RSH0010.1177/1757913914545294Current Topics & OpinionsCurrent Topics & Opinions

Current Topics & Opinions

The Spanish public health workforce Matthew Murphy and Alberto Fernández of the European Association of Social Psychology (EASP), and Antonio Daponte, CIBER Epidemiología, Salud Pública and EASP describe the history and current nature of the Spanish public health workforce, giving examples of the difficulties Spanish health administrations will face in the future. The death of General Francisco Franco on organization of the health system. In fact, during the process of devolution, the field 20th November 1975 and the subsequent of public health was the first transition to democracy was a seminal administrative element that was turned moment in Spanish history, laying the over to the autonomous communities. As groundwork for important administrative and institutional changes. One of the most it involved limited financial resources and important changes during this time period infrastructure at the time, it was viewed as easily transferable. However, the was the establishment of a right to health government has struggled since then to care in the Constitution of 1978. Previously, the Spanish health system had organize and coordinate public health initiatives between the different granted access based on employment autonomous communities. The principal status, with financing via payroll taxes coordination mechanism for healthmanaged by the Social Security related issues is a body called the Administration. With the passage of the Consejo Interterritorial de Salud where Constitution of 1978 and subsequently the 17 health ministers from the different the General Health Law of 1986, Spain communities as well as national developed a national health system which professional groups meet with the guaranteed universal access to the national Minister of Health. Here, they population and was financed through plan the response to disease outbreaks general taxation. At the same time, the or discuss the effects of new legislation country began to move away from a strongly centralized administration through on regional health systems. One of their major initiatives now is standardizing a devolution process which granted national preventive programs such as administrative responsibility for governing areas such as education and health to the population screening procedures and the paediatric vaccine calendar in response 17 autonomous communities of Spain. to important intercommunal variations in The process began with Cataluña in initiatives and resources. Ultimately, the 1981, followed several years later by Consejo has little legal authority and acts Andalucía and was completed in 2002. more as a facilitator for Both of these elements collaboration than a are essential to The universal regulatory agency. understanding the role nature of the As a result of the and organization of the Spanish health decentralization of the country’s public health care system is administration of health workforce. The universal regarded as the services and the early nature of the Spanish most significant health care system is guarantor of the devolution of the responsibility to ensure regarded as the most country’s health public health reaches the significant guarantor of and wellbeing autonomous the country’s health and communities, it is difficult wellbeing. At the same to discuss a national public health time, the central government has a very workforce. There are no national limited role in the management and

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. Yet, there is limited information on their number, training, academic backgrounds and areas of specialization. However, there is some information about those working for certain public health agencies in the different autonomous communities. In Cataluña, for example, a recent report noted that 1,743 individuals make up the public health workforce serving the region’s population of about seven million.1 Nearly half of those professionals come from a medical background and nearly three-quarters work in the field as practitioners as opposed to researchers or administrators. A recent analysis of Andalucía’s workforce shows that provincial and regional health organizations employ approximately 1,260 health professionals serving a population of nearly 8.5 million. The most common profile is veterinarians, of which there are

Copyright © Royal Society for Public Health 2014 September 2014 Vol 134 No 5 l Perspectives in Public Health  257 SAGE Publications Downloaded from rsh.sagepub.com at University of New England on June 9, 2015 ISSN 1757-9139 DOI: 10.1177/1757913914545294

