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 and ageism .

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.

Communicable diseases. Vaccination

Vaccination is the main tool for the prevention of communicable diseases, and is one of the most cost-effective public health measures. It is our best defence against serious, and sometimes fatal, preventable infectious diseases. Thanks to large-scale immunisation, 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 the majority of vaccine-preventable diseases.

In 2018, the Ministry agreed a common lifetime immunisation schedule with the autonomous communities, extending the programme beyond childhood and adolescent vaccination to include prenatal vaccination (i.e. vaccinating pregnant women) as well as the vaccination of elderly people and people in risk groups . The current schedule includes the recommendation to vaccinate against 16 vaccine-preventable diseases.

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

In Spain, vaccination is not mandatory, and the uptake of the immunisation schedule is high among the population and health professionals. In general, vaccine coverage is above 95 % for the vaccines recommended from birth up to 24 months, with the coverage rate decreasing slightly in older age groups.

Other tools for prevention: screening programmes

Evidence-based screening programmes provide another important tool for disease prevention. They have great potential to improve public health outcomes. When organised effectively, they can prevent disease, reduce disability and cut mortality.

The public health services portfolio includes the following population screening programmes:

• Breast cancer, colorectal cancer and cervical cancer screening programmes.

• Newborn screening programme for endocrine and metabolic disorders.

The common services portfolio of the Spanish National Health System also includes the newborn hearing screening programme and prenatal screening.

All citizens have access to these programmes under equal conditions, in accordance with the criteria established in each case in terms of their target population and the characteristics of each programme.

Cancer screening programmes

Breast cancer, colorectal cancer and cervical cancer screening programmes are carried out in all the autonomous communities and cities.

Breast cancer screening

This is a population screening programme which is offered to all women aged between 50 and 69, consisting of a mammogram taken every two years. The target population is invited for screening either by phone or by letter, depending on the autonomous community in which they live.

Colorectal cancer screening programme

This programme is currently offered in all the autonomous communities and cities, although some have yet to achieve 100 % population coverage.

The programme is offered to men and women aged between 50 and 69, who are screened twice a year using a faecal occult blood test.

The target population is invited for screening either by phone or by letter, depending on the autonomous community in which they live.

Cervical cancer screening programme

This is a programme aimed at women aged between 25 and 65 and carried out in all the autonomous communities and cities.

The programme is currently being changed from a programme that was offered to women when they contacted primary care services, to an organised programme in which women will be invited to participate by letter.

A change is also being made to the screening test for women aged between 35 and 65: instead of a pap smear tests every three to five years, they will be tested for human papillomavirus (HPV).

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.

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Response to health alerts and emergencies

In Spain, the Health Alert and Emergency Coordination Centre coordinates the management of information and provides support in the response to national or international health alerts or emergencies which pose a threat to the health of the population.

To this end, the National Early Warning and Rapid Response System was set up.

In turn, public health surveillance encompasses the processes of collecting, analysing, interpreting and disseminating data relating to the health of the population and the factors that affect it, in order to inform public health activities.

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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.

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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 which affect our health include extreme temperatures , hazardous chemical substances , some physical agents such as exposure to electromagnetic fields, ionising radiation (radon) and noise , or certain biological agents (Legionella and disease vectors) . The prevention and control of risks associated with exposure to all of the above are also essential environmental health tasks.

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 of products for human consumption or use. 

• Export of food.

• Import and export of biological samples for human diagnostic and research purposes.

• Import of 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

The National Health System must uphold the principles of universality, equity and quality.

The objective of the Quality Plan for the National Health System is to ensure the provision of excellent healthcare which is focussed on patient needs and is safe, effective, efficient, equitable and accessible.

That clinical excellence is fostered by:

• Auditing health centres and services
• Quality standards and recommendations for health care units
• Improving patient safety
• Improving clinical practice
• Improving patient care and the network of Health Schools
• A strategic framework for primary care

In order to improve patient care specifically, several strategies have been drawn up on prevalent diseases with high social and economic impacts, such as cancer, ischaemic heart disease, on palliative care, diabetes, strokes, on mental health, chronic obstructive pulmonary disease (COPD) and rare diseases, and on issues related to care during regular childbirth, and sexual and reproductive health. You can find out more about each of these strategies in the ‘Useful links’ section at the end of this page.

Within the framework of these strategies, identifying and disseminating good practice in the National Health System is a priority. The strategies incorporate innovative aspects which enhance the quality of professional care and the involvement of the user and patient population.

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Information for each Autonomous Community

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