Maria Isabel Pasarin

We aimed to investigate the perceptions of Mapuche young adults in Araucanía, Chile, regarding the impact of the COVID-19 pandemic on their communities, adherence to restrictions, and coping responses. Eight Mapuche individuals were included in this qualitative study, segmented by gender. Interviews with a semi-structured script were carried out between February and May 2023. A thematic analysis of the discourse was used with subsequent triangulation and validation of the results. The people interviewed believed that, although the pandemic affected their communities, this challenge strengthened ties and contributed to the recovery of the ancestral worldview. There was a temporal dynamic in adherence to restrictions, with initial distrust but high compliance, including vaccination. There was complementarity between Western and traditional Mapuche medicine, which highlights the importance of intercultural health strategies. The pandemic had an impact on young Mapuche adults by altering community dynamics and cultural practices, with the potential to exacerbate inequalities in their communities. This study emphasizes the need to integrate the indigenous worldview in decisions about restrictions and advocates considering cultural diversity in future health crises.

Background: Health care is not exempt from harboring social inequalities, including in those countries with a universal public system. The objective was to ascertain whether the population’s assessment of primary care (PC) changed between 2006 and 2016, the decade that included the economic crisis of 2008, and also if it exhibited patterns of social inequality in Barcelona (Spain). Methods: This was a cross-sectional study using Barcelona Health Surveys 2006 and 2016. Samples (4027 and 3082 respectively) comprised residents in Barcelona, over 15 years old. Dependent variable: Primary Care (PC) index. Independent variables: age, social class, and birthplace. Analyses included means and percentiles of PC index, and Somers’ D test to compare the distribution of the groups. Results: Comparing 2016 with 2006, the distribution of the PC index remained in women (median of 73.3) and improved in men (from 70 to 73.3). By social class, the pattern of inequality observed in 2006 in men with perceived poor health status disappeared in 2016. Inequalities according to birthplace persisted in women, regardless of perceived health status, but disappeared in men. Conclusions: In the 10 years between which the global economic crisis occurred, the assessment of PC did not worsen, and it did improve for men, but the study points to the need for more focus on people born abroad.

Background We aim to assess the effect of a smoke-free beaches (SFB) intervention in Barcelona on smoking during the 2021 bathing season. Methods Quasi-experimental pre-post design (pre-intervention period: 15–28 May; post-intervention period: 29 May–12 September). Based on users’ profiles and location, four beaches were assigned to the intervention group (IG) and five to the comparison group (CG). The intervention involved: a mayoral decree (29 May), a communication campaign and beach on-site information. We established two 3 m × 3 m transects per beach from the coastline to the promenade. Trained teams collected smoking-related information in the transects through observations and surveys to beach users. Outcomes are as follows: percentage of people reporting witnessing smoking behaviours the last fortnight and percentage of people observed smoking. We calculated and compared prevalence ratios (PRs) with adjusted Poisson regressions. Results 3751 interviews (1721 IG; 2030 CG) and 1108 observations (498 IG, 610 CG) were carried out. SFB were associated with a significant reduction in the percentage of people reporting witnessing smoking (IG (pre: 87.2%; post: 49.7%); CG (pre: 86.2%; post: 74.1%); PR (95% CI): 0.7 (0.6 to 0.8)); and in the users observed smoking in the beach (IG (pre: 3.8%; post: 3.0%); CG (pre: 2.3%; post: 9.9%); PR (95% CI): 0.3 (0.3 to 0.4)). Satisfaction scores were 8.3 (IG) and 8.1 (CG) out of 10. Conclusion An SFB intervention is an effective and well-accepted measure to reduce smoking and smokers’ visibility. Smoke-free measures should be extended to beaches and other non-regulated outdoor areas.

Introduction: In the past, health inequalities were not prioritised in the political agenda of Barcelona. The change of city government (2015) was an opportunity to develop a Surveillance System for Social Health Inequalities in the city, which is described in this article. Methods: The design of the Surveillance System formed part of the Joint Action for Health Equity in Europe (JAHEE), funded by the European Union. Various steps were considered by the experts to set up the System: define its objectives, target population, domains and indicators, and sources of information; perform data analysis; implement and disseminate the system; define the evaluation; and perform regular data updates. Results: The System considers the following domains: social determinants of health, health-related with behaviours, use of healthcare, and health outcomes, and includes eight indicators. As axes of inequality, the experts chose sex, age, social class, country of origin, and geographical area. The Surveillance System for Social Health Inequalities is presented on a website including different types of figures. Conclusion: The methodology used to implement the Surveillance System can be used to implement similar systems in other urban areas around the world.

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.

Issue/problem: Drug policies in Barcelona have been guided by the Barcelona City Drug Action Plan (PADB). This four-year plan aims to prioritise and evaluate drug policies. The need to have a low-threshold residential resource for homeless people using drugs (HPWUD) is an objective that had been present in successive plans, but unfortunately could not be realised so far. In Spain, the covid-19 pandemic led to a total country lockdown. A great intersectoral coordination effort involving Barcelona City Council and the Public Health Agency of Barcelona together with third sector organisations resulted in the opening of the first gender responsive low-threshold residential resource for HPWUD in Barcelona. Description of the problem: Pending a broader evaluation, quantitative indicators are available for 6 months (3 April to 3 October 2021), informing about: How many people were accommodated? What are their profiles? What drugs do they use? How many overdoses were reverted? How many successful discharges? How many people confined/isolated due to covid-19? What are the challenges? Results: Preliminary results showed that during first 6 months, 120 people (74 men, 42 women and 4 non-binary) were accommodated. All places reserved for women were covered. About 44% were Spaniards; being opioids and alcohol, the main used in the HPWUD. Thirty overdoses reverted (60% due to stimulants). There were 39 people confined and 2 residents isolated due to covid-19. The challenges are to continue to improve the new alcohol harm reduction program, work on adherence and mainstreaming gender. Lessons: Barcelona PADB is instrumental to guide evidence-based interventions to reduce health and social inequalities in highly vulnerable and underserved population. This new gender-responsive residential setting for HPWUD with a comprehensive harm reduction program together with health and social care is unique in Barcelona. Key messages: Drug policy to guide evidence-based interventions to reduce health and social inequalities in highly vulnerable and underserved population. First low-threshold gender responsive residential resource for homeless people using drugs has opened in Barcelona.

Background: The objective of this paper is to analyze social inequalities in COVID-19 incidence, stratified by age, sex, geographical area, and income in Barcelona during the first two waves of the pandemic. Methods: We collected data on COVID-19 cases confirmed by laboratory tests during the first two waves of the pandemic (1 March to 15 July and 16 July to 30 November, 2020) in Barcelona. For each wave and sex, we calculated smooth cumulative incidence by census tract using a hierarchical Bayesian model. We analyzed income inequalities in the incidence of COVID-19, categorizing the census tracts into quintiles based on the income indicator. Results: During the two waves, women showed higher COVID-19 cumulative incidence under 64 years, while the trend was reversed after that threshold. The incidence of the disease was higher in some poor neighborhoods. The risk ratio (RR) increased in the poorest groups compared to the richest ones, mainly in the second wave, with RR being 1.67 (95% Credible Interval-CI-: 1.41–1.96) in the fifth quintile income group for men and 1.71 (95% CI: 1.44–1.99) for women. Conclusion: Our results indicate the existence of inequalities in the incidence of COVID-19 in an urban area of Southern Europe.