The Spanish public health workforce.

Abstract

the death of General Francisco Franco on 20th November 1975 and the subsequent transition to democracy was a seminal moment in Spanish history, laying the groundwork for important administrative and institutional changes. one of the most important changes during this time period was the establishment of a right to health care in the Constitution of 1978. previously, the Spanish health system had granted access based on employment status, with financing via payroll taxes managed by the Social Security Administration. With the passage of the Constitution of 1978 and subsequently the General Health Law of 1986, Spain developed a national health system which guaranteed universal access to the population and was financed through general taxation. At the same time, the country began to move away from a strongly centralized administration through a devolution process which granted administrative responsibility for governing areas such as education and health to the 17 autonomous communities of Spain. the process began with Cataluna in 1981, followed several years later by Andalucia and was completed in 2002.Both of these elements are essential to understanding the role and organization of the country's public health workforce. the universal nature of the Spanish health care system is regarded as the most significant guarantor of the country's health and wellbeing. At the same time, the central government has a very limited role in the management and organization of the health system. in fact, during the process of devolution, the field of public health was the first administrative element that was turned over to the autonomous communities. As it involved limited financial resources and infrastructure at the time, it was viewed as easily transferable. However, the government has struggled since then to organize and coordinate public health initiatives between the different autonomous communities. the principal coordination mechanism for health- related issues is a body called the Consejo Interterritorial de Salud where the 17 health ministers from the different communities as well as national professional groups meet with the national Minister of Health. Here, they plan the response to disease outbreaks or discuss the effects of new legislation on regional health systems. one of their major initiatives now is standardizing national preventive programs such as population screening procedures and the paediatric vaccine calendar in response to important intercommunal variations in initiatives and resources. ultimately, the Consejo has little legal authority and acts more as a facilitator for collaboration than a regulatory agency.As a result of the decentralization of the administration of health services and the early devolution of the responsibility to ensure public health reaches the autonomous communities, it is difficult to discuss a national public health workforce. there are no national databases or registries of the public health workforce in Spain. each community has developed its workforce based on its history, political philosophy and perceived health needs. Additionally, there is no national accrediting body for public health professionals in Spain, something that is essential for professional regulation and political importance in the workplace. However, there are important professional associations at the national and regional level that fall under the umbrella group SeSpAS, or the Spanish Society of public Health and Health Administration. these associations include groups such as the Spanish Network of primary Healthcare, the Spanish Association of epidemiology and the Spanish Society of environmental Health among others.the national government does play a central role in insuring compliance with european legislation and regulations, particularly in areas of occupational health, environmental health and food safety. As a result, the public health workforce is organized around these areas and usually includes a diverse set of professional profiles. …