[Public health functions, activities and structures: the role of large and middle-sized municipalities]

The aim of this paper was to analyze how public health functions are covered in large or medium-sized cities in Catalonia (Spain) by assessing the role, activities and structure of local services.

Data were collected through a questionnaire with items on public health functions and activities and on the structure of municipal services. The study population comprised the 43 cities of Catalonia with a population above 25,000 (3% of towns and 70% of the population). Answers were obtained from 28 cities (65%), covering 60% of the population of Catalonia and all towns with a population above 50,000 inhabitants.

The public health function in which local governments were least active was need assessment while they were more active in policy development and service delivery assurance. For public health activities, the role of local governments was relatively greater in health protection while few municipal services were active in epidemiological surveillance and substance abuse. Municipal public health expenditure per resident/year was estimated at 1,063 pesetas (approximately 6 Euros). Among the public health personnel, 72% worked full-time while the remaining (mainly members of the corps of health officers serving local administration) worked part-time. Local governments often mixed within the same structure public health services and services, mainly consumer affairs, environmental or social services.

Local governments showed significant activity in public health. The volume of resources involved and management capacity were considerable. In some cities, some public health activities were perceived as not covered.