There is practically no health indicator that does not worsen as socioeconomic conditions decline.
Most diseases affect those who have the least the most, who are also those who have the most limited resources to pay for care.
Mental health is the big gap in this health inequity, according to a study presented this Thursday by the Economic and Social Council (CES), which also points to cancer or emergency care.
Félix Martín, president of the working commission that prepared this report, gives an example to show these social determinants of health: “A 30-year-old man who has higher education has a life expectancy five years higher than another who only has higher education. has primaries.
And these differences between territories can reach seven years.”
Perhaps in the area where inequality is most present is mental health, which the CES considers the “Achilles heel” and, “without a doubt, one of the weakest chapters of the Spanish health system.”
From the nearly 14,000 consultations in the public system carried out in 2010, this increased to 26,000 in 2021 (the last year analyzed by the study) and there was a 20% increase in urgent hospital admissions in the period from 2017 to 2021. an indicator that until that date remained relatively stable.
“The insufficiency of resources allocated to mental health care in the National Health System has led to the rise of the private sector in this area of care, so that 8 out of every 10 psychiatric consultations are carried out in that sector while the The public system accounts for only 2 out of 10. This distribution of total activity, which implies spending for the majority of patients, can result in a situation of inverse care, with those who need it most receiving less attention, since the segments with “The least economic resources are precisely those most exposed to the risk of suffering from mental health problems,” states the text, under the title
Report on the Health System: current situation and perspectives for the future
.
The relationship between mental health and material conditions has very contrasting evidence.
Problems making ends meet or facing unexpected expenses represent anguish that often leads to psychological pathologies.
Without going any further, EL PAÍS published a survey last week in which it showed people with fewer economic resources have, on average, more problems sleeping.
The authors reproach that, despite the importance of epidemiological data, and its implications in the areas of well-being and the economy (the cost of mental health problems in Spain is 4.2% of GDP), this area health requires “a small portion of the resources”: there are only 10 psychiatrists per 100,000 inhabitants, a rate lower than the EU average, and much lower than that of some countries such as Germany, Belgium or Poland.
Antón Costas, president of the CES, points out that there is “a blind spot” that is not usually addressed when talking about health, which goes beyond equity, and which is reflected in the productivity and growth of the economy: “ A healthy population is an extraordinary driving force for growth, productivity and innovation.
This blind spot is not taken into account in political life.”
The second area of health characterized by inequity is cancer.
“Participation in cancer screening programs is lower in population segments with lower income and lower educational level, which are precisely those who are most at risk of suffering from poor health.
This lower adherence to the established Public Health programs limits the possibilities of early detection and increases the rates of worsening and worsens the prognoses,” states the CES.
There are several factors that explain this relationship between cancer and low resources.
Tobacco, alcohol and obesity are three of the major environmental factors that increase the risk of tumors, and all are more present in lower socioeconomic classes than in higher ones.
In the general population, cancer is the second cause of death after diseases of the circulatory system, although in men it has been, since 2000, the first cause of death.
In 2019, three in 10 deaths in men and two in 10 in women were caused by cancer.
Digitalization and emergencies
In addition to mental health and cancer, the study highlights two other factors that contribute to health inequity: the digitalization of consultations and emergencies such as covid.
With respect to the first, the CES points out that one of the most important changes in Primary Care activity in recent years is the advance of telemedicine.
“Offering interesting possibilities for improvement in terms of efficiency, it may be generating negative effects due to worsening levels of risk and disease detection, as well as the control and monitoring of chronic pathologies.
Elderly people and those with limited skills in digital tools are precisely those who need medical care the most, but they are also the ones who least access care through digital means, whose progress has been confirmed, partially replacing in-person care. ”.
With respect to emergencies, he points out the pandemic as a enhancer of territorial inequalities: “It is worth highlighting the fact that some communities, such as Castilla y León, whose dependency rates for those over 64 years of age are above the national average, show rates very high mortality rates, while others, with a smaller elderly population, have also experienced very high mortality rates from covid and not attributable to a particularly aged population, as in the case of Madrid.
Therefore, the causes of the important territorial differences must be sought in other factors.”
Faced with these problems, the CES proposes increasing efforts in the detection, analysis and evaluation of health inequalities;
analyze the impact on equity of co-payments and exclusions of benefits, medicines and health products from financing and provide “progressively more intense responses based on socioeconomic conditions, applying selective measures to improve the circumstances of elderly people vulnerability".