La salud en todas las políticas. Tiempo de crisis, ¿tiempo de oportunidades? Informe SESPAS 2010 / Health in all policies. Is the economic depression a time of opportunities? SESPAS Report 2010

El diseño coste-efectivo y equitativo de la política de salud implica abordar los determinantes sociales de la salud y tomar conciencia del impacto de las políticas no sanitarias. Para ello se requieren cambios estructurales en las formas de organización de las instituciones, que han de favorecer la gobernanza en red. La inercia institucional, las deficiencias en los mecanismos de coordinación y cooperación entre sectores, niveles de gobierno y agentes, los intereses económicos y las pautas culturales que mantienen el paradigma biomédico, o la falta de colaboración entre expertos, profesionales y autoridades sanitarias, actúan como factores de ralentización, pero pueden contrarrestarse con voluntad política y con el conocimiento que proporcionan las experiencias propias y ajenas. La coyuntura actual derivada de las recientes crisis de salud pública, y particularmente de la última crisis económica, ofrece una oportunidad excepcional para introducir cambios en la planificación de las acciones orientadas a mejorar la salud (AU)

A cost-effective and equitable health policy design involves tackling social determinants of health and becoming aware of the impact of non-healthcare policies. Structural changes in institutional organization, targeted to create a new space for network governance, are required. Some factors tend to delay this process, such as institutional inertia, poor coordination and cooperation mechanisms among sectors, levels of government and agents, the consolidation of the biomedical paradigm reinforced by lobbies and cultural patterns, and inadequate collaboration among experts, practitioners and health authorities. However, these factors may be counterbalanced by political will and by the knowledge provided by domestic and foreign experiences. The present situation arising from the recent public health crises, and particularly from the current economic depression, offers a major chance to introduce the needed changes in health oriented actions (AU)

[Health in all policies. Is the economic depression a time of opportunities? SESPAS Report 2010]. / La salud en todas las políticas. Tiempo de crisis, tiempo de oportunidades? Informe SESPAS 2010.

A cost-effective and equitable health policy design involves tackling social determinants of health and becoming aware of the impact of non-healthcare policies. Structural changes in institutional organization, targeted to create a new space for network governance, are required. Some factors tend to delay this process, such as institutional inertia, poor coordination and cooperation mechanisms among sectors, levels of government and agents, the consolidation of the biomedical paradigm reinforced by lobbies and cultural patterns, and inadequate collaboration among experts, practitioners and health authorities. However, these factors may be counterbalanced by political will and by the knowledge provided by domestic and foreign experiences. The present situation arising from the recent public health crises, and particularly from the current economic depression, offers a major chance to introduce the needed changes in health oriented actions.

Recomendaciones para una futura Ley de Salud Pública en España / Suggestions for the upcoming public health law in Spain

La nueva ley estatal de salud pública ha de sustanciar la reforma de la salud pública. El texto legal debería abrir paso a la modernización y a la adaptación de las estructuras de salud pública a las nuevas necesidades. Se precisa un concepto más amplio de salud pública y una redefinición de sus funciones y servicios básicos. La creación de una Agencia Española de Salud Pública y de un Consejo de Salud Pública, la elaboración de una Estrategia Española de Salud Pública y la reforma de la formación de los profesionales, son algunas de las principales recomendaciones para la futura ley (AU)

The upcoming public health law must serve (..) (AU)

[Suggestions for the upcoming public health law in Spain]. / Recomendaciones para una futura Ley de Salud Pública en España.

The upcoming public health law must serve as the basis for public health reform. The text of the law should allow public health structures to be modernized and adapted to the country's new needs. A broader concept of public health and a redefinition of its functions and basic services are required. Some of the main suggestions for the upcoming law are the establishment of a Spanish Agency for Public Health and a Public Health Council, the design of a Spanish Strategy of Public Health, and reform of professional training.

[Public and private supply of health services by autonomous communities in Spain]. / Oferta pública y privada de servicios sanitarios por comunidades autónomas.

