Public health activities

Health promotion and disease prevention

Chronic or non-communicable diseases

The most common diseases, both globally and in Spain, are chronic diseases, also known as non-communicable diseases (e.g. cardiovascular disease, cancer, diabetes, chronic respiratory diseases, etc.).

The main chronic diseases are associated with well-known factors such as unhealthy eating, a lack of physical activity and sedentary behaviour, smoking and drinking alcohol , which in turn are influenced by people’s living conditions and circumstances. A healthy lifestyle (a healthy diet, following public recommendations on physical activity , reducing sedentary behaviour, not smoking or drinking alcohol, etc.) benefits our health and wellbeing and reduces the risk of us developing these diseases.

The Spanish Ministry of Health has drawn up a Strategy on Health Promotion and Prevention for the National Health System . It also has a webpage on ‘Healthy Lifestyles’ aimed at the population as a whole, with recommendations, interactive tools, videos and other useful materials and resources to encourage healthier lifestyles. 

The strategy also includes actions to improve safety and protection against unintentional injuries , to promote healthy ageing and to prevent frailty, falls and ageism .

Promoting health and disease prevention in children and teenagers is fundamental to improving public health and achieving health equity. Particularly important are the promotion of breastfeeding , the prevention of childhood obesity and health promoting schools .

Violence against children and adolescents is also a major preventable and avoidable public health problem. A global approach based on a preventive, scientific and comprehensive strategy is therefore necessary.

Vaccine-preventable communicable diseases

Vaccination is the main tool for preventing communicable diseases , and is one of the most cost-effective public health measures. It is the best defence against serious, and sometimes fatal, diseases that are preventable by vaccination. Through public vaccination strategies , it has been possible to eradicate smallpox, eliminate polio in several regions of the World Health Organisation, eliminate measles and rubella in Spain, and control most vaccine-preventable diseases.

In 2018, the Ministry and the Autonomous Communities (within the Interterritorial Council of the National Health System) agreed on a common lifetime vaccination schedule which sets out vaccination recommendations each year. They include pre-natal vaccinations (vaccinations for pregnant women), as well as vaccinations for the elderly and people with at-risk conditions . The vaccination schedule currently in place recommends vaccinating against 16 diseases that are prevented by vaccination.

The common lifetime vaccination schedule evolves all the time and is under continuous evaluation . The schedule is evaluated to modify or incorporate vaccines on the basis of recommendations set out in the ‘Evaluation criteria to inform changes to the vaccination programme’ .

In Spain, vaccination is not mandatory, and the vaccination schedule has a high uptake by most of the public and by health professionals. Vaccine coverage is generally above 95 % for vaccines recommended for infants up to the age of 24 months, and there is a slight decrease in the coverage rate thereafter as ages rise.

The vaccination coverage in Spain is published annually.

Other preventive measures Screening programmes

Public screening programmes are an important secondary preventive measure for improving public health.

These programmes target people with no symptoms who have not sought medical help, so as to detect diseases early. In this way, they can obtain early diagnosis and treatment so as to improve the disease prognosis, avoid premature mortality, and prevent against related physical and mental disabilities.

They are implemented as a standardised evidence-based process, in a coherent and fair way under the National Health System in Spain. Eligible members of the general public can access these programmes under the criteria set out in each case both for the target public and specific aspects of each programme.

