Spain

Country profile

Spain is the second largest country in the EU, and holds a population of 46 million. Spain is composed of 17 relatively autonomous communities (and two autonomous cities in North Africa). The communities have their own parliaments and regional governments, and act as the first level of administrative division below the state. The communities are divided into 50 provinces, which are integrated by municipalities. The municipalities manage internal provincial tasks, whereas the provinces carry out State activities.

The Spanish healthcare system is decentralized, and the 17 autonomous communities are responsible for delivering and organizing healthcare. The system is public and provides free or low-cost healthcare to citizens contributing to the social security system and their dependents, as well as to pensioners. The private health system is also very advanced. In 2006, life expectancy was 81.1 years, which is more than two years above the EU average.

Policy responses

Spanish Politicians started to address health inequalities at the national level in 1996 as a result of the work by a Scientific Commission to study health inequalities in Spain. The efforts got an extra boost in 2008 when a new government was put in place. This resulted in a National Commission on the reduction of Social Health Inequalities, which came up with 166 recommendations, of which the Ministry of Health prioritized nine. Currently, a National Strategy for Health Equity is being developed, which will build on the nine priority areas identified by the Ministry of Health. During the Spanish EU Presidency in the first half of 2010 the issue was also placed very high on the agenda.

In Spain, health inequalities are addressed both at the national and the regional level in an explicit and direct way, and cross-sectoral collaborations are taking place. The overall policy response has certainly been influenced by the work of the WHO and Michael Marmot, along with EU advocacy work. In general, the level of implementation of the policies and measures brought forward by the government is satisfactory. Moving forward monitoring and evaluation systems is a shared responsibility of the Ministry of Health, the health governments of Autonomous Communities and external experts and researchers from Health Institutes and Universities.

An overview of policy responses addressing health inequalities in can be found in our Policy Database.

Good practices

Key actors

Please find below an overview of key actors in Spain working on health inequality issues:

• Gobierno de España - Ministerio de Sanidad, Politica Social e Igualdad. Government of Spain - Ministry of Health, Social Policy and Equality

• Área de Promoción de la Salud. S.D Promoción de la Salud y Epidemiología. DG de Salud Pública y Sanidad Exterior (Ministerio de Sanidad, Política Social e Igualdad (Health Promotion Area. General Sub directorate of Health Promotion and Epidemiology. General Directorate of Public Health and Foreign Health. Ministry of Health, Social Policy and Equality)Agencia de Calidad del Sistema Nacional de Salud. Ministerio de Sanidad, Política Social e Igualdad (National Health System Quality Agency. Ministry of Health, Social Policy and Equality)

• Instituto de la Mujer (Womens Institute)

Are you aware of any other key actors that should be added to this list? 
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Key resources

Please find below an overview of relevant documents addressing health inequality issues in Spain. Further publications can be found in our Publications Database.

• Avanzando hacia la equidad. Propuesta de Políticas e intervenciones para reducir las Desigualdades sociales en salud en españa - 2010 (Moving forward equity. Proposal of policies and interventions to reduce social health inequalities in Spain)

• Hacia la equidad en salud: Monitorización de los Determinantes Sociales de la Salud y Reducción de las Desigualdades en Salud - (Moving Forward Equity In Health: Monitoring Social Determinants of Health and the Reduction of Health Inequalities)

• Anteproyecto de ley integral para la igualdad de trato y la no discriminacion - 2011 (Draft law for full and equal treatment and non-discrimination) The law aims at guaranteeing the right to an equal treatment in both public and private sector for each person.

• Plan de Acción para el Desarrollo de la Población Gitana 2010-2012. (Action Plan for Roma Development)

• Hacia la equidad en salud. Disminuir las desigualdades en una generación en la comunidad gitana (2006) (Towards health equity. Closing the gap in a generation in the Roma people)

• Health and the Roma Community

• Handbook for action in the area of health services with the Roma community

• National Report on Strategies for Social Protection and Social Inclusion of the Kingdom of Spain 2008‐2010

• Strategic Plan for Citizenship and integration An updated version of this plan is now in development but the main objectives are the same as in the previous version.

• Social determinants and health inequities in Spain (2009) Presentation for the EU Expert Group on Social Determinants and Health Inequalities. Ministry of Health and Consumer Affairs. Luxembourg, 30-31 March 2009.

• The Commission to tackle social inequalities in health in Spain (2008) Presentation by the Commission to tackle social inequalities in health in Spain: initiative of the General Directorate for Public Health of the Spanish Ministry of Health, Social Policy and Equality.

• Social determinants and health inequities in Spain (2007)

• National Health Survey 2006

Are you aware of any other key resources that should be added to this list?
Please let us know!