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Published in: International Journal for Equity in Health 1/2015

Open Access 01-12-2015 | Research

Perceptions and beliefs of public policymakers in a Southern European city

Authors: Joana Morrison, Mariona Pons-Vigués, Elia Díez, Maria Isabel Pasarin, Sergio Salas-Nicás, Carme Borrell

Published in: International Journal for Equity in Health | Issue 1/2015

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Abstract

Introduction

Socio-economic inequalities in health are large in urban areas; however, local municipal governments may plan, manage and provide services and policies which can reduce these. The objective of this study was to describe the beliefs and perceptions of public policymakers in a European city, Barcelona. They are the key actors in designing and implementing urban public policies.

Methods

A qualitative research study describing policymakers’ beliefs on health inequalities. The study population were twelve policymakers. These were politicians or officers from the city council. Informant profiles were selected using a theoretical sample. Semi-structured individual interviews were performed to collect the data and a thematic content analysis was carried out.

Results

Politicians were aware of health inequalities in their city and identified diverse social causes. They viewed reducing inequalities as a priority for the city’s government. Officers were less knowledgeable and described less efforts in addressing health inequalities. It was stated by some that reducing inequalities in non-health sectors helped to reduce health inequalities indirectly and there was some collaboration between two sectors. The most frequent barriers encountered when implementing policies were funding and the cities’ limited authority.

