Demographic Analysis of Socioeconomic Health Inequalities in Catalonia in the Context of the Latest Economic Crisis: Gender, Generation and Territory

Jeroen Spijker, Autonomous University of Barcelona (UAB)
Jordi Bayona-i-Carrasco, CED, Barcelona
Tere Menacho, Centre d''Estudis Demogràfics
Antonio Medina, Centre d''Estudis Demogràfics

The economic crisis hit Catalonia in 2008 and its impact has led to a growing concern for population health in the medium and short term. Concomitantly, the new economic context and EU pressures have meant budget reductions by public administrations to meet public deficit objectives. However, budget cuts compromise the functioning of public health and therefore the health of individuals as they cannot receive the same benefits in medical assistance as before. This is especially the case for the most unfavourable groups.

Perhaps paradoxically however, the relationship between economic crisis and health status at the population level is still unclear as studies have shown contradictory results. The present study therefore aims to analyse socioeconomic health inequalities, paying specific attention to the impact of both an economic boom and bust. Using data from the Catalan Health Survey (ESCA) for the years 2002 (pre-boom), 2006 (boom), 2010-12 (early crisis) and 2013-15 (late crisis) the main research question addressed is whether “economic up- and downturns affect the association between socioeconomic factors and different health and behavioural indicators”. Regarding the latter, these include self-reported health, mental health, GALI, physical activity and the consumption of tobacco, alcohol and medicines. The 50+ population is studied and individual-level data are used.

Preliminary results show little change in self-reported health up to the economic boom among men and a substantial worsening among women. Improvements are observed during the economic crisis among both sexes, especially among lower SES categories. Mental health worsened during the early-crisis period but improved greatly during the late-crisis period for both the employed and non-employed. Among the non-employed, mental health also worsened during the boom-years.

While low SES groups have worse health than high SES groups, changes are mainly anti-cyclical. Results on other health indicators and policy implications will be discussed in final paper.


Background:Over the last 25 years life expectancy in Catalonia has not stopped increasing,even during the lingering economic crisis that hit the region in 2008.Nevertheless, the impact of the crisis led to a growing concern for populationhealth in the medium and short term. Concomitantly, ensuing the new economiccontext and pressured by the EU, public administrations reduced their budgetsto meet public deficit objectives. This included means destined for publichealth despite, which, in times of economic crisis, should receive more ratherthan fewer resources to cover the health needs of the most unfavourable groups.

Perhapsparadoxically, however, the relationship between economic crisis and healthstatus at the population level is still unclear as national and internationalstudies have shown contradictory results. The purpose of the present study istherefore to analyze health inequalities based on the socioeconomic profile ofthe Catalan population with specific attention to the impact of the crisis onolder adults (50+). Our interest in this specific age group lies in the factthat they experienced rapid social, cultural and economic changes andimprovements in public health later but at a faster rate than in Western Europeand earlier than in most other Spanish regions. Such development led togeneration-specific factors that have played an important role in determiningtheir health. If we then consider the speed of these changes that affectedespecially those born after the Spanish Civil War (50-74 year olds) such as theincrease in life expectancy due to the rapid improvement in living conditions,educational expansion (especially among women) and change to a tertiary sectordominated economy, it is plausible to assume that the relationship betweensocio-economic status and health varies across these generations. Toillustrate, the education expansion that started in the 1960s was thefoundation of the current heterogeneity of socioeconomic profiles: among theolder generations the proportion of the population with higher education isvery low and concentrated in men, but increases and becomes more gender equalamong younger generations. A priori the relationship between socioeconomicstatus and health is therefore expected to show greater complexity for morerecent cohorts.

General researchobjective: To study the effect of the recent economic crisis on therelationship between sociodemographic factors and health, basing it on threeanalytical axes: the socioeconomic level, gender and generation. Each isaddressed by considering the possible impact of economic change:

  1. To study whether the relationship between SES and health has been constant between different generations. The null hypothesis is that SES does not have an equal effect on health across generations.
  2. Study the effect of the recent economic crisis on the relationship between socioeconomic status and health. The null hypothesis is that this has been more acute among lower socioeconomic classes than among higher classes.
  3. To study the differences between men and women in the two previous objectives. The null hypothesis is that the unequal socioeconomic profile of men and women has resulted in a gender-differentiated association between SES and health, both in the long-term (generations) and during economic cycles. This conjecture is based on the fact that economic cycles have different effects on male and female labour force participation as well as on the subjective dimension of one’s health.

Data and method:The Catalan Health Survey (ESCA) is used to analyse four different periods:2002 (pre-boom), 2006 (boom), 2010-12 (early crisis) and 2013-15 (late crisis).The health indicators include self-reported health, mental health (GHQ-12),GALI, disability, physical activity and the consumption of tobacco, alcohol andmedicines and are analysed according the five different socioeconomicindicators, namely educational level, social class, household income, labourforce activity and type of health care coverage.

Preliminaryresults: Little change is observed in self-reported health during the economicboom among men and a substantial worsening among women. Improvements areobserved during the economic crisis among both sexes, especially among lowerSES categories (see Figure 1 for education), even when categories of differentSES indicators are crossed (e.g. education, social class, household income,health insurance with employment status - see Table 1). Mental health worsenedduring the early-crisis period but improved greatly during the late-crisis periodfor both the employed and non-employed. Among the non-employed, mental healthalso worsened during the boom-years.

Discussion:While low SES groups have worse health than high SES groups, changes are mainlyanti-cyclical. Moreover, between 2002 and 2013-15 a clear convergence ratherthan divergence in SES health differences can be observed. Results on otherhealth indicators and policy implications will be discussed in the final paper.

Figure 1.Self-reported health among the 50+ living in Catalonia according to educationalattainment

Table 1. Self-reported health among50-64 year-olds living in Catalonia according to different combinations ofemployment status and other SES.

Presented in Session 1234: Posters