The public screening programmes forming part of the portfolio of common services under the National Health System and their targeted public are:

• Prenatal screening programmes : for all pregnant women who attend a health centre for pregnancy check-ups.
  • Pre-natal screening programme for infectious diseases: this involves a series of tests for pregnant women for early detection of some infectious diseases that could be dangerous if transmitted to the foetus.
  • Pre-natal chromosomopathy screening programme: this involves a series of tests for pregnant women for early detection of genetic diseases of the foetus.
• Neonatal screening programmes: for all newborn infants.
  • Neonatal heel prick screening programme for congenital diseases : this is a test for measuring various parameters from a blood sample taken from the heel of newborn infants in the first hours of life.
  • Neonatal hypoacusis screening programme: this is a test that uses different techniques (otoacoustic emissions or evoked potentials) in both ears of newborn infants in the first days of life.
  • Neonatal screening programme for critical congenital heart disease: this programme is currently in the final stage of the regulatory process. The screening test is performed by pulse oximetry to measure the oxygen saturation of newborn infants in the first hours of life.
• Cancer-screening programmes Breast, colorectal and cervical.
  • Mammogram cancer-screening programme: this is offered to all women aged between 50 and 69, and consists of a mammogram done every two years.
  • Colorectal cancer-screening programme: this is offered to men and women aged between 50 and 69, who are screened every two years by means of a faecal occult blood test.
  • Cervical cancer-screening programme: this is offered to all women aged between 25 and 65 and consists of a cervical smear or high-risk HPV (human papillomavirus) screening, according to age.

Social determinants of health

Our health is dependent on the circumstances in which we are born and in which we grow, live, work and age. These circumstances encompass all aspects of our lives: socio-economic conditions, the culture and values of society, the policies in place, type of work and working conditions, education, gender, housing conditions, health services, etc. These are known as the social determinants of health. The fact that our health depends on those factors, and that those factors are not equal among the population generates health inequalities which, being of social origin, are considered to be unfair and avoidable.

Achieving health equity would give all people the opportunity to attain their full health potential regardless of their social position or other socially determined circumstances.

Commercial determinants of health are strategies used by the private sector to promote products and choices that are detrimental to people's health and which play a key role in our environment and our individual lifestyles, thus impacting the public health. The term also encompasses strategies and tactics that companies use to exert power and influence on governments, society and consumers. Commercial determinants of health are a key social determinant.

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Response to health alerts and emergencies

The Health Alert and Emergency Coordination Centre (CCAES), set up in 2004 (ORDER SCO/564/2004 of 27 February) , is a centre under the Directorate-General for Public Health and Equity in Health (Royal Decree 718/2024 of 23 July 2024) within the Ministry of Health and operates in the following areas:

Actions relating to international public health

As set out in Article 39 of Law 33/2011 of 4 October, the CCAES acts as the National Focal Point for the International Health Regulations (IHR) 2005 and as the National Focal Point for the European Centre for Disease Prevention and Control , and ensures the exchange of information relevant to international public health.

For this purpose, it gathers information on risks of an international nature to public health and informs the competent bodies of the General State Administration (AGE) responsible for emergency coordination and civil protection. It produces reports on trends and factors affecting international public health and their implications for Spain, and incorporates into the public health strategy actions relating to international public health that are of interest to the Government of Spain.

It establishes and coordinates a network of healthcare professionals ready to be deployed for immediate health cooperation, to respond to international public health emergencies.

It is responsible for proposing the appointment of experts in public health to Spain’s Permanent Representations to international organisations and institutions.

Coordination of the development of preparedness and response plans

The CCAES is the Unit within the Ministry of Health responsible for coordinating at national level preparedness activities for public health threats , as well as early public health response activities in response to health alerts and emergencies. The objectives of these activities are to reduce vulnerability to health threats and improve the efficiency of the response through planning. On the other hand, they aim to reduce the impact of public health alerts or emergencies on the population through an early and effective response.

While preparedness and response planning has historically focused on biological health risks, current planning is developed under the ‘all-hazards’ approach.

Coordination of the response to health alerts and emergencies

The National Early Warning and Rapid Response System (SIAPR) consists of a network of regional liaison centres, coordinated by a National Liaison Centre, which facilitates continuous and rapid communication of situations posing a risk to public health, with the aim of improving prevention and preparedness in the face of such risks and coordinating response measures when there is an impact at national or international level. The CCAES acts as the system’s National Liaison Centre and establishes collaboration agreements with the nodes of different surveillance and alert systems and networks of the General State Administration (AGE).