Conclusions

Officers and policymakers had different levels of awareness and access to information on health and its socials determinants. Officers referred to specific causes of health inequalities and policies which related to their sectors and politicians were more familiar with upstream determinants and policies. Some participants explained that policies and programmes needed to be evaluated and very little intersectoral action was said to be carried out. More efforts should be made to provide all policymakers with information on the social determinants of health inequalities. Research on health inequalities and policy should engage with policymakers and promote health as a cross cutting issue in the city council in liaison with the third sector.
Literature
1.
go back to reference United Nations. Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings. Geneva: WHO; 2010. United Nations. Hidden Cities: Unmasking and Overcoming Health Inequities in Urban Settings. Geneva: WHO; 2010.
2.
go back to reference World Health Organization, Centre for Health Development. Our Cities, our Health, our Future. Acting on Social Determinants for Health Equity in Urban Settings. In: Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings. Geneva: WHO; 2010. World Health Organization, Centre for Health Development. Our Cities, our Health, our Future. Acting on Social Determinants for Health Equity in Urban Settings. In: Report to the WHO Commission on Social Determinants of Health from the Knowledge Network on Urban Settings. Geneva: WHO; 2010.
3.
go back to reference Vlahov D, Freudenberg N, Proietti F, Ompad D, Quinn A, Nandi V, et al. Urban as a determinant of health. J Urban Health. 2007;84:16–26.CrossRefPubMedCentral Vlahov D, Freudenberg N, Proietti F, Ompad D, Quinn A, Nandi V, et al. Urban as a determinant of health. J Urban Health. 2007;84:16–26.CrossRefPubMedCentral
4.
go back to reference Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, et al. Fair Society, Healthy Lives. The Marmot Review. Strategic Review of Health Inequalities in England post-2010. England: Institute of Health Equity; 2010. Marmot M, Allen J, Goldblatt P, Boyce T, McNeish D, Grady M, et al. Fair Society, Healthy Lives. The Marmot Review. Strategic Review of Health Inequalities in England post-2010. England: Institute of Health Equity; 2010.
5.
go back to reference Borrell C, Pons-Vigues M, Morrison J, Diez E. Factors and processes influencing health inequalities in urban areas. J Epidemiol Community Health. 2013;67(5):389–91.CrossRefPubMed Borrell C, Pons-Vigues M, Morrison J, Diez E. Factors and processes influencing health inequalities in urban areas. J Epidemiol Community Health. 2013;67(5):389–91.CrossRefPubMed
6.
go back to reference Collins PA, Hayes MV. Examining the capacities of municipal governments to reduce health inequities: a survey of municipal actors’ perceptions in Metro Vancouver. Can Journal Public Health. 2013;104(4):304–10. Collins PA, Hayes MV. Examining the capacities of municipal governments to reduce health inequities: a survey of municipal actors’ perceptions in Metro Vancouver. Can Journal Public Health. 2013;104(4):304–10.
7.
go back to reference Collins PA, Hayes MV. The role of urban municipal governments in reducing health inequities: a meta-narrative mapping analysis. Int J Equity Health. 2010;9:13.CrossRefPubMedCentralPubMed Collins PA, Hayes MV. The role of urban municipal governments in reducing health inequities: a meta-narrative mapping analysis. Int J Equity Health. 2010;9:13.CrossRefPubMedCentralPubMed
8.
go back to reference Mackenbach JP, Looman CW. Changing patterns of mortality in 25 European countries and their economic and political correlates, 1955–1989. Int J Public Health. 2013;58(6):811–23.CrossRefPubMed Mackenbach JP, Looman CW. Changing patterns of mortality in 25 European countries and their economic and political correlates, 1955–1989. Int J Public Health. 2013;58(6):811–23.CrossRefPubMed
9.
go back to reference Mackenbach JP, Kulhanova I, Menvielle G, Bopp M, Borrell C, Costa G, et al. Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. J Epidemiol Community Health. 2015;69(3):207-17. Mackenbach JP, Kulhanova I, Menvielle G, Bopp M, Borrell C, Costa G, et al. Trends in inequalities in premature mortality: a study of 3.2 million deaths in 13 European countries. J Epidemiol Community Health. 2015;69(3):207-17.
10.
