Prevention is better than cure, so the saying goes. And the truth is that good health involves prevention, leading a healthy lifestyle, and having access to health information and access to healthcare benefits. Social inequalities have an impact on this equation. Marina Bosque (born Ibiza, 1984) has degrees in Biology and in Human Nutrition and Dietetics. She is an expert in public health and is researching how to improve public health and how to prevent the appearance of diseases by focusing on social inequalities. Since 2018, she has been a member of the Faculty of Health Sciences at the Universitat Oberta de Catalunya (UOC) and for the last few months she has been the principal investigator of Epi4health (Epidemiology and Public Health in the Digital Health Context), a recently established interuniversity research group in the Faculty of Health Sciences, which works closely with the eHealth Center.
Bosque has worked at the Barcelona Public Health Agency, at the Drug Addiction Prevention and Care Service, and she is the coordinator of the alcohol working group of the Spanish Epidemiology Society (SEE). She has also been involved in several research projects in the field of drug addictions, and in the design and evaluation of a programme for emotional education aimed at children aged between three and five years old which is currently being implemented in many schools in Barcelona.
How did this new Epi4health research group come about?
It's the result of the partnership between various researchers who all used to work together at the Barcelona Public Health Agency at a specific point in time, and who gradually went to work at other institutions, and especially at universities. We initially created the Epidemiology and Public Health Research Group (GRESP), an interuniversity group coordinated by the University of Vic - Central University of Catalonia (UVic-UCC), which was gradually joined by new members until we launched the Epi4Health group. We periodically rotate the coordination of the research group among the three universities involved, the UOC, UVic-UCC and the Universitat Autònoma de Barcelona (UAB).
What are the group's main goals?
The initial aim was to establish ourselves as a group to promote research in various areas related to epidemiology and public health in central Catalonia. Research in these fields often focuses on studying the population that lives in big cities like Barcelona, and more rural areas and small towns are overlooked. That's why we set up the research group, seeking synergies in order to be able to undertake research projects in that region.
What research projects have you been able to conduct in the region?
One of the projects to which we are devoting the most efforts is DESKcohort, a project led by Albert Espelt and UManresa, which is organized by the Subdirectorate-General for Drug Addiction, HIV, Sexually Transmitted Infections and Viral Hepatitis of the Catalan Public Health Agency. The target population is students at secondary schools, on vocational training and in upper secondary education at secondary schools in central Catalonia, and it aims to address social inequalities in areas including education and health. This project consists of a multidisciplinary panel of surveys that is carried out every two years in the schools in the region, which enables us to monitor the variables that can influence the health and well-being of young people.
It focuses on particularly vulnerable groups in the population.
It is important to take into account the effects of social inequalities in health within populations. This provides an explanation for why people have different opportunities for good health and how people from the most disadvantaged social positions generally have the poorest health. We always take this perspective into account in our research, as we need to create a fairer world so that everyone is equally likely to live in a healthy way.
Are inequalities determining factors for some behaviours in the population groups you study, such as addictions among young people?
Social inequalities in health mean that people have different levels of access to tangible and intangible resources depending on their social position, gender, socio-economic level, immigration status, social class, age and other factors, and this simultaneously means some people are at greater risk of unhealthy behaviours, having less information on health-related issues, and less access to health services and benefits. So we can say that inequalities affect people not only when we are in good health, but also when we are in poor health they influence the healing process.
Can ICTs help improve lifestyle habits and behaviours in order to improve health and prevent disease?
Including ICTs in healthcare systems is essential for addressing the challenges arising from socio-economic changes, such as the high level of demand for healthcare, the ageing of the population, the increase in people's mobility, the need to deal with large amounts of information, global competitiveness and the provision of better quality healthcare. Digital health can help with all this, despite budget limitations and restrictions on spending.
Digital health is an opportunity for new challenges to improve healthcare, especially through the internet. Internet-based systems are now a means of interaction between patients, professionals and health organizations for initiatives related to prevention, diagnosis, treatment and management of the health services. They enable information to be transferred and knowledge to be managed using a ubiquitous global communications network.
Telemedicine is an example.
It's the subject of renewed interest in the wake of COVID-19. A recent World Health Organization (WHO) study with the participation of the UOC shows how telemedicine is effective in reducing waiting times for access to treatment and for clinical decisions, it avoids repetition of unnecessary tests, it reduces the length of hospital stays and the number of visits to emergency facilities, and provides more accurate diagnoses. The study also highlights improvements in some clinical outcomes such as anxiety and depression in mental health disorders and neurological symptoms, among others. Telemedicine has also been found to be reliable and sensitive for detecting changes in cognition over time, and improves patients' quality of life and well-being in the long term.
In one of Epi4health's research lines, you apply new technologies and tools including gamification and virtual reality.
Scientific studies have shown that introducing features like these can be useful stimuli for patients in the follow-up of treatments and during rehabilitation. Mobile apps work very well, for example. They're tools that are fast, flexible, practical, versatile and easy to administer, which is why their development and use is growing exponentially. There are more than 165,000 mobile health apps on the market, and as part of our collaboration with the WHO, we are designing an evaluation tool to certify those that meet specific criteria in the context of health. We also have another research line focused on how clinical decision systems based on artificial intelligence and machine learning can provide effective results in automated research which are useful for healthcare personnel, such as when diagnosing a patient.
The International Day of Women and Girls in Science is just around the corner. In an area like health, which is very feminized, there is still an imbalance in terms of women occupying positions of responsibility. You are the principal investigator in Epi4health, although your situation is still unusual.
There are more and more women working in the scientific and academic field, that's true, but in many cases there are significant gender inequalities in terms of pay, opportunities and prestige in the positions and responsibilities involved. There's still a glass ceiling that makes it difficult for women to reach positions of greater responsibility. The main positions of governance or responsibility are still mostly held by men. Various factors might explain this, but we can't ignore the fact that we live in a patriarchal state where there are still many gender differences in society. So we still have some way to go in order to achieve real equality between men and women.
Is research in health undertaken with a gender perspective?
In public health, the reasons for inequality, one of which is gender, are given serious consideration when any measure is planned, whether it is the development of a prevention programme or the design of research to study how a disease affects a population. So taking gender into account is a way of working that is almost inherent in the way health research is carried out by public health specialists. Even so, I'm aware that research goes far beyond public health, and in other fields, aspects as simple as presenting the results of a study separately for men and women are sometimes difficult to find. A lot more work to raise awareness still needs to be done.
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