Within this system, the Committee on Alerts and Preparedness and Response Plans (under the Public Health Committee of the Interterritorial Council of the National Health System) was established in 2012; it serves as the body responsible for territorial coordination, management and monitoring, and is tasked with proposing and reviewing its rules of operation.

Epidemiological intelligence activities

Epidemiological intelligence is the process of detecting, screening, verifying, analysing, assessing and investigating events or situations that may pose a threat to public health, and providing early warning to facilitate a rapid response based on high-quality, verified data.

Epidemiological intelligence encompasses both the results of indicator-based public health surveillance and the monitoring of events that may impact public health, drawn from official and unofficial sources where information may be more or less structured.

The CCAES carries out this activity on a daily basis and produces the relevant reports for those responsible for action. It also receives notifications and queries from national alert systems, the National Epidemiological Surveillance Network, and national and international bodies such as the World Health Organization (WHO) and the European Centre for Disease Prevention and Control (ECDC).

Development and coordination of the Public Health Surveillance Network

Public health surveillance is a set of activities aimed at collecting, analysing, interpreting and disseminating information relating to the population’s health status and the factors that determine it, with the aim of supporting public health actions (Law 33/2011 of 4 October on General Public Health).

The CCAES is responsible for developing and coordinating the Public Health Surveillance Network established by Royal Decree 568/2024 of 18 June, as well as its territorial coordination body, the Epidemiological Surveillance Working Group , a working group of the Public Health Committee of the Interterritorial Council of the National Health System.

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Prevention and control of HIV, STIs, viral hepatitis and tuberculosis

HIV, STI, viral hepatitis and tuberculosis epidemics have common social determinants and shared individual risk factors. This is why epidemics overlap in some population groups, and action plans require integrated approaches and complementary responses and solutions.

Since 2018, the Division for the Control of HIV , STIs, Viral Hepatitis and Tuberculosis has published annual reports on the activities of this section of the Directorate-General for Public Health.

HIV prevention and control

The plenary of the Interregional Council of the National Health System adopted the Plan for the Prevention and Control of HIV and other STIs 2021-2030 . This Plan has an extended timeline so as to facilitate the assessment of measures taken and align them with both the Sustainable Development Goals and the proposed UNAIDS’ targets for 2030.

The overall objective of the Plan is to promote and coordinate actions to eliminate HIV and STIs as a public health problem by 2030, through prevention, early diagnosis and treatment of these infections, chronic disease care and improvements to quality of life, as well as by addressing stigma and discrimination linked to HIV and other STIs in Spain.

The Plan includes the guiding principles of universal health coverage, health equity, ownership, coordination and complementarity as the inspiration for all related actions. It also integrates cross-cutting approaches keeping the focus on rights, gender, migration and sexual diversity, the social determinants of health and community participation and actions founded on scientific evidence and innovation. 

The Plan defines four strategic objectives and a set of cross-cutting elements, comprising equal rights, equal treatment and opportunities, non-discrimination and the full exercise of fundamental rights on the basis of the Social Contract, and improvements to the health information and governance systems.

In Spain, the estimates for continuing HIV care published in 2020 were as follows: 87 % for people with diagnosed HIV, -97.3 % for those undergoing antiretroviral treatment, and -90.4 % for those receiving viral suppression treatment. The main focus of HIV prevention is to diagnose HIV as early as possible in order to control HIV transmission.

The Social Contract for Non-Discrimination and Equal Treatment of Persons with HIV is essential for combatting stigma and discrimination in all areas of life, and for improving the quality of life of persons with HIV (known as ‘the fourth 95’).

Prevention efforts are accompanied by information campaigns addressed to target audiences. There should be a special focus on campaigns targeting men who have sex with men (MSM) and young people, as well as campaigns around World AIDS Day.

