Social inequalities in a population based colorectal cancer screening programme in the Basque Country

Background: While it is known that a variety of factors (biological, behavioural and interventional) play a major role in the health of individuals and populations, the importance of the role of social determinants is less clear. The effect of social inequality on population-based screening for colorectal cancer (CRC) could limit the value of such programmes. The present study aims to determine whether such inequalities exist. Methods: Data was obtained from the population-based screening programme administered in the Autonomous Community of the Basque Country, Spain, with a target population aged 50 to 69, first invited to participate between 2009 and 2011. The magnitude of inequality was analysed using the odds ratio (taking the least disadvantaged socioeconomic quintile as the reference population), the population attributable risk and the relative index of inequality, based on the regression, which is the ratio of the rates in the most and least disadvantaged socioeconomic groups. Results: The target population comprised 242,394 people, with the test kit successfully sent to 95.1 % (230,510). The overall response rate was 64.3 % (67.1 in women and 61.4 % men). Among women, the highest participation was in the third quintile (71.5 %) and the lowest in the first - the least disadvantaged (65.7 %). The lowest and highest rates of people with identified lesions were in the second and fourth quintiles (14.7/1000 and 17.0/1000 respectively). Among men, the response rate was lowest in the fifth - most disadvantaged - quintile (60.2 %). The highest rate of identified lesions was in the fifth quintile; 38 % higher than the first (55.7/1000 compared to 41.0/1000). Conclusions: Sex and socioeconomic group influence the rate of participation in the CRC programme and the rate of lesions found in the participants. Any public health programme is morally and ethically obliged to strive for equity and effectiveness. Improving participation of men and socially disadvantaged groups should be taken in account

Socioeconomic inequalities in mortality from conditions amenable to medical interventions: do they reflect inequalities in access or quality of health care?

Peer reviewe

Soberanía Alimentaria y restauración ecológica en el Espinal = Food Sovereignty and ecological restoration in Espinal : The case of Pueblo Mampa : El caso de Pueblo Mampa

En el presente trabajo se analizó el metabolismo social de la región de Yucat dividido en los períodos históricos “originario”, “colonial”, “agroexportador” y “agroindustrial”. El proceso de apropiación iniciado en la colonialidad y profundizado en la modernidad rompió la relación que las comunidades nativas y campesinas desarrollaban con el territorio llevando a la extinción del ecosistema del Espinal, distrito del Algarrobo. Tal transformación se refleja en el paisaje local que pasó de caracterizarse por espesos bosques de algarrobo a extensas llanuras de monocultivos. Se produjo así la devastación de la base material-ecosistémica de la región amenazando la Soberanía Alimentaria de los pueblos. En este contexto se considera urgente emprender acciones para la restauración ecosistémica, planificando participativamente a escala de paisaje, protegiendo las áreas críticas como cabeceras de cuenca, riberas y zonas bosque nativo. La experiencia de transición agroecológica de “Pueblo Mampa” aporta para imaginar otro modo de habitabilidad y producción donde el ordenamiento social y la técnica se acoplen a las particularidades ecosistémicas. La comunidad habita a la vera del Ctalamochita, dentro de uno de los últimos montes del Espinal, distrito del Algarrobo. Rehabitar a través de la agroecología implica también profundos cambios culturales y ontológicos; comprendiendo que los principios vitales distan de ser la homogeneidad y competencia para ser autonomía, diversidad y complementariedad. Se destacó la territorialización de prácticas ancestrales como la construcción de casas-pozo típicas Kamiare (comechingonas), que permitieron construir sin dañar la cobertura arbórea e integrarse al paisaje; y la cosecha de algarroba, que revaloriza al Takkú o Algarrobo como fuente de alimento de alta calidad, emblema identitario y base ecosistémica. In the present work, the social metabolism of the Yucat region was analyzed, divided into the historical periods “original”, “colonial”, “agro-exporter” and “agro-industrial”. The appropriation process initiated in coloniality and deepened in modernity broke the relationship that the native and peasant communities developed with the territory, leading to the extinction of the Espinal ecosystem, Algarrobo district. This transformation is reflected in the local landscape, which went from being characterized by dense forests to extensive monoculture plains. Thus, the devastation of the material-ecosystem base of the region occurred, threatening the Food Sovereignty of the peoples. In this context, it is considered urgent to undertake actions for ecosystem restoration, planning participatively at the landscape scale, protecting critical areas such as headwaters, riverbanks and native forest areas. The experience of agroecological transition of “Pueblo Mampa” contributes to imagine another way of habitability and production where the social order and the technique are coupled to the ecosystem particularities. The community lives on the edge of Ctalamochita, within one of the last native forest of Espinal, Algarrobo district. Rehabbing through agroecology also implies profound cultural and ontological changes; understanding that the vital principles are far from being homogeneity and competence to being autonomy, diversity. The territorialization of ancestral practices was highlighted, such as the construction of typical Kamiare (comechingon) well-houses, which made it possible to build without damaging the tree cover and integrate into the landscape; and the carob harvest, which revalues the Takkú or Algarrobo as a source of high-quality food, identity emblem and ecosystem base. --Fil: Santi Esnaola, Evelyn. Universidad Nacional de Villa María; Argentina.Fil: Quiroga Ayrala, Marina. Universidad Nacional de Villa María; Argentina

Effect of the Financial Crisis on Socioeconomic Inequalities in Mortality in Small Areas in Seven Spanish Cities

Background: The aim of this study was to analyze the trend in socioeconomic inequalities in mortality in small areas due to several specific causes before (2001–2004, 2005–2008) and during (2009–2012) the economic crisis in seven Spanish cities. Methods: This ecological study of trends, with census tracts as the areas of analysis, was based on three periods. Several causes of death were studied. A socioeconomic deprivation index was calculated for each census tract. For each small area, we estimated standardized mortality ratios, and controlled for their variability using Bayesian models (sSMR). We also estimated the relative risk of mortality according to deprivation in the different cities, periods, and sexes. Results: In general, a similar geographical pattern was found for the socioeconomic deprivation index and sSMR. For men, there was an association in all cities between the deprivation index and all-cause mortality that remained stable over the three periods. For women, there was an association in Barcelona, Granada, and Sevilla between the deprivation index and all-cause mortality in the third period. Patterns by causes of death were more heterogeneous. Conclusions: After the start of the financial crisis, socioeconomic inequalities in total mortality in small areas of Spanish cities remained stable in most cities, although several causes of death showed a different pattern