Health beyond Covid-19

Taula amb un fonendoscopi i un aparell per mesurar la pressió. © Carlota Serarols

Krushenka Bayas Design (Storydata)

Covid-19 has posed a huge challenge for all public health services and has had an unequal impact on the population of Barcelona, depending on age, neighbourhood and socioeconomic status. A lack of primary care professionals and long waiting lists for diagnostic tests and treatments are just two of the issues the pandemic has highlighted and exacerbated.

There is a lot of work to do if the health system is to recover its capacity for preventing, detecting and treating chronic illnesses early; treat drug addictions and related issues; and respond to rising numbers of mental illnesses.

Health professionals

In Barcelona, there are 7.7 general practitioners for every 10,000 inhabitants: a figure close to the Spanish average but a long way from the European average, which is currently 9.1 according to data from the Spanish Independent Trade Union for Civil Servants (CSIF). The number of nurses is 7.6 (the Spanish average is 6.8), while the number of paediatricians has risen from 9.5 in 2019 to 10.3 in 2020.

Dentistry is a particularly inaccessible speciality through the public health system: there is not even 1 dentist per 10,000 Barcelona residents. According to the World Health Organisation (WHO), more than 68% of the worldwide population has access to fewer than 5 dentists per 10,000 inhabitants. Barcelona City Council tried to create a municipal dentist service, but the initiative was thrown out by the courts. It has, however, managed to set up a dentistry service for vulnerable people.

Tumours and infections: leading causes of death

On average, women in Barcelona live for 86.7 years, while the life expectancy for the city’s men is 80.7. According to the ‘Health in Barcelona 2020’ report published by the Barcelona Public Health Agency (ASPB), the leading cause of death among women is infectious or parasitic diseases, followed by circulatory system diseases and tumours. For men, the main cause of death is tumours, followed by infectious diseases and circulation system diseases. Both for men and for women, Covid-19 was the fourth biggest cause of death in the year of the pandemic.

Death rate by neighbourhood

The distribution of premature deaths (deaths earlier than expected) was uneven across the districts and neighbourhoods of Barcelona in 2020. Torre Baró, Trinitat Nova and Montbau recorded the highest premature death rates. The leading causes of premature death in the city are tumours in the trachea, bronchi and lungs in men, and malignant breast tumours in women, according to ASPB data (2018).

One virus, six waves

Since the beginning of the pandemic, 425,814 people in Barcelona have caught Covid-19, 7,590 of which lived or worked in care homes for elderly people (data as of 31 January 2022). Over these two years, there have been six waves of the virus, each with different characteristics. The first wave was the most lethal, with the highest number of deaths caused by Covid-19. This was the wave with the least positive tests recorded, as until May 2020, only priority groups were tested for the virus.

From October 2020 onwards, the figures started to include results from lateral flow tests as well as PCR tests, and tests were carried out on the whole population. In the second, third and fourth waves, most cases were detected in the population aged between 25 and 54. From January 2021, when the vaccination campaign began, the number of infections recorded fell, as seen in the figures for the third and fourth waves. From June to November 2021, there was a fifth wave, thanks to the arrival of the delta strain of the virus, which affected the younger population (the least vaccinated age group).

Since mid-November, we have been going through a sixth wave, characterised by a very high number of infections due to the omicron strain, but with much fewer hospitalisations and deaths. In all waves, the number of cases has been slightly higher among women than among men.

5,778 more deaths than expected

Between March 2020 and January 2022, there were 5,778 more deaths than expected, according to ASPB data. Most of these excess deaths are from the first wave of the pandemic: between March and June 2020, there was an excess of 3,423 deaths.

The excess deaths carried on, to a lesser degree, into the second and third wave, from October 2020 to March 2021. In the first and second waves, a vaccine was not available yet, and in the third, the vaccination campaign had only just begun, so the percentage of people vaccinated was still low.

Inequality in vaccination

The vaccination campaign in Barcelona, and in Catalonia, started on 27 December 2020. It took place in three stages, which overlapped. As indicated by the ASPB, this pandemic has affected people of lower socioeconomic status the most, due to their living and working conditions (smaller homes and fewer teleworking opportunities). Vaccination coverage has also been poorer in neighbourhoods of low socioeconomic status.

Poor mental health rampant among young women

According to provisional ASPB data, the prevalence of mental health issues has increased both in adults and in teenagers. Mental illness have gone from affecting 16.5% of men to 23.3%, and 19.9% of women to 35.8%. Among the adolescent population, girls are more affected; the data shows a sharp increase in prevalence of mental health problems among girls in their second year of secondary school and girls in their second year of vocational training between 2016 and 2021.