This chapter summarizes the main territorial inequalities in health care supply, and the related effects on access and use of health care facilities. Firstly, in the field of primary health care, the most notable inequalities refer to the process of introduction of the reform and to complementary services supply, together with the coverage of and access to some health care programs. Secondly, the distribution of hospital beds across regions is far from being uniform, specially with respect to geriatric and psychiatric beds. In addition, profit oriented private care is unequally distributed across territories. Thirdly, the availability of high-tech health care services is remarkably different across regions, although inequalities have been reduced during the last decade. Inequality in long-term care (not only in terms of supply, but also in access and use) is even higher than regional inequalities in health care supply. In addition to these territorial inequalities there are some significant gender inequalities.

[The impact of healthcare financing on health inequalities]. / El impacto de la financiación de la asistencia sanitaria en las desigualdades.

This article summarizes the impact of health care financing instruments on inequalities of supply, access and use of health care services. Firstly, the new scheme of regional and health care financing, apart from the initial gains in terms of equity and sufficiency, introduces uncertainty about the volume of resources that will be devoted to health care facilities by the regions. This fact may cause some inter-territorial inequalities in the health care supply and the access to public services. The Health Care Cohesion Fund, which was designed to guarantee equality of access to the National Health Service, is not the optimal instrument to achieve such an ambitious goal. Secondly, the change in composition of health care financing sources, by increasing the burden of indirect taxes, may imply some losses of vertical equity or progressiveness. Finally, this paper analyses the possible impact that the present allocation of public health funds, excessively biased to specialised health care, may have on inequalities in the use of health care facilities.

El impacto de la financiación de la asistencia sanitaria en las desigualdades / The impact of healthcare financing on health inequalities

El presente trabajo examina el impacto de la financiación de la asistencia sanitaria sobre las desigualdades en la oferta, el acceso y la utilización de los servicios de salud. El nuevo modelo de financiación autonómica y sanitaria, pese a las iniciales ganancias de equidad y suficiencia en el momento de su puesta en funcionamiento, introduce incertidumbre con respecto al volumen de recursos que en el futuro podrán dedicar las comunidades autónomas a la financiación de la sanidad, lo que puede originar desigualdades en la oferta de servicios y en el acceso a la asistencia sanitaria. El Fondo de Cohesión Sanitaria, diseñado para financiar la atención a los desplazados, no parece el instrumento adecuado para garantizar la igualdad de acceso a las prestaciones en el conjunto del Sistema Nacional de Salud. Por otra parte, el cambio en la composición de las fuentes de financiación de la sanidad, en la medida en que otorgue más peso a los impuestos indirectos, puede acarrear pérdidas de equidad o progresividad. Finalmente, este trabajo discute el posible impacto de la actual asignación funcional del presupuesto sanitario, excesivamente sesgada hacia el ámbito de la atención especializada, en las desigualdades en su utilización (AU)

Power relations and premature mortality in Spain's autonomous communities.

This trends ecological study analyzes, across 17 autonomous communities of Spain from 1989 to 1998, the relationship between mortality (total and by main causes of death) and power relations (type of government: social democratic (SDP), conservative (CDP), and others), labor market variables, welfare state variables, income inequality, absolute income, poverty, and number of civil associations. The authors conducted a descriptive analysis; a bivariate analysis (Pearson correlation coefficients) between mortality and each of the independent variables; and a multivariate analysis, adjusting multilevel linear regression models. All dimensions of the conceptual power relations model were related to premature mortality in the direction hypothesized. The cross-pooled multilevel regression models show that total premature mortality in males, male and female cerebrovascular mortality, male and female cirrhosis mortality, and male lung cancer mortality decreased somewhat more in communities where primary health care reform was implemented more quickly. Premature mortality decreased somewhat more in SDP than in CDP communities for male and female total premature mortality, cerebrovascular mortality, and cirrhosis mortality, and male lung cancer mortality. These results are in accord with earlier studies that found a relationship among health indicators and variables related to labor market, welfare state, income inequalities, civil associations, and power relations.