Perceived discrimination and health by gender, social class, and country of birth in a Southern European country
Introduction
Social inequalities in health imply that health determinants such as economic deprivation, discrimination, and hazardous living and working conditions are accumulated by the most disadvantaged social groups (Krieger, 1999, Krieger, 2001, Kerbo, 1991). In the case of Spain, recent changes in its social structure may have increased discrimination against various social groups. Spain was under the rule of a fascist dictatorship from 1939 to 1977, when political parties and trade unions were illegal. The recognition of civil liberties, including those related to women, was delayed until the end of the decade of the 1970s and early 1980s of the 20th century (Navarro and Shi, 2001). Additionally, immigration has been one of the most important social changes in Spain. At the end of the 20th century, a wave of foreign immigration from low-income countries to Spain began and its rate increased markedly at the beginning of the 21st century (11.3% of the population in 2008). The majority of these immigrants are from Latin American, Eastern European, and North African countries (Instituto Nacional de Estadística, 2009). The political history of Spain, the changes in its economic context and labor market, and the relentless increase of immigrant population of working age may influence the different patterns of discrimination, as well as its different impact on population health compared with other countries.
In the last decade, the evidence showing the relationship between discrimination and health has increased (Williams et al., 2003, Krieger, 2000, Paradies, 2006, Williams et al., 2008, Ahmed et al., 2007, Zucker and Landry, 2007, Krieger, 2005, Pascoe and Smart Richman, 2009, Williams and Mohammed, 2009). Although the evidence is not conclusive, different studies have shown how social class and race or ethnicity can modify the patterns of perceived discrimination's impact on health (Paradies, 2006, Karlsen and Nazroo, 2002, Krieger et al., 1993, Forman, 2003, Harris et al., 2006, Kelaher et al., 2008). The majority of studies on the impact of discrimination in health have been carried out in the USA. Research in Europe and elsewhere is very scarce and particularly in Southern Europe is almost non-existent (Krieger, 2000, Paradies, 2006, Pascoe and Smart Richman, 2009, Williams and Mohammed, 2009), although several articles have been published in Spain studying patterns of discrimination and health in immigrants (Agudelo-Suarez et al., 2009, Llacer et al., 2009) Moreover, the majority of studies to date analyze selected populations and a reduced number of health outcomes. The present article tries to fill these gaps. Our objectives thus are to examine the association between perceived discrimination and five health outcomes in Spain as well as to analyze whether these relationships are modified by sex, country of birth, or social class.
Section snippets
Study population, sample, and data collection
We used a cross-sectional design. The population frame was the 2006 Spanish population not living in any institution. Data were collected as part of the 2006 Spanish Health Interview Survey, which is representative of the whole population living in households. The total number of people interviewed older than 16 years was 29,476. Data were collected through face-to-face interviews at home between June 2006 and June 2007 (Ministerio de Sanidad y Consumo, 2006). The present analysis was
Results
The prevalence of perceived discrimination during the year prior to the interview was 4.8% of men and 7.7% of women (Table 1). The majority of them had a score of 1 implying that they had perceived only one type of discrimination and in one situation.
More than half of the population belonged to non-manual (I, II, III) social classes. The proportions of men and women who had been born in low income countries were 11.7% and 13.3%, respectively. The majority of the population was single or
Discussion
The main findings of our study were as follows: (a) perceived discrimination was higher among migrants from low-income countries and among women; (b) perceived discrimination showed positive and consistent associations with the majority of poor health outcomes; (c) a consistent gradient was found with these associations significantly increasing as the level of the discrimination score increased; and (d) these patterns were modified by gender, country of birth, and social class.
Conflict of interest
There are no conflicts of interest.
Acknowledgments
This study was partially funded by «CIBER Epidemiología y Salud Pública» (Spain) and by the “Ministerio de Sanidad y Consumo–Observatorio de Salud de la Mujer, Dirección General de la Agencia de Calidad–y Ministerio de Ciencia e Innovación– Instituto de Salud Carlos III” (Spain).
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