Current Topics & Opinions 529, followed by pharmacists, of which there are 313.2 Their primary role within Andalucía is ensuring food safety as well as working on environmental health issues. Other professional groups include epidemiologists, physicians, nurses, and technical as well as laboratory staff. Together, these regions represent about one-third of the Spanish population, and they offer insight into the makeup of the public health workforce nationally. While more information is known about those who work in the public sector, there is a wide variety of public health professionals who also carry out important functions in the private sector. Currently, there are limited data regarding their participation in the workforce and minimal government monitoring of their role in private industry. The educational offerings in public health within Spain are limited to graduate and doctoral programs. Currently, there are no undergraduate programs that offer a university degree in public health and there are only a handful of PhD programs.1 However, there are between 15 and 20 academic institutions offering a master’s degree in public health, including institutions such as Pompeu Fabra University in Barcelona and the Andalusian School of Public Health located in Granada. While these programs attract a wide variety of students from different parts of the world and with different academic profiles, the master’s programs form the basis of academic preparation for physicians entering the preventive medicine and public health specialty. As professionals within the country’s health system, they are among the most visible members of the public health workforce with a formalized accreditation structure and system of professional development. Each resident within the preventive medicine and public health specialty must receive 4 years of training in a residency

Spanish health administrations face program with the first year consisting of a other important demands that will Master of Public Health degree. Because require a more diverse and better of the importance of this specialty within organized public health workforce. the health system and the content Rising socioeconomic inequality requirements imposed on the master’s combined with systemic unemployment programs from the national government, resulting from the economic crisis will there is a heavy biomedical focus in continue to present challenges to the Spanish public health education. health system as well as public health The content of the degree and the services, requiring comprehensive training requirements are established by the National Commission of the Preventive monitoring and a well-articulated Medicine and Public Health3 specialty and response to mitigate their impact on population health. The ageing population confirmed by the National Council of as well as increasing chronic health Medical Specialties. This same needs, will place a growing strain on the administrative body also determines the health system necessitating a proactive number of residents for each specialty in public health response. The emergence each autonomous community. According of new academic degrees and to national statistics, there are currently professions within the field of public 3.7 preventive medicine specialists per health will require a more adaptable 100,000 inhabitants. The total number of public administration and a more specialists is projected to stabilize around coherent accreditation system. Finally, 1,750 or about 3.8 per 100,000 the recent reforms of the inhabitants between now Spanish health system and 2025.4 However, the The ageing implemented in 2012 number of residency positions usually depends population as well specifically exclude a as increasing portion of the population on the requests made by chronic health from the health system for the health systems of the needs, will place a the first time since the autonomous growing strain on General Health Law of communities. For the health system 1986 was passed, limiting example, this year in necessitating a access to health services Andalucía, there were 7 proactive public for a significant segment positions available in the health response. of the population. Now, preventive medicine irregular immigrants and specialty which was even some Spanish citizens will only down from the previous year when there have limited access to health services: were 11 residency spots. presenting a new challenge for public This constitutes one of the few health professionals, who must contend examples of public health workforce with a large community with important planning in Spain, carried out by the health needs but without the right to health ministries of the autonomous communities based on perceived needs. health care. These emerging challenges necessitate a reappraisal of the At the same time, this process is now organization of public health being significantly affected by the global professionals, the preparation of public financial crisis as well as European and national austerity policies. Apart from the health workers and the development of workforce planning tools to assure that difficulties posed by the financial crisis future needs can be met. and government spending cuts, the

References 1. Aluttis CA, Chiotan C, Michelsen M, Costongs C, Brand H, on behalf of the public health capacity consortium (2013). Review of Public Health Capacity in the EU. European Commission Directorate General for Health and Consumers. Luxembourg, 2013. 2. Data provided to the authors by the General Secretariat for Quality, Innovation and Public

Health. Ministry of Equity, Health and Social Policies. Regional Government of Andalucía. June 2014. Available under request. 3. Orden DEF/226/2012, de 3 de febrero, por la que se crean y suprimen ficheros de datos de carácter personal de diversos órganos de la Dirección General de Personal. BOE núm. 152; 27 junio 2005: 22751-22759

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4. Patricia Barber; Beatriz González; Rafael Suárez. Oferta y necesidad de especialistas médicos en España (2010 -2025) Equipo de Economía de la Salud. Available online at: http://www.msssi.gob. es/profesionales/formacion/necesidad Especialistas/doc/11-NecesidadesMEspecialis tas(2010-2025).pdf (Last accessed July 2014).

The Spanish public health workforce.

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