This contribution summarizes the article “Impact of the economic crisis on body mass index in Spain: a multilevel intersectional analysis using a socioeconomic and regional perspective”, which was published in Population Research and Policy Review: Hernández-Yumar, A., Wemrell , M ., Abásolo-Alessón, I. et al. Impact of the economic crisis on body mass index in Spain: a multilevel intersectional analysis from a socioeconomic and regional perspective. Popular Resolution Policy Review 4269 (2023). https://doi.org/10.1007/
the motivation
The global economic crisis that began in 2007, known as the Great Recession, reached Spain, deteriorating the living conditions of the population and especially affecting the most disadvantaged groups (Karanikolos et al., 2013; Zapata Moya et al., 2015). In terms of health, previous studies concluded that the 2007 crisis damaged the mental and nutritional health of Spaniards (Antennas & Vivas,2014; Gili et al., 2014; Urbanos-Garrido & López-Valcárcel, 2015), and that the prevalence of obesity increased (Hernández-Yumar et al., 2019; Norte et al., 2019; Radwan and Gil, 2014) and the risk of suffering from it in groups of low socioeconomic level (Norte et al., 2019), during the period in which it took place. On the other hand, a widening of socioeconomic inequalities in health has been observed in different countries in periods of crisis (Bacigalupe & Escolar-Pujolar, 2014; Escolar-Pujolar et al., 2014; Maynou and Sáez, 2016). Although the impact of economic crises on health inequalities has been investigated, no studies have been identified that analyze the potential effect of the Great Recession on these inequalities in body mass index (BMI), despite ample evidence . which confirms the existence of a socioeconomic gradient in this and in obesity (Ailshire and house, 2011; Costa-Font et al., 2014; Devaux and Sassi, 2013; García-Goñi & Hernández-Quevedo, 2012; Jongnam et al., 2019; Merino Ventosa & Urbanos-Garrido, 2016; OECD and EU., 2014; Raftopoulou, 2017; Rodríguez-Caro et al., 2016; WHO, 2000). In addition to socioeconomic determinants, place of residence can also influence BMI and give rise to disparities at different geographic levels, as an exponent. Costa-Font & Gil, 2008 and Raftopoulou, 2017.
Given the increase in obesity and the deterioration of living conditions after the economic crisis of 2007, especially in the most disadvantaged groups, We wanted to study the impact of the Great Recession on inequalities in BMI in Spainfrom socioeconomic and territorial perspectives, for which the following two research questions were posed:
The analysis
The study was carried out with data extracted from the Spanish National Health Survey (ENSE). The ENSE of 2006/2007 were chosen to represent the pre-crisis period, the ENSE 2011/2012, which corresponded to the crisis period, and the ENSE 2016/2017, relating to the post-crisis period.
Using Intersectionality Theory as inspiration (Bow leg, 2012; Collins, 1990; Crenshaw, 1989; Hancock, 2016; Hankivski, 2012; McCall, 2005; Seng et al., 2012), the BMI of Spanish adults (≥18 years) was analyzed through the creation of intersectional strata, defined by the combination of demographic, social and economic variables (gender, age, income, educational level, and type of home). ). ), along with a geographic variable (region of residence). Three approaches were created (A, B and C), which determined the definition of these intersectional strata, based on the variables considered in each of them. All three include gender and age as covariates, in addition to the following:
Applying Multilevel Intersectional Analysis of Individual Heterogeneity and Discriminatory Accuracy (MAIHDA) (Merlo, 2018), it was possible to know how the BMI is distributed between the different strata. To this end, two multilevel linear regression models were built for each survey and each approach, with individuals at the first level and these nested in intersectional strata at the second level, and the Intraclass Correlation Coefficient (ICC) was estimated to study the discriminatory accuracy and validity of intersectional strata in predicting BMI.
The results
Impact of the economic crisis on BMI
The average BMI of the Spanish population increased from 2006 to 2017 (+1.5%), but this increase occurred especially until 2012 (+1.1%). Furthermore, the groups most affected by these increases were those with a medium and low level of education, in which an increase of 2.3% and 2.1% was observed, respectively, between 2006 and 2017.
From a regional point of view, the average BMI increased in all Spanish regions (except Castilla y León and Aragón), in most of them following the temporal trend previously described.
Impact of the economic crisis on inequalities in BMI
The analysis confirms, once again, the existence of a socioeconomic gradient, that is, groups with lower income and educational level have a higher average BMI, and vice versa. This is observed throughout the period studied. However, these disparities are more pronounced in the crisis years (2011/2012) than in the other two periods (2006/2007 and 2016/2017).
The evolution of the BMI of the intersectional strata shows that the difference between the average BMI of the strata located at the extremes (that is, those with the lowest and highest BMI) increased with the economic crisis and decreased in the subsequent period. If we consider the inverse association observed between socioeconomic variables and BMI, the accentuation of socioeconomic inequalities during the crisis is clear.
Influence of socioeconomic and geographic variables on BMI
According to the ICC values estimated for each approach, socioeconomic variables have a greater influence on BMI in the periods in which an economic crisis does not take place (i.e., 2006/2007 and 2016/2017), presenting the higher ICC value (12.6% for approach A). However, in times of crisis (2011/2012), it is approach C that has the highest CCI (12.9%) of the three, which suggests the importance of the regional variable, along with the socioeconomic ones, in the BMI distribution.
These values also show that intersectional strata, although they are contexts with some influence on BMI, do not have sufficient discriminatory precision to motivate the design of policies focused solely on certain groups.
The conclusions
This is the first study, to our knowledge, that analyzes the impact of the Great Recession on BMI and its disparities in Spain.
From the results obtained, an impact of this economic crisis on BMI and socioeconomic inequalities seems to be observed. While the average BMI increased throughout the study period, although especially until 2011/2012, inequalities were accentuated in the crisis period and reduced in the subsequent period.
Furthermore, although socioeconomic variables seem to have an influence on BMI, the additional consideration of the regional variable plays a relevant role in periods of economic crisis, so regional policies will be fundamental at such times.
Finally, based on the discriminatory precision of the intersectional strata studied, interventions designed to fight obesity must be based on proportionate universalism (Fisher et al., 2021), that is, they should target those groups with higher BMI, but maintaining the universalist nature of social interventions.