A strategic pillar in the development of public health interventions aimed at preventing HIV infection and other STIs is programme funding for community-based non-profit organisations with country-wide deployment and proximity and access to the most vulnerable and exposed groups. Every year, there is a call for grants for projects and programmes for the prevention and control of HIV infection.

To obtain better information on early diagnosis in community settings, the RedCoHIV project has been launched to examine the extent of rapid-testing for HIV infection and the diagnostic performance of these tests.

Progress has been made by adopting an innovative approach to prevention strategies, through pre-exposure prophylaxis and better accessibility to condoms for under-resourced and vulnerable groups. Of particular importance is the creation of the SIPrEP information system, which provides information on the characteristics of the target population accessing this healthcare service. The complex phenomenon of chemsex  is also being tackled, with a series of recommendations for public health action being prepared with the most relevant stakeholders, and clinical guidelines for diagnosis and antiretroviral treatment being drawn up.

Prevention and control of Sexually Transmitted Infections (STIs)

The main goal is to reduce the incidence of STIs , encourage early diagnosis and improve the study of contacts, as well as preventing comorbidities and resistant forms of infection. Prevention among young people and in the MSM group is the priority, in view of the incidence rate among these groups. Campaigns are organised containing tailored information and encouraging condom use among different groups of special epidemiological interest.

The objectives of the 2021-2030 Plan for the Prevention of HIV and other STIs include increasing awareness of actions and infrastructures dedicated to STIs, as well as improving early diagnosis of STIs in key groups. To this end, various structural actions have been initiated in the health system, such as a review of the actions taken in the field of STI prevention and control in the different autonomous communities , a definition of the medical care infrastructures dedicated to STIs in Spain , a review of the regulatory framework for rapid testing in community settings , and the study of new ways of improving early diagnosis of HIV and other STIs based on self-testing and self-sampling.

Prevention and control of tuberculosis

Tuberculosis, particularly drug-resistant and multidrug-resistant strains, continues to pose a threat to public health. The aim at national level is to stop the transmission of tuberculosis through universal access to prevention, diagnosis and treatment. Spain’s activities are described in the Plan for the Prevention and Control of Tuberculosis in Spain .

The Plan sets out the main actions in terms of early diagnosis, epidemiological surveillance, study of contacts and treatment management, in line with the global ‘End TB’ strategy and the Agenda 2030 Sustainable Development Goals. The Plan includes coordinated actions with other sectors, with the competent bodies of the autonomous communities and cities, with the Laboratory Network for TB and with scientific and civil society organisations.

Monitoring indicators are collected for the Plan for the Prevention and Control of Tuberculosis in Spain and published annually.

Prevention and control of viral hepatitis

The aim is to eliminate the public health issue posed by viral hepatitis.

In Spain, hepatitis C remains a significant public health concern which requires integrated political, health and social responses, with prevention and equal access to treatment being the key pillars of action. The Strategic Plan for Tackling Hepatitis C is aimed at promoting the prevention and diagnosis of hepatitis C virus infection in order to reduce morbidity and mortality rates in Spain. Various documents , such as one on hepatitis C screening recommendations , have been drawn up for this purpose.

Finally, it should be noted that the Division for the Control of HIV, STIs, viral hepatitis and tuberculosis has promoted the conclusion of various agreements with entities, organisations, scientific societies and others, with the aim of raising awareness of these issues, providing training for healthcare professionals, producing guidelines and relevant documents, promoting early diagnosis, and combating stigma and discrimination, among other objectives.

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Environmental health

Our health and the environment that surrounds us are closely linked. The quality of the air we breathe and the sanitary quality of water for consumption or for recreational use have major implications for our health and wellbeing. For this reason, in order for us to stay healthy, the quality and health of our environment are vital.

Other environmental factors that have an impact on our health include the cold , extreme heat , hazardous chemicals, some physical agents including electromagnetic fields , ionising radiation (radon) and noise , and some biological agents (e.g. Legionella and disease-carrying vectors ).