go back to reference Whitehead M, Petticrew M, Graham H, Macintyre SJ, Bambra C, Egan M. Evidence for public health policy on inequalities: 2: assembling the evidence jigsaw. J Epidemiol Community Health. 2004;58(10):817–21.CrossRefPubMedCentralPubMed Whitehead M, Petticrew M, Graham H, Macintyre SJ, Bambra C, Egan M. Evidence for public health policy on inequalities: 2: assembling the evidence jigsaw. J Epidemiol Community Health. 2004;58(10):817–21.CrossRefPubMedCentralPubMed
11.
go back to reference Petticrew M, Whitehead M, Macintyre SJ, Graham H, Egan M. Evidence for public health policy on inequalities: 1: the reality according to policymakers. J Epidemiol Community Health. 2004;58(10):811–6.CrossRefPubMedCentralPubMed Petticrew M, Whitehead M, Macintyre SJ, Graham H, Egan M. Evidence for public health policy on inequalities: 1: the reality according to policymakers. J Epidemiol Community Health. 2004;58(10):811–6.CrossRefPubMedCentralPubMed
12.
go back to reference Lavis JN, Posada FB, Haines A, Osei E. Use of research to inform public policymaking. Lancet. 2004;364(9445):1615–21.CrossRefPubMed Lavis JN, Posada FB, Haines A, Osei E. Use of research to inform public policymaking. Lancet. 2004;364(9445):1615–21.CrossRefPubMed
13.
go back to reference Lavis JN. Research, public policymaking, and knowledge-translation processes: Canadian efforts to build bridges. J Contin Educ Health Prof. 2006;26(1):37–45.CrossRefPubMed Lavis JN. Research, public policymaking, and knowledge-translation processes: Canadian efforts to build bridges. J Contin Educ Health Prof. 2006;26(1):37–45.CrossRefPubMed
14.
go back to reference Lavis JN. Ideas at the margin or marginalized ideas? Nonmedical determinants of health in Canada. Health Aff. 2002;21(2):107–12.CrossRef Lavis JN. Ideas at the margin or marginalized ideas? Nonmedical determinants of health in Canada. Health Aff. 2002;21(2):107–12.CrossRef
15.
go back to reference Lavis JN, Ross SE, Stoddart GL, Hohenadel JM, McLeod CB, Evans RG. Do Canadian civil servants care about the health of populations? Am J Public Health. 2003;93(4):658–63.CrossRefPubMedCentralPubMed Lavis JN, Ross SE, Stoddart GL, Hohenadel JM, McLeod CB, Evans RG. Do Canadian civil servants care about the health of populations? Am J Public Health. 2003;93(4):658–63.CrossRefPubMedCentralPubMed
16.
go back to reference Kemm J. Health impact assessment: a tool for healthy public policy. Health Promot Int. 2001;16(1):79–85.CrossRefPubMed Kemm J. Health impact assessment: a tool for healthy public policy. Health Promot Int. 2001;16(1):79–85.CrossRefPubMed
18.
go back to reference Hoffmann R, Borsboom G, Saez M, Mari Dell’Olmo M, Burstrom B, Corman D, et al. Social differences in avoidable mortality between small areas of 15 European cities: an ecological study. Int J Health Geogr. 2014;13:8.CrossRefPubMedCentralPubMed Hoffmann R, Borsboom G, Saez M, Mari Dell’Olmo M, Burstrom B, Corman D, et al. Social differences in avoidable mortality between small areas of 15 European cities: an ecological study. Int J Health Geogr. 2014;13:8.CrossRefPubMedCentralPubMed
19.
go back to reference Borrell C, Mari-Dell’olmo M, Palencia L, Gotsens M, Burstrom B, DominguezBerjon F, et al. Socioeconomic inequalities in mortality in 16 European cities. Scand J Public Health. 2014;42(3):245–54.CrossRefPubMed Borrell C, Mari-Dell’olmo M, Palencia L, Gotsens M, Burstrom B, DominguezBerjon F, et al. Socioeconomic inequalities in mortality in 16 European cities. Scand J Public Health. 2014;42(3):245–54.CrossRefPubMed
20.
go back to reference Borrell C, Morrison J, Burstrom B, Pons-Vigues M, Hoffmann R, Gandarillas A, et al. Comparison of health policy documents of European cities: are they oriented to reduce inequalities in health? J Public Health Policy. 2013;34(1):100–20.CrossRefPubMed Borrell C, Morrison J, Burstrom B, Pons-Vigues M, Hoffmann R, Gandarillas A, et al. Comparison of health policy documents of European cities: are they oriented to reduce inequalities in health? J Public Health Policy. 2013;34(1):100–20.CrossRefPubMed
21.
go back to reference Pons-Vigues M, Diez E, Morrison J, Salas-Nicas S, Hoffmann R, Burstrom B, et al. Social and health policies or interventions to tackle health inequalities in European cities: a scoping review. BMC Public Health. 2014;14(1):198.CrossRefPubMedCentralPubMed Pons-Vigues M, Diez E, Morrison J, Salas-Nicas S, Hoffmann R, Burstrom B, et al. Social and health policies or interventions to tackle health inequalities in European cities: a scoping review. BMC Public Health. 2014;14(1):198.CrossRefPubMedCentralPubMed