Covid-19 turns primary care and emergency medical services upside down

One of the areas most impacted by the pandemic has been primary care. According to a study by the Catalan Healthcare Institute, in 2020, the number of consultations made for infectious and parasitic diseases doubled, due to the outbreak of the pandemic. The percentage increase was 91.07%, as 52,220 diagnoses were made in 2019, compared to 99,779 in 2020. All in all, the total consultations attended was similar (1,402,406 appointments in 2020 and 1,421,779 in 2019), but the reason for the consultations changed. The increase in appointments related to Covid-19 led to a fall in consultations for chronic issues, such as high blood pressure, diabetes or obesity.

In 2020, emergency services attended 14.9% fewer patients than the previous year, with a total of 1,071,304 patients, as indicated by the City of Barcelona Statistics Year Book 2021. In terms of type of diagnosis, the only emergencies attended that increased in number were those related to Covid-19 (external causes of morbidity and infectious and parasitic diseases). All other types of emergency fell in number, especially emergencies due to injuries and poisoning and ‘factors influencing health status and contact with health services’, which refers to medical checks and examinations, and people at high risk of infection or specific procedures, among other factors (according to International Classification of Diseases).

Sharp fall in resource mobilisation

In 2020, Medical Emergencies Services (SEM) activity grew by 65% compared to the previous year. This increase is directly linked to the growth in incidents without resource mobilisation, such as health consultations (+78.43%) or requests for information (+132.6%). Meanwhile, there was a decrease in emergencies with resource mobilisation. Basic life support journeys, for example, fell from 200,000 annually to just 18,000 in 2020 (a 90% reduction compared to 2019).

Fewer traumas, more home care

By type of incident, the emergencies that fell most sharply in number were accidents or traumas and care for illnesses in public spaces. Meanwhile, the number of emergencies due to illness at home shot up (83%), due to mobility restrictions. Emergencies classified as ‘other’ increased the most (104%). These probably include all other healthcare emergencies relating to the pandemic. 

Long waits for medical tests

Waiting times for diagnostic tests in Barcelona’s hospitals increased sharply throughout 2020, in the first three waves of Covid-19. Between May and September 2020, diagnostic tests suffered the longest delays. In September 2020, for example, there was a six-month wait for a

mammogram or a gynaecological ultrasound.

The situation is getting back to normal now, and waiting times have gone back to what they were before the pandemic. The average waiting time in September 2020 was almost four months (113 days) for any kind of test, whereas this waiting time had been reduced by half in December 2021, at up to two months on average (55 days).

The pandemic has therefore led to an underdiagnosis of chronic illnesses of up to -36% at all ages and with both sexes. Furthermore, in 2020, 7,618 new cases of cancer were diagnosed: 2,203 fewer than 2019, which represents a 22% reduction in diagnoses on the previous year.

Fewer abortions

The voluntary termination of pregnancy is a right that has been recognised in our country since 2010. Since that time, the number of abortions carried out has not changed drastically, but it has decreased slightly: there were 6,800 abortions in 2010, and this number had fallen to 5,717 by 2019. Most abortions were carried out among women aged between 20 and 39 years, with the highest incidence among those aged between 25 and 29. Voluntary abortions have decreased in number the most in the 15–19 age group, and they have only risen slightly among women aged over 35.


More weeks of gestation

In the first 14 weeks of gestation, abortion is allowed without any justification. Abortion is permitted until week 22, but a medical certificate is required. From week 22 onwards, abortion is only allowed if the foetus’s anomaly is incompatible with life. The data on voluntary abortions according to weeks of gestation shows that numbers have fallen since 2010, except in the case of abortions after 17 weeks. The fact that the average age to become a mother in Barcelona has risen to 33.6 may result in more medical problems during pregnancy and could explain this number of abortions after 17 weeks.

Drug addiction treatment services

During 2020, the number of patients treated for drug addictions fell in comparison to the previous year. In 2019, the number of patients addicted to illegal drugs (2,284) and to alcohol (2,019) increased, reaching its peak just before Covid-19. Meanwhile, tobacco addictions have become less common since 2010; indeed, 2020 was the year in which the fewest patients were treated for this problem (136).

Mental disorders among the main chronic illnesses

The distribution of chronic illnesses is different among men and women and according to age group. As indicated in the Barcelona Public Health Agency’s report ‘Health in Barcelona 2020’, diseases related to the respiratory system are the most common chronic illnesses among boys and men aged 15 to 24. Anxiety disorders make up 15.8% of the chronic illnesses suffered by men aged between 25 and 44, while after the age of 45, illnesses relating to the endocrine and circulatory systems are the most common.

In women, throughout all age groups, illnesses related to psychological problems represent a large percentage of all diagnoses. In the 15–24 group, anxiety disorders make up 14% of all chronic illnesses. Among women aged between 25 and 44, this percentage reaches 19.1%.

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