Determinants of social inequalities in selfrated health: analysis at the intersection of gender, class and migration type

Abstract

This dissertation aims to describe social inequalities in self-rated health in an integrated framework of gender, social class and immigration, and to identify the main intermediary factors and health problems that contribute to these inequalities. Three cross-sectional studies were performed with data from surveys of the general population residing in Catalonia and Spain in 2006. Migration from poor regions of Spain to Catalonia emerged as a health inequality dimension in addition to and interaction with gender and social class, highlighting the transitory nature of the ‘healthy immigrant effect’ partially observed in foreign immigrants. Material and economic resources made major contributions to all three types of health inequalities: individual income made the greatest contribution to gender inequalities; household material assets and financial difficulties to migration-related inequalities; and both to social class inequalities. Poorer self-rated health of women was showed to be not an issue of perception but a precise reflection of the higher burden of chronic conditions they suffered compared to men, such as musculoskeletal, mental and other pain disorders, which could be targets for a health system responsive to gender inequalities. Intersections between axes of inequality created complex social locations with unique consequences on health.