22.
go back to reference Diez E, Morrison J, Pons-Vigues M, Borrell C, Corman D, Burstrom B, et al. Municipal interventions against inequalities in health: the view of their managers. Scand J Public Health 2014; 22;42(6):476-487 Diez E, Morrison J, Pons-Vigues M, Borrell C, Corman D, Burstrom B, et al. Municipal interventions against inequalities in health: the view of their managers. Scand J Public Health 2014; 22;42(6):476-487
23.
go back to reference Morrison J, Pons-Vigues M, Becares L, Burstrom B, Gandarillas A, Dominguez Berjon F, et al. Health inequalities in European cities: perceptions and beliefs among local policymakers. BMJ Open. 2014;4(5):e004454.CrossRefPubMedCentralPubMed Morrison J, Pons-Vigues M, Becares L, Burstrom B, Gandarillas A, Dominguez Berjon F, et al. Health inequalities in European cities: perceptions and beliefs among local policymakers. BMJ Open. 2014;4(5):e004454.CrossRefPubMedCentralPubMed
24.
go back to reference Reeves S, Albert M, Kuper A, Hodges BD. Why use theories in qualitative research? BMJ. 2008;337:a949.CrossRefPubMed Reeves S, Albert M, Kuper A, Hodges BD. Why use theories in qualitative research? BMJ. 2008;337:a949.CrossRefPubMed
25.
go back to reference Atlas. Ti. Qualitative Data Analysis Software. In: Scientific Software Development GmbH. 2010. Atlas. Ti. Qualitative Data Analysis Software. In: Scientific Software Development GmbH. 2010.
27.
go back to reference The Commission To Reduce Social Inequalities in Health in S. A proposal of policies and interventions to reduce social inequalities in health in Spain. Commission to Reduce Social Inequalities in Health in Spain. Gac Sanit/ SESPAS. 2012;26(2):182–9. The Commission To Reduce Social Inequalities in Health in S. A proposal of policies and interventions to reduce social inequalities in health in Spain. Commission to Reduce Social Inequalities in Health in Spain. Gac Sanit/ SESPAS. 2012;26(2):182–9.
28.
go back to reference Marmot M, Commission Social Determinants H. Achieving health equity: from root causes to fair outcomes. Lancet. 2007;370(9593):1153–63.CrossRefPubMed Marmot M, Commission Social Determinants H. Achieving health equity: from root causes to fair outcomes. Lancet. 2007;370(9593):1153–63.CrossRefPubMed
29.
go back to reference Bambra C, Joyce KE, Bellis MA, Greatley A, Greengross S, Hughes S, et al. Reducing health inequalities in priority public health conditions: using rapid review to develop proposals for evidence-based policy. J Public Health. 2010;32(4):496–505.CrossRef Bambra C, Joyce KE, Bellis MA, Greatley A, Greengross S, Hughes S, et al. Reducing health inequalities in priority public health conditions: using rapid review to develop proposals for evidence-based policy. J Public Health. 2010;32(4):496–505.CrossRef
30.
go back to reference Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health. 2010;64(4):284–91.CrossRefPubMedCentralPubMed Bambra C, Gibson M, Sowden A, Wright K, Whitehead M, Petticrew M. Tackling the wider social determinants of health and health inequalities: evidence from systematic reviews. J Epidemiol Community Health. 2010;64(4):284–91.CrossRefPubMedCentralPubMed
31.
go back to reference World Health Organisation. Review of Social Determinants and the Health Divide in the WHO European Region. London: Institute of Health Equity; 2013. World Health Organisation. Review of Social Determinants and the Health Divide in the WHO European Region. London: Institute of Health Equity; 2013.
32.
go back to reference World Health Organisation. How can the health equity impact of universal policies be evaluated? insights into approaches and next steps. Copenhagen; 2011 World Health Organisation. How can the health equity impact of universal policies be evaluated? insights into approaches and next steps. Copenhagen; 2011
33.
go back to reference Collins PA. Do great local minds think alike? Comparing perceptions of the social determinants of health between non-profit and governmental actors in two Canadian cities. Health Educ Res. 2012;27(3):371–84.CrossRefPubMed Collins PA. Do great local minds think alike? Comparing perceptions of the social determinants of health between non-profit and governmental actors in two Canadian cities. Health Educ Res. 2012;27(3):371–84.CrossRefPubMed
34.
