outcomes and two health behaviour measurements were used. Robust Poisson regression was run to estimate inequalities between couple and lone mothers, calculating prevalence ratios adjusted by age and stratified by social class and employment status. We found inequalities in health and health behaviours between couple and lone mothers in Spain amongst the manual social class, with lone mothers reporting a more than 30% higher prevalence of poor self-perceived health and being smoker in both time points of study compared with couple mothers. Furthermore, lone mothers were at 50% higher risk of having at least one selected chronic condition and 86% higher probability of sleeping less than 6 hours/day in 2011-2012 This study could not confirm that inequalities between couple and lone mothers changed in Spain during the study period, although some patterns were noticeable. Inequalities pointed towards an increase amongst mothers in the manual social class with paid employment, while inequalities amongst unemployed mothers (both manual and non-manual social class) pointed towards a decrease.