Unequal impact of the Covid-19 pandemic on excess deaths, life expectancy, and premature mortality across Spanish regions in 2020 and 2021

Spain is one of the most heavily affected countries by the Covid-19 pandemic. In this study, we estimated the regional inequalities in excess deaths and premature mortality in Spain. Between January 2020 and June 2021, an estimated 89,200 (men: 48,000; women: 41,200) excess deaths occurred in the 17 Spanish regions with a substantial variability (highest in Madrid: 22,000, lowest in Canary Islands: -210). Highest reductions in life expectancy at birth (e0) in 2020 were observed in Madrid (men: -3.48 years, women: -2.15), Castile La Mancha (men: -2.67, women: -2.30), and Castile and León (men: -2.00, women: -1.32). In the first six months of 2021, the highest reduction in e0 was observed in Valencian Community (men: -2.04, women: -1.63), Madrid (men: - 2.37), and Andalusia (men: -1.75; women: -1.43). In some Spanish regions, life expectancy at age 65 during the Covid-19 pandemic in 2020 was comparable to that observed as far back as 20 years ago

The healthy migrant effect in primary care

Objective: To compare the morbidity burden of immigrants and natives residing in Aragón, Spain, based on patient registries in primary care, which represents individuals’ first contact with the health system. Methods: A retrospective observational study was carried out, based on linking electronic primary care medical records to patients’ health insurance cards. The study population consisted of the entire population assigned to general practices in Aragón, Spain (1,251,540 individuals, of whom 12% were immigrants). We studied the morbidity profiles of both the immigrant and native populations using the Adjusted Clinical Group System. Logistic regressions were conducted to compare the morbidity burden of immigrants and natives after adjustment for age and gender. Results: Our study confirmed the “healthy immigrant effect”, particularly for immigrant men. Relative to the native population, the prevalence rates of the most frequent diseases were lower among immigrants. The percentage of the population showing a moderate to very high morbidity burden was higher among natives (52%) than among Latin Americans (33%), Africans (29%), western Europeans (27%), eastern Europeans and North Americans (26%) and/or Asians (20%). Differences were smaller for immigrants who had lived in the country for 5 years or longer. Conclusion: Length of stay in the host country had a decisive influence on the morbidity burden represented by immigrants, although the health status of both men and women worsened with longer stay in the host country

An ethics training specific for European public health

Training in public health ethics is not at the core of public health programmes in Europe. The fruitful progress of the United States could stimulate the European schools of public health and other academic institutions to develop specifically European teaching programmes for ethics that embrace both transatlantic innovations and some adaptations based on the evolution of moral values in European societies. This paper reviews the arguments for a European public health ethics curriculum and recommends the main features of such a programme. Europe shares common values and, above all, the three major ethical principles that were socially and politically crystallized by the French Revolution: liberty, equality, and fraternity. Fraternity, otherwise known as solidarity, although rarely mentioned in the literature on ethical issues, is the moral value that best defines the European concept of public health expressed as a common good, mutual aid, and a collective or shared responsibility for health of the population. Specific political motivations were responsible for the origin of European health systems and for current policy proposals led by the European Union, such as Europe’s commitments, at least in theory, to: reduce social inequities in health and to develop the health in all policies approach. These and other initiatives, albeit not exclusively European, have political and legal repercussions that pose unique ethical challenges. Europe combines homogeneity in social determinants of health with heterogeneity in public health approaches and interventions. It is therefore necessary to develop training in ethics and good government for all public health workers in Europe, especially since a large segment of the population’s health depends on actions and decisions adopted by the European Commission and its regulatory agencies as well as for non EU European Region countries. Based on these arguments, the paper concludes with several recommendations for a common nucleus for the ethics curriculum in Europe