The dangers that climate change poses to our health are diverse and global in nature, ranging from the increased risk of extreme weather events to changes in the dynamics of infectious diseases.

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Occupational health

There is a direct relationship between health and work . The ‘health surveillance of workers’ is therefore necessary. Surveillance of occupational disease and injury consists of the systematic and continuous monitoring of health-related incidents among those in active employment, with a view to preventing and controlling occupational risks and the injuries and disease associated with them. Exposure to asbestos is a prime example of an occupational risk.

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Cross-border and international health

Duties and actions concerning  Cross-border health  are set out in national legislation, which is the exclusive competence of the State.

As far as international legislation on public health is concerned, the purpose and scope of the International Health Regulations of 2005 (IHR 2005) are to prevent and control the spread of disease internationally, and to provide a response that is commensurate with and restricted to public health risks and avoids unnecessary interference with international traffic and trade. A series of recommendations are made in the IHR, some of which are binding in certain countries (States Parties) and others that are of a general nature.

Main areas of activity:

• International vaccination . When we travel, in addition to getting the relevant vaccines, it is also very important to listen to health advice and recommendations (e.g. the ‘ Health also travels ’ guide) that can help us to stay healthy while we are away.

• Health and hygiene checks and controls at ports, international airports, border-crossing points and on international means of transport.

• Import . 

• Export.

• Import and export of biological material
  • Biological samples , including human pathogen samples, for human diagnostics or research purposes.
  • Human cells and tissue , except reproductive cells.
  • Human gametes, embryos, pre-embryos and embryonic stem cells.
  • Human blood and blood components for use in transfusions .

• Post-mortem public health: the international transfer of bodies, human remains and corpses, and of parts of the anatomy for teaching or research purposes, is regulated by the State. Other aspects related to post-mortem public health are the responsibility of the autonomous communities. A consensus guide has been produced in that connection, providing guidance on exclusively health-related issues in the context of post-mortem care: Consensus Guidelines on Post-Mortem Care .

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Transfusion medicine

Transfusion medicine is a core activity of the Health System which contributes to improving the health and quality of life of a large number of patients.

There is a perpetual need to use transfusion as a therapeutic measure in care settings.

Its vital importance determined the need to develop a solid structure with the autonomous communities’ Blood Transfusion Centres and Services, creating a genuine Transfusion Network in Spain, and a National System for Transfusion Safety.

New national and international agreements and recommendations are drawn up on a regular basis, all kinds of conferences and events are organised and reports and articles are published, along with the latest news in the field.

If you have any questions or you would like more information on a particular subject, you will find a number of useful links to official bodies, scientific organisations, etc. If you would like to become a blood donor, it is easy to find out how to donate blood in your autonomous community ( donate blood ).

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Quality of care

Quality of care provides the strategic framework that guides the planning, evaluation and improvement of healthcare, ensuring common standards at all levels.

The Sub-Directorate-General for Quality of Care, which forms part of the Directorate-General for Public Health and Equity in Health, is tasked with promoting the continuous improvement of quality, safety and equity within the National Health System.

Its key functions include:

• The design, implementation and evaluation of health strategies and plans targeting conditions with high prevalence or significant impact.
• The development of processes for the assessment, audit and accreditation of services or care units.
• The integration of patient safety as an essential dimension of quality of care.
• The promotion of clinical excellence through the generation and dissemination of knowledge and good practices.
• The promotion of the active participation of patients and their families in improving the healthcare system, through the Network of Health Schools for the public.
• Participation in international activities and programmes of significant interest for promoting a culture and knowledge of quality of care, such as the HOPE exchange programme.
• The promotion of initiatives to improve accessibility and reduce waiting lists.

All of these actions focus on reducing inequalities, promoting health equity and ensuring coordination with other organisations and institutions.

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Information for each Autonomous Community

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