go back to reference Borrell C, Bartoll X, Garcia-Altes A, Pasarin MI, Pineiro M. Twenty five years of health reports in Barcelona: a commitment to transparency and a tool for action. Rev Esp Salud Publica. 2011;85(5):449–58.CrossRefPubMed Borrell C, Bartoll X, Garcia-Altes A, Pasarin MI, Pineiro M. Twenty five years of health reports in Barcelona: a commitment to transparency and a tool for action. Rev Esp Salud Publica. 2011;85(5):449–58.CrossRefPubMed
35.
go back to reference The Public Health Agency of Barcelona. Barcelona Health Report 2012. Barcelona: The Public Health Agency of Barcelona; 2013. The Public Health Agency of Barcelona. Barcelona Health Report 2012. Barcelona: The Public Health Agency of Barcelona; 2013.
36.
go back to reference Metcalfe O, Higgins C. Healthy public policy–is health impact assessment the cornerstone? Public Health. 2009;123(4):296–301.CrossRefPubMed Metcalfe O, Higgins C. Healthy public policy–is health impact assessment the cornerstone? Public Health. 2009;123(4):296–301.CrossRefPubMed
37.
go back to reference Borrell C, Artazcoz L. Policies to reduce inequalities in health [Las politicas para disminuir desigualdades en salud]. Gac Sanit. 2008;22(5):465–73.CrossRefPubMed Borrell C, Artazcoz L. Policies to reduce inequalities in health [Las politicas para disminuir desigualdades en salud]. Gac Sanit. 2008;22(5):465–73.CrossRefPubMed
38.
go back to reference Borrell C, Malmusi D. Research on social determinants of health and health inequalities: evidence for health in all policies. Gac Sanit. 2010;24 Suppl 1:101–8.CrossRefPubMed Borrell C, Malmusi D. Research on social determinants of health and health inequalities: evidence for health in all policies. Gac Sanit. 2010;24 Suppl 1:101–8.CrossRefPubMed
39.
go back to reference Ritsatakis A. Equity and social determinants of health at a city level. Health Promot Int. 2009;24 Suppl 1:181–90. Ritsatakis A. Equity and social determinants of health at a city level. Health Promot Int. 2009;24 Suppl 1:181–90.
40.
go back to reference Mehdipanah R, Rodriguez-Sanz M, Malmusi D, Muntaner C, Diez E, Bartoll X, et al. The effects of an urban renewal project on health and health inequalities: a quasi-experimental study in Barcelona. J Epidemiol Community Health. 2014;68(9):811–7.CrossRefPubMed Mehdipanah R, Rodriguez-Sanz M, Malmusi D, Muntaner C, Diez E, Bartoll X, et al. The effects of an urban renewal project on health and health inequalities: a quasi-experimental study in Barcelona. J Epidemiol Community Health. 2014;68(9):811–7.CrossRefPubMed
41.
go back to reference Mehdipanah R, Malmusi D, Muntaner C, Borrell C. An evaluation of an urban renewal program and its effects on neighborhood resident’s overall wellbeing using concept mapping. Health Place. 2013;23:9–17.CrossRefPubMed Mehdipanah R, Malmusi D, Muntaner C, Borrell C. An evaluation of an urban renewal program and its effects on neighborhood resident’s overall wellbeing using concept mapping. Health Place. 2013;23:9–17.CrossRefPubMed
42.
go back to reference Guix J, Villalbi JR, Armengol R, Llebaria X, Manzanera R, Plasencia A, et al. Innovating the service management of public health: the experience of the Barcelona Public Health Agency (Spain). Gac Sanit. 2008;22(3):267–74.CrossRefPubMed Guix J, Villalbi JR, Armengol R, Llebaria X, Manzanera R, Plasencia A, et al. Innovating the service management of public health: the experience of the Barcelona Public Health Agency (Spain). Gac Sanit. 2008;22(3):267–74.CrossRefPubMed
43.
go back to reference Whitehead M, Dahlgren G. What can be done about inequalities in health? Lancet. 1991;338(8774):1059–63.CrossRefPubMed Whitehead M, Dahlgren G. What can be done about inequalities in health? Lancet. 1991;338(8774):1059–63.CrossRefPubMed
44.
go back to reference Fuertes C, Pasarin MI, Borrell C, Artazcoz L, Diez E. Feasibility of a community action model oriented to reduce inequalities in health. Health Policy. 2012;107(2–3):289–95.CrossRefPubMed Fuertes C, Pasarin MI, Borrell C, Artazcoz L, Diez E. Feasibility of a community action model oriented to reduce inequalities in health. Health Policy. 2012;107(2–3):289–95.CrossRefPubMed
Metadata
Title
Perceptions and beliefs of public policymakers in a Southern European city
Authors
Joana Morrison
Mariona Pons-Vigués
Elia Díez
Maria Isabel Pasarin
Sergio Salas-Nicás
Carme Borrell
Publication date
01-12-2015
Publisher
BioMed Central
Published in
International Journal for Equity in Health / Issue 1/2015
Electronic ISSN: 1475-9276
DOI
https://doi.org/10.1186/s12939-015-0143-5

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